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Extrameningeal Complications of Neisseria meningitidis Serogroup W135 Infection

2004; Oxford University Press; Volume: 38; Issue: 11 Linguagem: Inglês

10.1086/421030

1537-6591

Michael A. Apicella,

Amoebic Infections and Treatments

Neisseria meningitidis serogroup W135 has gone from a rarely implicated cause of invasive meningococcal diseases to being involved in outbreaks on infection with a world-wide distribution. The incidence of meningococcal disease due to the W135 serogroup has gradually increased over the past 15 years in Europe and the United States. Meningococcal epidemics associated with the annual pilgrimage to Mecca have occurred in the past and may have been a factor in the spread of infection in Africa, Asia, and the Middle East in the past [1]. The combination of 11 million individuals living in crowded conditions during the Hajj is a unique setting for acquisition and spread of invasive meningococcal disease. In 1987, an epidemic caused by N. meningitidis serogroup A prompted the Saudi Arabian government to mandate vaccination with the meningococcal A polysaccharide vaccine by all pilgrims entering the country for the Hajj. A subsequent serogroup A outbreak occurred in 1992 during Ramadan and Umra. The vaccination was subsequently made mandatory for all Umra visitors [2]. This program worked quite well until 2000 and 2001, when an epidemic caused by N. meningitidis serogroup W135 occurred in pilgrims and their contacts. Because of the immigration of Muslim populations over the past fifty years to western Europe and the United States, cases caused by W135 were reported with a worldwide distribution involving Saudi Arabia, western Europe, Africa, the United States, Asia, and the Middle East after the Hajj [3‐5]. The W135 strain causing these outbreaks