Data 2007 (eng)

Data of the German Reference Centre for Meningococci 2007

1) Introduction

The German Reference Centre for Meningococci (NRZM) is assigned by the Robert-Koch-Institute (RKI) to perform finetyping on meningococcal strains and to survey trends in antibiotic susceptibilities. In the year 2007 it processed 495 samples from 433 patients. Neisseria meningitidis was identified in 388 individuals. In 349 cases the organism was detected in normally sterile body fluids (e.g. csf; this figure corresponds to the number of cases with invasive meningococcal disease, IMD). During the same period 436 cases of IMD were reported to the RKI (data as of 2.4.2008, cf. SurvStat@RKI). Since NRZM submits all results to the appropriate local health authorities, samples of approximately 80% of all notified cases were processed (previous year: 88%). Both sources, however, suggest a decline of the incidence of IMD in Germany (0.53 per 100,000 inhabitants). For 50 patients the detection of meningococci was carried out solely with non-culture methods. The share of serogroup C disease slightly dropped to 23,8%, whilst that of serogroup B disease remained stable at 67,0%. Meningococci of the serogroups Y and W-135 caused 5,4% and 2,9% of all invasive diseases, respectively.

Apart from the serogroup, PorA and FetA are important targets for finetyping (see our previous reports for 2004, 2005, and 2006). 146 unique serogroup-PorA-FetA combinations were observed in 2007 (each of these unique combinations represents a "finetype"). The most common finetypes for the year 2007 were C:P1.5,2:F3-3 (10,6% of all invasive isolates), B:P1.7-2,4:F1-5 (10,6%), B:P1.7,16:F3-3 (6,7%), B:P1.18-1,3:F1-5 (4,1%), and B:P1.7-2,16:F3-3 (3,2%) (see below).

Early detection of finetype-specific clusters and the interpretation of spatial dynamics of disease have been greatly facilitated by the implementation of the geographical information system EpiScanGIS (summer 2006) and the usage of SaTScan.

2) Serogroup distribution according to German states

BW: Baden-Wuerttemberg, BY: Bavaria, BE: Berlin, BB: Brandenburg, HB: Bremen, HH: Hamburg, HE: Hesse, MV: Mecklenburg-West-Pomerania, NI: Lower Saxony, NW: Nordrhine-Westphalia, RP: Rhineland-Palatinate, SL: Saarland, SN: Saxony, ST: Saxony-Anhalt, SH: Schleswig-Holstein, TH: Thuringia, Au: foreigners who contracted meningococcal disease in Germany

3) Serogroup distribution according to age groups 2007

4) Frequency of PorA-types 2007, determined by the variable regions VR1 and VR2

5) Frequency of finetypes according to age groups:

6) Antibiotic susceptibilities 2007

(according to CLSI)

The proportion of penicillin intermediate strains decreased to approx. 12,5%. The share of these strains with corresponding penA-alleles was 38%.

7) Geographical distribution of cases 2007

ET-15 (culturally confirmed cases only) (brown triangles)

Remarks: Spatial distribution of serogroups B and C is comparable. Accumulation of the finetype B:P1.7-2,4:F1-5 in western NRW has become less marked. Also, the share of ET-15 meningococci dropped tp 3% of all cases of IMD. Nevertheless, the numbers of ET-15 cases in Germany are likely underestimated, since only culture confirmed cases are included.
The asterisk (*) denotes maps, that have been generated using EpiScanGIS.

8) Reported lethality for serogroups B and C 2007

Data regarding lethality are reported on a voluntary basis by the senders and are not verified by the NRZM. False negative cases are likely. Lethality for serogroup B disease seems lower than for serogroup C disease (7,3% vs. 12,0%). The difference, however, is not statistically significant (Fisher's exact Test p=0.16).

