Global Distribution of Invasive Meningococcal Disease by Serogroup (A, B, C, W-135, X, Y)
Meningococcal disease incidence differs geographically, and the reason behind this variation is not clear. Distribution of N meningitidis serogroups varies widely from one part of the globe to the other (Figure 8). In Europe, South America, and Australia, serogroups B and C predominate, whereas in Asia, serogroups A and C are the most common. In North America, most meningococcal disease is caused by serogroups B, C, and Y.3 Although serogroup W-135 also causes a substantial proportion of meningococcal disease in Africa, serogroup A—the serogroup responsible for the larger epidemics—is responsible for most cases in the meningitis belt and in the expanded epidemic-susceptible region.1-4
Serogroup-Specific Meningococcal Disease Estimated Incidence in the
Currently in the United States, meningococcal disease is commonly caused by serogroups B, C, and Y. As per a laboratory-based surveillance performed in the United States for meningococcal disease in 2009 (Figure 9), serogroup Y accounted for approximately 40% of the disease.5 Recent data from 2009 demonstrate that serogroup B causes most cases of meningococcal disease in infants below the age of 1 year (Figure 10).5
Changing Serogroup Distribution Over Time in the United States
Over the past 20 years in the United States, serogroups B, C, and Y have caused the most meningococcal disease, but the proportion has varied by serogroup. Serogroup Y is now the most common serogroup in the United States.5 The proportion of meningococcal disease caused by serogroup Y increased dramatically from 2% of reported cases in 1989 to 36% of reported cases in 2009 (Figure 11).5,18 Serogroup A was once predominant in the United States but is now rarely reported.
Studies from 1989 to 1991 show maximum prevalence of serogroups B and C (46% and 45%) in the United States, whereas serogroups Y and W-135 were very low, accounting for only 2% and 7% of cases, respectively. In 1998, the proportion of disease caused by serogroups Y and W-135 increased to 33% and 17%, respectively, whereas the rates of proportion of disease caused of serogroups B and C dropped to 27% and 23%, respectively. In 2009, a different scenario can be seen again. The proportion of disease caused by serogroup Y further increased to 36%, while the cases caused by W-135 and other serogroups were reduced to 4%.5,18
Estimated Incidence of Meningococcal Disease by Serogroup in Infants and Adolescents
In the years from 1998 to 2007, a total of 2262 cases of meningococcal disease were reported in the United States, resulting in an estimated US average incidence of 0.53 cases per 100,000 population.19
The estimated incidence of serogroups B and Y was highest in children below the age of 2 years. Importantly, regardless of the serogroup variability by age, as illustrated by Figure 12, the estimated incidence of meningococcal disease caused by all serogroups is highest in infants.19
- Stephens D, Greenwood B, Brandtzaeg P. Epidemic meningitis, meningococcaemia, and Neisseria meningitidis. Lancet. 2007;369(9580):2196-2210.
- World Health Organization. WHO Fact Sheet: Meningococcal Meningitis.
http://www.who.int/mediacentre/factsheets/fs141/en/. December 2010.Accessed June 23, 2011.
- Molesworth A, Thomson M, Connor S, et al. Where is the meningitis belt? Defining an area at risk of epidemic meningitis in Africa. Trans R Soc Trop Med Hyg. 2002;96(3):242-249.
- Nicolas P, Garnotel E, Djibo S, Caugant DA. Molecular epidemiology of Neisseria meningitidisisolated in the African Meningitis Belt between 1988 and 2003 shows dominance of sequence type 5 (ST-5) and ST-11 complexes. J ClinMicrobiol. 2005;43(10):5129-5135.
- Centers for Disease Control and Prevention. Active Bacterial Core Surveillance Report, Emerging Infections Program Network, Neisseria meningitidis, 1998-2009.
http://www.cdc.gov/abcs/reports-findings/surv-reports.html. Accessed June 23, 2011.
- European Centre for Disease Prevention and Control Surveillance Report: Surveillance of invasive bacterial diseases in Europe 2008/2009. Stockholm, Sweden: ECDC; 2011.
- National Advisory Committee on Immunization (NACI). An update on the invasive meningococcal disease and meningococcal vaccine conjugate recommendations. An Advisory Committee Statement (ACS). Can Commun Dis Rep. 2009;35(ACS-3):1-40.
- OrganizaciónPanamericana de la Salud. Informe Regional de SIREVA II, 2009: datosporpaís y porgrupos de edadsobrelascaracterísticas de los aislamientos de Streptococcus pneumoniae, Haemophilusinfluenzaey Neisseria meningitidisen procesosinvasores. Washington, DC: Vigilancia Sanitaria, Prevención y Control de Enfermedades (HSD); 2010.
- INEI-ANLIS C.G. Malbran. 2009
- Ceyhan M, Yildrim I, Balmer P, Borrow R. Serotype shift of Neisseria meningitidisfrom W135 to B in Turkish children with meningitidis. Presented at: 6th World Congress of the World Society for Pediatric Infectious Diseases; November 18-22, 2009; Buenos Aires, Argentina.
- Al-Mazrou YY, Al-Jeffri MH, Abdalla MN, Elgizouli SA, Mishskas AA. Changes in epidemiological pattern of Meningococcal disease in Saudi Arabia. Does it constitute a new challenge for prevention and control? Saudi Med J. 2004;25(10):1410-1413.
- vonGottberg A, du Plessis M, Cohen C, et al. Emergence of endemic serogroup W135 meningococcal disease associated with a high mortality rate in South Africa. Clin Infect Dis. 2008;46(3):377-386.
- Gniel D, Schultze V. ModerneKonjugat-Impfstoffe und Meningokokken C-Impfkampagnen: Grundlagen, Daten, Fakten und Ausblicke. Impf Dialog. 2008;8(1):13-22.
- Takahashi H, Kuroki T, Watanabe Y, et al. Characterization of Neisseria meningitidisisolates collected from 1974 to 2003 in Japan by multilocus sequence typing. J Med Microbiol. 2004;53(Pt 7):657-662.
- Chiou CS, Liao JC, Liao TL, et al. Molecular epidemiology and emergence of worldwide epidemic clones of Neisseria meningitides in Taiwan. BMC Infect Dis. 2006;6:25.
- Australian Meningococcal Surveillance Programme. Annual report of the Australian Meningococcal Surveillance Programme, 2009. CDI. 2010;34:291-302.
- Lopez L, Sexton K, Carter P. The Epidemiology of Meningococcal Disease in New Zealand in 2010. Wellington, New Zealand: Institute of Environmental Science and Research Ltd (ESR); 2011. http://www.surv.esr.cri.nz/PDF_surveillance/MeningococcalDisease/2010/2010AnnualR pt.pdf. May 2011. Accessed June 27, 2011.
- Jackson L, Wenger J. Laboratory-based surveillance for meningococcal disease in selected areas, United States, 1989-1991. MMWR CDC SurveillSumm.1993;42:21-30.
- Cohn AC, MacNeil JR, Harrison LH, et al. Changes in Neisseria meningitidis disease epidemiology in the United States, 1998-2007: implications for prevention of meningococcal disease. Clin Infect Dis. 2010;50(2):184-191.