Format

Send to

Choose Destination
Lancet Infect Dis. 2018 Dec;18(12):1360-1367. doi: 10.1016/S1473-3099(18)30476-6. Epub 2018 Oct 15.

Outbreak of Neisseria meningitidis serogroup C outside the meningitis belt-Liberia, 2017: an epidemiological and laboratory investigation.

Author information

1
Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, US Centers for Disease Control and Prevention, Atlanta, GA, USA.
2
Division of Global Health Protection, Center for Global Health, US Centers for Disease Control and Prevention, Monrovia, Liberia.
3
National Public Health Institute of Liberia, Monrovia, Liberia.
4
Liberia Ministry of Health, Monrovia, Liberia.
5
Division of Reproductive Health, National Center for Chronic Diseases Prevention and Health Promotion, US Centers for Disease Control and Prevention, Atlanta, GA, USA.
6
World Health Organization-Liberia, Monrovia, Liberia.
7
World Health Organization-AFRO, Brazzaville, Republic of Congo.
8
World Health Organization, Geneva, Switzerland.
9
Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, US Centers for Disease Control and Prevention, Atlanta, GA, USA. Electronic address: lfox@cdc.gov.

Abstract

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.

Supplemental Content

Full text links

Icon for Elsevier Science
Loading ...
Support Center