Open Access Research article

An expanded age range for meningococcal meningitis: molecular diagnostic evidence from population-based surveillance in Asia

Soon Ae Kim1*, Dong Wook Kim26, Bai Qing Dong3, Jung Soo Kim4, Dang Duc Anh5 and Paul E Kilgore17

  • * Corresponding author: Soon A Kim sakim@ivi.int

  • † Equal contributors

Author Affiliations

1 Translational Research Division, International Vaccine Institute, SNU Research Park, San 4-8 Nakseongdae-Dong, Kwanak Gu, Seoul, 151-919, South Korea

2 Laboratory Science Division, International Vaccine Institute, Seoul, South Korea

3 Guangxi Zhuang Autonomous Region Center for Disease Control & Prevention, Nanning, China

4 Department of Pediatrics, Jeonbuk National University Hospital, Jeonju, South Korea

5 National Institute of Hygiene and Epidemiology, Hanoi, Vietnam

6 Department of Pharmacy, College of Pharmacy, Hanyang University, Suwon, South Korea

7 Department of Pharmacy Practice, Eugene Applebaum College of Pharmacy & Health Sciences, Wayne State University, Detroit, USA

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BMC Infectious Diseases 2012, 12:310  doi:10.1186/1471-2334-12-310

Published: 19 November 2012

Abstract

Background

To understand epidemiologic patterns of meningococcal disease in Asia, we performed a retrospective molecular analysis of cerebrospinal fluid (CSF) specimens collected in prospective surveillance among children aged < 5 years of age in China, South Korea, and Vietnam.

Methods

A total of 295 isolates and 2,302 CSFs were tested by a meningococcal species- and serogroup-specific polymerase chain reaction (PCR) assay targeting the Neisseria meningitidis (Nm) ctrA gene. Multi-locus sequence typing (MLST) was performed in Nm gene amplification analysis and incidence rates for meningococcal meningitis were estimated.

Results

Among 295 isolates tested, 10 specimens from Vietnam were confirmed as serogroup B and all were Sequence Type (ST) 1576 by MLST. Among the 2,032 CSF specimen tested, 284 (14%) were confirmed by PCR (ctrA gene), including 67 (23.6%) from China, 92 (32.4%) from Korea, and 125 (44.0%) from Vietnam. Neonates and infants aged < 6 months of age accounted for more than 50% of Nm-PCR positive CSF. Two CSF specimens from Vietnam were identified as serogroup B using MLST. In addition, 44 specimens underwent sequencing to confirm meningococcal serogroup; of these, 21 (48%) were serogroup C, 12 (27%) were serogroup X, 9 (20%) were serogroup Y and 2 (5%) were serogroup B. The incidence rates of meningococcal meningitis among children < 5 years of age was highest in Vietnam (7.4/100,000 [95% CI, 3.6—15.3] followed by Korea (6.8/100,000 [95% CI, 3.5-13.5] and China (2.1/100,000) [95% CI, 0.7-6.2]).

Conclusions

These results suggest that there is a previously undetected, yet substantial burden of meningococcal meningitis among infants and young children. Standardized, sensitive and specific molecular diagnostic assays with Nm serogrouping capacity are needed throughout Asia to understand the true burden of N. meningitidis disease.

Keywords:
Cerebrospinal fluid; Meningococcal meningitis; Neisseria meningitidis; Serogroup; Surveillance