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.
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.
Authors: M C Maiden; J A Bygraves; E Feil; G Morelli; J E Russell; R Urwin; Q Zhang; J Zhou; K Zurth; D A Caugant; I M Feavers; M Achtman; B G Spratt Journal: Proc Natl Acad Sci U S A Date: 1998-03-17 Impact factor: 11.205
Authors: Alexandra Malachová; Michael Sulyok; Eduardo Beltrán; Franz Berthiller; Rudolf Krska Journal: J Chromatogr A Date: 2014-08-17 Impact factor: 4.759
Authors: Caroline L Trotter; Clément Lingani; Katya Fernandez; Laura V Cooper; André Bita; Carol Tevi-Benissan; Olivier Ronveaux; Marie-Pierre Préziosi; James M Stuart Journal: Lancet Infect Dis Date: 2017-05-22 Impact factor: 25.071
Authors: Zoltan Rumbus; Robert Matics; Peter Hegyi; Csaba Zsiboras; Imre Szabo; Anita Illes; Erika Petervari; Marta Balasko; Katalin Marta; Alexandra Miko; Andrea Parniczky; Judit Tenk; Ildiko Rostas; Margit Solymar; Andras Garami Journal: PLoS One Date: 2017-01-12 Impact factor: 3.240
Authors: John Doedeh; Joseph Asamoah Frimpong; Kwuakuan D M Yealue; Himiede W Wilson; Youhn Konway; Samson Q Wiah; Vivian Doedeh; Umaru Bao; George Seneh; Lawrence Gorwor; Sylvester Toe; Emmanuel Ghartey; Lawrence Larway; Dedesco Gweh; Philemon Gonotee; Thomas Paasewe; George Tamatai; James Yarkeh; Samuel Smith; Annette Brima-Davis; George Dauda; Thomas Monger; Leleh W Gornor-Pewu; Siafa Lombeh; Jeremias Naiene; Nathaniel Dovillie; Mark Korvayan; Geraldine George; Garrison Kerwillain; Ralph Jetoh; Suzanne Friesen; Carl Kinkade; Victoria Katawera; Maame Amo-Addae; Roseline N George; Miatta Z Gbanya; E Kainne Dokubo Journal: MMWR Morb Mortal Wkly Rep Date: 2017-10-27 Impact factor: 17.586
Authors: Sean A Buono; Reagan J Kelly; Nadav Topaz; Adam C Retchless; Hideky Silva; Alexander Chen; Edward Ramos; Gregory Doho; Agha Nabeel Khan; Margaret A Okomo-Adhiambo; Fang Hu; Daya Marasini; Xin Wang Journal: Front Genet Date: 2020-11-26 Impact factor: 4.599
Authors: Brenda Anna Kwambana-Adams; Adam L Cohen; Lee Hampton; Aquino Albino Nhantumbo; Robert S Heyderman; Martin Antonio; Andre Bita; Jason Mathiu Mwenda Journal: J Infect Dis Date: 2021-09-01 Impact factor: 5.226
Authors: Ryan T Novak; Olivier Ronveaux; André F Bita; Honoré Flavien Aké; Fernanda C Lessa; Xin Wang; Ado M Bwaka; LeAnne M Fox Journal: J Infect Dis Date: 2019-10-31 Impact factor: 7.759
Authors: James Douglas Sinnatwah; Hajah Kenneh; Alvan A Coker; Wahdae-Mai Harmon-Gray; Joelyn Zankah; Liam Day; Emma Hubbell; Michael J Murphy; Mandy Izzo; David Kong; Peter Sylwester; Qinghua Long; Elena Bertozzi; Laura A Skrip Journal: Front Digit Health Date: 2022-01-04