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

• Published in: BMC infectious diseases 2012-09, Vol.12 (1), p.205-205, Article 205
• Main Authors: Xu, Xi-Hai, Ye, Ying, Hu, Li-Fen, Jin, Yu-Hui, Jiang, Qin-Qin, Li, Jia-Bin
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Aged; Child; Child, Preschool; China; China - epidemiology; Cluster Analysis; Disease control; Electrophoresis, Gel, Pulsed-Field; Endemic Diseases; Epidemics; Female; Forecasts and trends; Genotype; Health surveillance; Hospitals; Humans; Incidence; Infant; Male; Medical laboratories; Meningitis; Meningitis, Meningococcal - epidemiology; Meningitis, Meningococcal - microbiology; Meningitis, Meningococcal - mortality; Meningococcal infections; Middle Aged; Molecular Epidemiology; Mortality; Multilocus Sequence Typing; Neisseria meningitidis; Neisseria meningitidis, Serogroup C - classification; Neisseria meningitidis, Serogroup C - genetics; Neisseria meningitidis, Serogroup C - isolation & purification; Patients; Serogroup C strain; Survival Analysis; Vaccines; Young Adult
• ISSN: 1471-2334; 1471-2334
• DOI: 10.1186/1471-2334-12-205

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. 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. 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. 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.