Post on 12-Dec-2018
Nancy Messonnier, M.D. Chief, Meningitis and Vaccine Preventable Diseases Branch
Epidemiology of Meningococcal Disease
Division of Bacterial Diseases National Center for Immunization and Respiratory Diseases
The “Meningitis Belt” of sub-Saharan Africa*
*“Meningitis belt” defined by Lapeyssonnie in 1963 Redefined by Greenwood in 1987
430 million at risk
Epidemic Meningitis Cases and Case-Fatality Rates – AFRO Region, 1965-2006*
*Meningitis in the Africa Region, 1965 – 2006, WHO/AFR, October 2006
Potential of MenA Conjugate Vaccine Programs in Africa*
• Prevent 123,000 deaths by 2018 • Prevent permanent disability in 287,000
children and adults • Prevent 11 million DALYs lost • Save approximately $99.7 million in
medical costs for diagnosis and treatment
*Meningitis Vaccine Project, 2010
Incidence of laboratory confirmed invasive meningococcal infection, EU-IBIS participants, 1999 or baseline year
Incidence per 100,000
≥ 4.00
2.00-3.99
1.00-1.99
0.5-0.99
< 0.5
年流脑分省发病率 the incidence rate of epidemic meningitis by province from 1990 to 2005(/105)*�
1990 1995
2000 2005
To To To To To To
2005
*courtesy, China, CDC
Invasive meningococcal disease case fatality ratio, by selected country* 2003 & 2004
• EU-IBIS, courtesy Mary Ramsay, • Countries with sufficient numbers, consistent reporting
Incidence of Meningococcal Meningitis by Age Groups - Niger, 1981-1994*
*Campagne et al. Bull World Health Organ 1999;77(6):499-508.
Cases of Meningococcal Meningitis, by Age Group, 1981-1996, Niamey, Niger*
*Campagne et al. Bull World Health Organ 1999;77(6):499-508.
Clinically Significant Meningococcal Serogroups*
Serogroup Characteristics
A • Leading cause of epidemic meningitis worldwide • Most prevalent serogroup in Africa and China • Rare in Europe and the Americas
B • A major cause of endemic disease in Europe and the Americas • No vaccine commercially available for endemic disease • Predominant serogroup in infants
C • A major cause of endemic disease in Europe and North America • Multiple outbreaks in schools/communities
Y • Infrequent worldwide; emerged in the U.S. in the 1990s W-135 • Infrequent worldwide; global outbreak- 2000 Hajj pilgrimage
X • Infrequent worldwide; small outbreaks reported in Africa
*Modified from Granoff DM, Harrison LH, Borrow R. Vaccines. WB Saunders; 2008
Age specific incidence of IMD by serogroup All EU countries combined, 1999 baseline year*
02468
1012141618
<1 year 1 - 4years
5-9years
10-14years
15 - 19years
20-24years
25-44years
45 - 64years
65+years
Serogroup BSerogroup C
*EU-IBIS, courtesy Mary Ramsay
*Modified from Caugant, APMIS 1998;106:505-525
1985
15:P1.7,16
15:P1.7,16
4:P1.19,15 15:P1.7,16
4:P1.19,15
15:P1.3 4:P1.19,15
4:P1.19,15 15:P1.7,16 * *
Oregon, 1994
Chile Brazil 1985
South Africa 1980
Cuba 1980
Spain 1974
Norway 1969
Japan 1979
Australia 1982
Distribution of Serogroup B ET-5 Epidemics*
New Zealand 1992 4:P1.4
Dec '04 ~12%
Dec '05 ~78%
Dec '06 ~83%
Vaccine Coverage (3 doses)
0
100
200
300
400
500
600
700
1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 Year
Num
ber
Group C Group B Other Group B with P1.4 Total Meningococcal Cases*
New Zealand Meningococcal B Notified Cases, 1990-2007*
*D. Lennon, presented to SAGE WG 2010
Serogroup B: distribution by major phenotypes All countries and years combined, Europe
others
BntP1.5/BntP1.2
BntP1.4
BntP1.15
BntP1.9
B15P1.7,16
B4P1.15
Bnt:nst
B4P1.4
*EU-IBIS, courtesy Mary Ramsay
2006–2007 1989–1991
B (46%)
C (45%)
Y (2%)
Other (7%)
B (25%)
C (30%)
Y (37%)
Other (8%)
Meningococcal Serogroup Distribution in US, Emergence of Serogroup Y
CDC, Active Bacterial Surveillance Report. 2007; CDC MMWR 1993.
France 21
Finland 2
S. Arabia 241
Singapore 4 USA 4
Indonesia 14
Morocco 3
Sweden 2 Norway 1
Germany 10
Denmark 1
Netherlands 9 Scotland 1
Belgium 1
England & Wales 50
Kuwait 3 Oman 18
International W-135 Outbreak 2000*
*cases 4/00-12/00, WHO
Burkina Faso (2002), 13,000 cases
Capsular Switching: Emergence of Serogroup W-135 N. meningitidis*
Serogroup C (C:2a:P1.5)
Serogroup W-135 (W-135:2a:P1.5)
Serogroup W-135
Recombination
*courtesy, Lee Harrison
Predominence of Serogroup A in Epidemic Districts, Africa, 2003-2007*
Serogroup 2003
(n=44) 2004
(n=22) 2005
(n=19) 2006
(n=74) 2007
(n=96) Total
A 70.5 95.5 89.5 85.1 95.8 87.8
W-135 29.5 4.5 10.5 9.5 3.1 10.2
X 0 0 0 4.1 1.0 1.6
A/X 0 0 0 1.4 0 0.4
*WHO, unpublished data