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Meningococcal disease due to strain W135

2001; Elsevier BV; Volume: 358; Issue: 9275 Linguagem: Inglês

10.1016/s0140-6736(00)05293-4

1474-547X

JM Sandell, Padmanabhan Ramnarayan, Steven B. Welch, Michael Levin, J. Britto,

Antibiotic Resistance in Bacteria

Since 1992, we have managed more than 700 children with meningococcal disease. Last year, we reported four cases of Hajj-related serogroup W135 meningococcal disease.1Bolt P Britto J Nadel S Levin M Meningococcal disease due to W135: fresh public health concerns.Arch Dis Child. 2001; 84: 89Crossref Google Scholar After this year's Hajj in March, we admitted a further six paediatric patients with meningococcal W135 infection (three were confirmed Type A, P1.2, 1.5, the Hajj-related serogroup), two of whom died. Each year, more than 1 million Muslim pilgrims travel to Mecca for the Hajj, around 20 000 from the UK. Last year, the Public Health Laboratory Service (PHLS) reported in the UK an outbreak of Hajj-related W135 meningococcal infection. Cases continued to be reported 9 months after the Hajj, which suggests sustained transmission of the strain.2Communicable Disease Surveillance CentreMeningococcal disease in pilgrims returning from Hajj.Commun Dis Rep CDR Wkly. 2001; 11: 12Google Scholar A similar pattern has followed this year's Hajj pilgrimage. This year, the UK Department of Health recommended the quadrivalent meningococcal polysaccharide vaccine, which provides protection against strains A, C, W135, and Y, for all pilgrims travelling for Hajj or Umrah. Despite the recommendations being distributed to health-care professionals and the Muslim community, the estimated uptake of the vaccine for this year's pilgrimage was less than 50%.3Communicable Disease Surveillance CentreMeningococcal disease associated with the Hajj 2001: update.Commun Dis Rep CDR Wkly. 2001; 11: 19Google Scholar No pilgrim contact of our admissions this year had been vaccinated with the quadrivalent vaccine. The higher personal cost (UK£17.14, excluding value added tax) compared with the previously recommended A and C polysaccharide vaccine (£6.39), and the fact that travel to Saudi Arabia, until recently, required only a certificate of vaccination against A and C strains, may well have contributed to this situation. Cost remains an issue for future consideration. Although the manufacturers report 50–85% seroconversion against serogroup W135, the polysaccharide vaccine might not affect nasopharyngeal carriage.4Communicable Diseases CentreAssessment of risk for meningococcal disease associated with the Hajj 2001.MMWR Morb Mortal Wkly Rep. 2001; 50: 221-228PubMed Google Scholar Therefore, secondary cases of W135 meningococcal infection could still occur in the UK, despite quadrivalent vaccination. Even if travellers have been vaccinated with the polysaccharide vaccine, contacts should be made aware of the possibility of contracting meningococcal disease. In the USA, the quadrivalent vaccine is routinely administered to travellers to Saudi Arabia. A recent US study reported that around 1% of returning Hajj pilgrims became W135 carriers.4Communicable Diseases CentreAssessment of risk for meningococcal disease associated with the Hajj 2001.MMWR Morb Mortal Wkly Rep. 2001; 50: 221-228PubMed Google Scholar Because of the low rate of serogroup W135 carriage, antimicrobial chemoprophylaxis was not recommended. Currently, there are no UK data on changes in nasopharyngeal carriage rates in returning pilgrims. Similar studies in the UK could alter future recommendations. Maiden and colleagues5Maiden MCJ Spratt BG Meningococcal conjugate vaccines: new opportunities and new challenges.Lancet. 1999; 354: 615-616Summary Full Text Full Text PDF PubMed Scopus (102) Google Scholar suggest that, after the introduction of meningococcal C vaccine in the UK, the epidemiological niche created might be occupied by hypervirulent strains of meningococci, including W135. Small changes in carriage of hypervirulent strains might greatly affect disease rates. With the theoretical risk of other serogroups becoming more prevalent as meningococcal C disease is controlled, continued clinical, laboratory, and epidemiological vigilance would be prudent throughout the year.