Underestimation of Invasive Meningococcal Disease in Italy

Knowing the incidence of invasive meningococcal disease (IMD) is essential for planning appropriate vaccination policies. However, IMD may be underestimated because of misdiagnosis or insufficiently sensitive laboratory methods. Using a national molecular surveillance register, we assessed the numbe...

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Bibliographic Details
Published in:Emerging infectious diseases 2016-03, Vol.22 (3), p.469-475
Main Authors: Azzari, Chiara, Nieddu, Francesco, Moriondo, Maria, Indolfi, Giuseppe, Canessa, Clementina, Ricci, Silvia, Bianchi, Leila, Serranti, Daniele, Poggi, Giovanni Maria, Resti, Massimo
Format: Article
Language:English
Subjects:
Adolescent
Adult
Child
Child, Preschool
Comparative analysis
Diagnosis
Diagnostic Errors
Female
Humans
Incidence
Infant
invasive meningococcal disease
Italy - epidemiology
Male
Meningitis
Meningococcal Infections - diagnosis
Meningococcal Infections - epidemiology
Meningococcal Vaccines
misdiagnosis
Neisseria meningitidis
PCR
Real-Time Polymerase Chain Reaction
Retrospective Studies
underestimation
Underestimation of Invasive Meningococcal Disease in Italy
underreporting
Vaccination
Young Adult
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Summary:Knowing the incidence of invasive meningococcal disease (IMD) is essential for planning appropriate vaccination policies. However, IMD may be underestimated because of misdiagnosis or insufficiently sensitive laboratory methods. Using a national molecular surveillance register, we assessed the number of cases misdiagnosed and diagnoses obtained postmortem with real-time PCR (rPCR), and we compared sensitivity of rPCR versus culture-based testing. A total of 222 IMD cases were identified: 11 (42%) of 26 fatal cases had been misdiagnosed or undiagnosed and were reclassified as IMD after rPCR showed meningococcal DNA in all available specimens taken postmortem. Of the samples tested with both rPCR and culture, 58% were diagnosed by using rPCR alone. The underestimation factor associated with the use of culture alone was 3.28. In countries such as Italy, where rPCR is in limited use, IMD incidence may be largely underestimated; thus, assessments of benefits of meningococcal vaccination may be prone to error.
ISSN:1080-6040
1080-6059
DOI:10.3201/eid2203.150928