Laura Willerton1, Jay Lucidarme2, Helen Campbell3, Dominique A Caugant4, Heike Claus5, Susanne Jacobsson6, Shamez N Ladhani7, Paula Mölling6, Arianna Neri8, Paola Stefanelli8, Muhamed-Kheir Taha9, Ulrich Vogel8, Ray Borrow2. 1. Meningococcal Reference Unit, Public Health England, Manchester, UK. Electronic address: laura.willerton@phe.gov.uk. 2. Meningococcal Reference Unit, Public Health England, Manchester, UK. 3. Immunisation and Countermeasures Division, Public Health England, London, UK. 4. Division for Infection Control and Environmental Health, Norwegian Institute of Public Health, Oslo, Norway. 5. Institute for Hygiene and Microbiology, University of Würzburg, Würzburg, Germany. 6. National Reference Laboratory for Neisseria meningitidis, Faculty of Medicine and Health, Örebro University, Örebro, Sweden. 7. Immunisation and Countermeasures Division, Public Health England, London, UK; Paediatric Infectious Diseases Research Group, St George's University of London, London, United Kingdom. 8. Department of Infectious Diseases, Istituto Superiore di Sanità, Rome, Italy. 9. Invasive Bacterial Infections Unit and WHO collaborating Centre for meningitis, Institut Pasteur, Paris, France.
Abstract
INTRODUCTION: Invasive meningococcal disease (IMD) caused by non-serogroupable (NG) strains mainly affects immunocompromised individuals. Reduced susceptibility to penicillin in meningococci is increasing in Europe but ciprofloxacin resistance remains rare. In 2019, three travel-related meningococcal disease cases caused by a ciprofloxacin-resistant NG strain were identified in England, leading Germany to report four additional IMD cases (2016 to 2019). We describe these and newly identified cases and characterise the strain responsible. METHODS: Cases were identified as part of national surveillance and by analysing available genomes using PubMLST tools. RESULTS: Of the cases identified in England in 2019, two geographically distinct cases developed conjunctivitis after returning from Mecca (Kingdom of Saudi Arabia) and a third linked case presented with IMD. Of the four cases from Germany, three occurred in asylum seekers - two familial and a further geographically distinct case. Further IMD cases were identified in Italy (n = 2; 2017-2018), Sweden (n = 1; 2016) and England (n = 1; 2015). A single ST-175 clonal complex (cc175) strain with genosubtype P1.22-11,15-25 was responsible. Decreased susceptibility to penicillin was widespread with three ciprofloxacin resistant subclusters. Constituent isolates were potentially covered by subcapsular vaccines. CONCLUSION: This disease associated NG cc175 strain exhibits resistance to antibiotics commonly used to prevent IMD but is potentially covered by subcapsular (meningococcal B) vaccines.
INTRODUCTION:Invasive meningococcal disease (IMD) caused by non-serogroupable (NG) strains mainly affects immunocompromised individuals. Reduced susceptibility to penicillin in meningococci is increasing in Europe but ciprofloxacin resistance remains rare. In 2019, three travel-related meningococcal disease cases caused by a ciprofloxacin-resistant NG strain were identified in England, leading Germany to report four additional IMD cases (2016 to 2019). We describe these and newly identified cases and characterise the strain responsible. METHODS: Cases were identified as part of national surveillance and by analysing available genomes using PubMLST tools. RESULTS: Of the cases identified in England in 2019, two geographically distinct cases developed conjunctivitis after returning from Mecca (Kingdom of Saudi Arabia) and a third linked case presented with IMD. Of the four cases from Germany, three occurred in asylum seekers - two familial and a further geographically distinct case. Further IMD cases were identified in Italy (n = 2; 2017-2018), Sweden (n = 1; 2016) and England (n = 1; 2015). A single ST-175 clonal complex (cc175) strain with genosubtype P1.22-11,15-25 was responsible. Decreased susceptibility to penicillin was widespread with three ciprofloxacin resistant subclusters. Constituent isolates were potentially covered by subcapsular vaccines. CONCLUSION: This disease associated NG cc175 strain exhibits resistance to antibiotics commonly used to prevent IMD but is potentially covered by subcapsular (meningococcal B) vaccines.
Authors: Laura Willerton; Jay Lucidarme; Andrew Walker; Aiswarya Lekshmi; Stephen A Clark; Lloyd Walsh; Xilian Bai; Lisa Lee-Jones; Ray Borrow Journal: PLoS One Date: 2021-11-29 Impact factor: 3.240