Meningococcal Surveillance Effectivess Workshop

11 -12 August, 2015

Ana Paula LemosMeningitis, Pneumonia and Pneumococcal Diseases

Adolfo Lutz Institute, São Paulo, Brazil

Review of Meningococcal Laboratory Surveillance

Brazil

0

20

40

60

80

100

Non Identified

Other etiology

Spn

Hi

Men

Bacterial meningitis by etiology, São Paulo, 2002-2013

%

Sentinel ProgramSentinel ProgramSource www.cve.saude.sp.gov.br/htm/cve_meni.htlm

50%

29%25%

Diagnostic criteria for meningococcal diseaseBrazil, 2014

Source COVER-SINAM/DEVEP/SVS/MSUpdated 12-02-2015

Collection Men strains IAL 398/317 = 80 % of cultures of Men reported

Culture

CIE

Latex

Clinic

Gram Stain

Clinic Epidemiologic

RT PCR

missing data

25,89 % (n=398)

2,08 % (n=32)

20,17 % (n=310)

4,24 % (n=65)

13,40 % (n=206)

2,47 % (n=38)

20,04 % (n=308)

11,71 % (n=180)

n=1,537 MD cases

Prevalence of serogroups by culture-confirmed of MD by year, Brazil, 2000-2014, all ages

año

Source : Adolfo Lutz Institute (IAL), São Paulo, BrazilVaccine MCC conjugate

by Lemos, AP

0%

20%

40%

60%

80%

100%

2000 2002 2004 2006 2008 2010 2012 2014

year

Y

W

C

B

Meningococcal C conjugate vaccination after 3 years of vaccine introduction into routine immunization in Brazil : A time series analysis

by Andrade, ALSS

12,999 8862,616

SINAN15,615

IAL3,502

Distribution of all meningococcal disease casesin SINAN and IAL databases. Brazil, 2008 to 2013

Presented at ESPID, Leipzig, May 12-16,2015

Distribution of MD cases in Brazil, by age group and notification year

After 2010, the decrease in MD cases is mostly due to the age groups of 3-11m 12 – 23 m (after 2010), and of 2-4 years (after 2011). In 2008, 39.3% of MD occurred in children less than five years of age. This proportion decreased to 24.9% in 2013

Presented at ESPID, Leipzig, May 12-16,2015 by Andrade, ALSS

2000-2013No. MD cases from MH n= 41,392No. MD culture-confirmed n= 12,516 (30%)No. meningococcal isolates n = 9,824 (72.7%)

No. N. meningitidis strains from laboratory based-surveillance by geographic region, 2000 – 2013 (No. 9,824)

by Gorla, MCO

North : 304 (3.2%)

Northeast: 1,990 (21.1%)

South : 1,190 (12.6% )

Central-West : 719 (7.6%)

Southeast : 6,104 (64.6%)

0

5

10

15

20

25

30

35

40

45

50

Penicilina (RI) Ceftriaxona (R ) Cloranfenicol (R ) Rifampicina (R ) Ciproloxacin (R )

2006

2007

2008

2009

2010

2011

2012

2013

% o

f st

rain

s

Antimicrobial Susceptibility of Neisseria meningitidis, Brazil, 2006-2013

PorA types among invasive MenB strains, Brazil 2010

0.0

10.0

20.0

30.0

40.0

50.0

60.0

70.0

porA typing among MenC, W and Y strains, Brazil 2012

0%

20%

40%

60%

80%

100% 5-2,10-1

5-11,10-13

5-1,2-2

22,9

21,4

19,15

18-1,30-2

18-1,3

5,2

22,14-6

5,2

18-1,3

22,9

Lemos, AP

22,14-6

C W Y

Unpublished data

0%

20%

40%

60%

80%

100%

2.43

2.25

2.22

2.21

2.16

1.679

1.13

1.679

Variation composition of fhbp among MenC, W and Y strains, Brazil 2012

Lemos, AP

2.252.43

1.13

2.25

2.21

2.16

C W Y Gorla, et al. Poster presented at: 32nd Annual Meeting of European Society for Paediatric Infectious Diseases (ESPID); May 6-10, 2014; Dublin, Ireland.

Variation composition of nadA among MenC, W and Y strains, Brazil 2012

0%

20%

40%

60%

80%

100%

3.8

3.7

2.6

1.1

no

Lemos, AP

2.6

3.7

3.8

1.1

3.8

C W Y

Unpublished data

Variation composition of NHBA among MenC, W and Y strains, Brazil 2012

0%

20%

40%

60%

80%

100% 620

53

29

24

20

9

7

6

3

Lemos, AP

24 29

20

6

C W Y

Gorla, et al. Poster presented at: 32nd Annual Meeting of European Society for Paediatric Infectious Diseases (ESPID); May 6-10, 2014; Dublin, Ireland.

Distribution of clonal complexes among MenC, W and Y strains, Brazil 2012

Lemos, AP

0%

20%

40%

60%

80%

100%

na

cc 32

cc 174

cc 22

cc 23

cc 11

cc 103

cc 103 cc 11

na

cc 174

cc 32

C W Y

1. Gorla, et al. Poster presented at: 32nd Annual Meeting of European Society for Paediatric Infectious Diseases (ESPID); May 6-10, 2014; Dublin, Ireland. 2. Unpublished data

Distribution of hipervirulent lineages causing outbreaks or epidemics in Brazil by period of time

A:4,21P1.10

subgroup I

C:2a:P1.2 ET37 Complex/

ST 11 Complex

A:4,21:P1.9

subgroup III

B:4,7:P1.19.15; ET 5 Complex/

ST-32 Complex

C:2b:P1.3 Cluster A4/

ST-8 Complex

C:23:P1.14-6

ST-103 Complex

1960s 1970s 1980s 1990s 2000s

Caugant, D. A. 1998. APMIS 106:505-525; Sacchi, C. T. et al. 1992 J. Clin. Microbiol. 30:1282-1286; Sacchi, C. T. et al. 1992 J. Clin Microbiol 30:1734-1738; Lemos, A. P. S. et al. 2006 J. Med. Microbiol. 55: 751-757; Lemos, A.P.S. et al. 2007 J. Clin Microbiol 45:1266-1273

obrigada

gracias

thank you