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Open Access Research article

Emergence of serogroup C meningococcal disease associated with a high mortality rate in Hefei, China

Xi-Hai Xu1, Ying Ye1, Li-Fen Hu23, Yu-Hui Jin4, Qin-Qin Jiang4 and Jia-Bin Li12*

Author Affiliations

1 Department of Infectious Diseases, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China

2 Anhui Center for Surveillance of Bacterial Resistance, Hefei, Anhui, China

3 Department of Center Laboratory, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China

4 Anhui Provincial Center for Disease Control and Prevention, Hefei, Anhui, China

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BMC Infectious Diseases 2012, 12:205  doi:10.1186/1471-2334-12-205

Published: 4 September 2012

Abstract

Background

Neisseria meningitidis serogroup C has emerged as a cause of epidemic disease in Hefei. The establishment of serogroup C as the predominant cause of endemic disease has not been described.

Methods

We conducted national laboratory-based surveillance for invasive meningococcal disease during 2000–2010. Isolates were characterized by pulsed-field gel electrophoresis and multilocus sequence typing.

Results

A total of 845 cases of invasive meningococcal disease were reported. The incidence increased from 1.25 cases per 100,000 population in 2000 to 3.14 cases per 100,000 in 2003 (p < 0.001), and peaked at 8.43 cases per 100,000 in 2005. The increase was mainly the result of an increase in the incidence of serogroup C disease. Serogroup C disease increased from 2/23 (9%) meningococcal cases and 0.11 cases per 100,000 in 2000 to 33/58 (57%) cases and 1.76 cases per 100,000 in 2003 (p < 0.01). Patients infected with serogroup C had serious complications more frequently than those infected with other serogroups. Specifically, 161/493 (32.7%) cases infected with serogroup C had at least one complication. The case-fatality rate of serogroup C meningitis was 11.4%, significantly higher than for serogroup A meningitis (5.3%, p = 0.021). Among patients with meningococcal disease, factors associated with death in univariate analysis were age of 15–24 years, infection with serogroup C, and meningococcemia.

Conclusions

The incidence of meningococcal disease has substantially increased and serogroup C has become endemic in Hefei. The serogroup C strain has caused more severe disease than the previously predominant serogroup A strain.

Keywords:
Neisseria meningitidis; Serogroup C strain; Incidence