2017 年脑膜炎奈瑟菌 C 群在脑膜炎带外的爆发——利比里亚：一项流行病学和实验室调查。
Outbreak of Neisseria meningitidis serogroup C outside the meningitis belt-Liberia, 2017: an epidemiological and laboratory investigation.
机构信息
Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, US Centers for Disease Control and Prevention, Atlanta, GA, USA.
Division of Global Health Protection, Center for Global Health, US Centers for Disease Control and Prevention, Monrovia, Liberia.
出版信息
Lancet Infect Dis. 2018 Dec;18(12):1360-1367. doi: 10.1016/S1473-3099(18)30476-6. Epub 2018 Oct 15.
BACKGROUND
On April 25, 2017, a cluster of unexplained illnesses and deaths associated with a funeral was reported in Sinoe County, Liberia. Molecular testing identified Neisseria meningitidis serogroup C (NmC) in specimens from patients. We describe the epidemiological investigation of this cluster and metagenomic characterisation of the outbreak strain.
METHODS
We collected epidemiological data from the field investigation and medical records review. Confirmed, probable, and suspected cases were defined on the basis of molecular testing and signs or symptoms of meningococcal disease. Metagenomic sequences from patient specimens were compared with 141 meningococcal isolate genomes to determine strain lineage.
FINDINGS
28 meningococcal disease cases were identified, with dates of symptom onset from April 21 to April 30, 2017: 13 confirmed, three probable, and 12 suspected. 13 patients died. Six (21%) patients reported fever and 23 (82%) reported gastrointestinal symptoms. The attack rate for confirmed and probable cases among funeral attendees was 10%. Metagenomic sequences from six patient specimens were similar to a sequence type (ST) 10217 (clonal complex [CC] 10217) isolate genome from Niger, 2015. Multilocus sequencing identified five of seven alleles from one specimen that matched ST-9367, which is represented in the PubMLST database by one carriage isolate from Burkina Faso, in 2011, and belongs to CC10217.
INTERPRETATION
This outbreak featured high attack and case fatality rates. Clinical presentation was broadly consistent with previous meningococcal disease outbreaks, but predominance of gastrointestinal symptoms was unusual compared with previous African meningitis epidemics. The outbreak strain was genetically similar to NmC CC10217, which caused meningococcal disease outbreaks in Niger and Nigeria. CC10217 had previously been identified only in the African meningitis belt.
FUNDING
US Global Health Security.
背景
2017 年 4 月 25 日，利比里亚锡诺州报告了一起与葬礼有关的不明原因疾病和死亡集群。分子检测在患者标本中发现了 C 群脑膜炎奈瑟菌（NmC）。我们描述了这一集群的流行病学调查和暴发菌株的宏基因组特征。
方法
我们从现场调查和病历回顾中收集了流行病学数据。根据分子检测和脑膜炎奈瑟氏菌病的症状或体征，确定了确诊、疑似和可能病例。从患者标本中提取的宏基因组序列与 141 株脑膜炎奈瑟氏菌分离株基因组进行比较，以确定菌株谱系。
结果
共发现 28 例脑膜炎病例，发病日期为 2017 年 4 月 21 日至 4 月 30 日，其中确诊 13 例，疑似 3 例，可能 12 例。13 例死亡。6 例（21%）患者有发热，23 例（82%）有胃肠道症状。参加葬礼的确诊和疑似病例的发病率为 10%。从 6 例患者标本中提取的宏基因组序列与 2015 年来自尼日尔的一个序列型（ST）10217（克隆群[CC]10217）分离株基因组相似。多位点序列分析确定了从一个标本中获得的七个等位基因中的五个与 ST-9367 相匹配，该基因在 PubMLST 数据库中由 2011 年来自布基纳法索的一个携带分离株代表，属于 CC10217。
结论
本次暴发具有高发病率和病死率。临床表现与以往脑膜炎奈瑟氏菌病暴发基本一致，但与以往非洲脑膜炎流行相比，胃肠道症状更为常见。暴发菌株在遗传上与 NmC CC10217 相似，该菌株曾在尼日尔和尼日利亚引起脑膜炎奈瑟氏菌病暴发。CC10217 以前仅在非洲脑膜炎带被发现。
资助
美国全球卫生安全。
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