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. 2015 Oct 7;10(10):e0139376.
doi: 10.1371/journal.pone.0139376. eCollection 2015.

Epidemiological and Molecular Characterization of Invasive Meningococcal Disease in Italy, 2008/09-2012/13

Arianna Neri  1 , Patrizio Pezzotti  1 , Cecilia Fazio  1 , Paola Vacca  1 , Fortunato Paolo D'Ancona  2 , Maria Grazia Caporali  2 , Paola Stefanelli  1
Affiliations

Epidemiological and Molecular Characterization of Invasive Meningococcal Disease in Italy, 2008/09-2012/13

Arianna Neri et al. PLoS One. .

Abstract

Background: Following the introduction of meningococcal serogroup C conjugate vaccine in Italy in 2005, changes in the epidemiology of Invasive Meningococcal Disease (IMD) were expected. The study aims were to describe the epidemiological trend and to characterize the isolates collected during the period 2008/09-2012/13 by multilocus sequence typing (MLST). Data on laboratory confirmed meningococcal diseases from National Surveillance System of IMD were reported.

Methods: Poisson regression models were used to estimate the incidence rate over time. Serogrouping and MLST were performed following published methods.

Results: The incidence rate of laboratory confirmed meningococcal disease decreased from 0.33 per 100,000 population in 2008/09 to 0.25 per 100,000 population in 2012/13. The serogroup B incidence rate was significantly higher (p<0.01) than that of other serogroups, among all age groups. The significant decrease of the IMD incidence rate (p = 0.01) reflects the decrease of serogroup B and C, in particular among individuals aged 15-24 years old (p<0.01). On the other hand, serogroup Y incidence increased during the period (from 0.01/100,000 in 2008/09 to 0.02/100,000 in 2012/13, p = 0.05). Molecular characterizations revealed that ST-41/44 cc and ST-11 cc were the main clonal complexes identified among serogroup B and C isolates, respectively. In particular, ST-41/44 cc was predominant in all age groups, whereas ST-11 cc was not identified in infants less than 1 year of age.

Conclusions: IMD incidence declined in Italy and serogroup B caused most of the IMD cases, with infants having the highest risk of disease. Continued surveillance is needed to provide information concerning further changes in circulating meningococci with special regard to serogroup distribution. Moreover, knowledge of meningococcal genotypes is essential to detect hyper-invasive strains.

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Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. Annual incidence, on logarithmic scale, of IMD in Italian Regions with <20% of annual cases with UNK serogroup by age group: A) <1, B) 1-to–4, C) 5-to–14, D) 15-to–24, E) ≥25 years.
p-values from Poisson univariate regression models with epidemiological year as covariate are in the right side.
Fig 2
Fig 2. Distribution of the main clonal complexes (ccs) identified among meningococci collected in the study period.
See this image and copyright information in PMC

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