9) Publications of the NRZM 2007

Research articles:

Elias, J. and U. Vogel. 2007. IS1301 Fingerprint Analysis of Neisseria meningitidis Strains Belonging to the ET-15 Clone. J. Clin. Microbiol. 45:159-167.
Findlow, H., Vogel, U., Mueller, J.E., Curry, A., Njanpop-Lafourcade, B.M., Claus, H., Gray, S.J., Yaro, S., Traoré, Y., Sangaré, L., Nicolas, P., Gessner, B.D., and Borrow, R. 2007. Three cases of invasive meningococcal disease in Burkina Faso caused by a capsule null locus strain circulating among healthy carriers. J. Infect. Dis. 195(7):1071-7.
Madico, G., Ngampasutadol, J., Gulati, S., Vogel, U., Rice, P.A., Ram, S. 2007. Factor H Binding and Function in Sialylated Pathogenic Neisseriae is Influenced by Gonococcal, but Not Meningococcal, Porin. J Immunol. 178(7):4489-97.
Taha, M.K., Vázquez, J.A., Hong, E., Bennett, D.E., Bertrand, S., Bukovski, S., Cafferkey, M.T., Carion, F., Christensen, J.J., Diggle, M., Edwards, G., Enríquez, R., Fazio, C., Frosch, M., Heuberger, S., Hoffmann, S., Jolley, K.A., Kadlubowski, M., Kechrid, A., Kesanopoulos, K., Kriz, P., Lambertsen, L., Levenet, I., Musilek, M., Paragi, M., Saguer, A., Skoczynska, A., Stefanelli, P., Thulin, S., Tzanakaki, G., Unemo, M., Vogel, U., Zarantonelli, M.L. 2007. Target gene sequencing to characterize the penicillin G susceptibility of Neisseria meningitidis. Antimicrob Agents Chemother. 51(8):2784-92.
Claus, H., Elias, J., Meinhardt, C., Frosch, M., Vogel, U. 2007. Deletion of the meningococcal fetA gene used for antigen sequence typing of invasive and commensal isolates from Germany: frequencies and mechanisms. J Clin Microbiol. 45(9):2960-4.
Freiberger, F., Claus, H., Günzel, A., Oltmann-Norden, I., Vionnet, J., Mühlenhoff, M., Vogel, U., Vann, W.F., Gerardy-Schahn, R., Stummeyer, K. 2007. Biochemical characterization of a Neisseria meningitidis polysialyltransferase reveals novel functional motifs in bacterial sialyltransferases. Mol Microbiol. 65(5):1258-75.
Valenza, G., Ruoff, C., Vogel, U., Frosch, M., Abele-Horn, M. 2007. Microbiological evaluation of the new VITEK 2 Neisseria-Haemophilus identification card. J Clin Microbiol. 45(11):3493-7.
Villwock A, Schmitt C, Frosch M, Kurzai O. Capsule acetylation does not impair recognition of serogroup C, W-135 and Y meningococci by human dendritic cells. Int J Med Microbiol. 2007 Dec 28;
Schmitt C, Turner D, Boesl M, Abele M, Frosch M, Kurzai O. A functional two-partner secretion system contributes to adhesion of Neisseria meningitidis to epithelial cells. J Bacteriol. 2007 Nov;189(22):7968-76.
Knaust A, Weber MV, Hammerschmidt S, Bergmann S, Frosch M, Kurzai O. Cytosolic proteins contribute to surface plasminogen recruitment of Neisseria meningitidis. J Bacteriol. 2007 Apr;189(8):3246-55. Epub 2007 Feb 16. Erratum in: J Bacteriol. 2007 Jul;189(14):5404.
Schubert-Unkmeir A, Sokolova O, Panzner U, Eigenthaler M, Frosch M. Gene expression pattern in human brain endothelial cells in response to Neisseria meningitidis. Infect Immun. 2007 Feb;75(2):899-914.

Review articles and books:

Frosch M, Maiden M. The European networking for combating meningococcal disease. FEMS Microbiol Rev. 2007 Jan;31(1):1-2
Trotter CL, Chandra M, Cano R, Larrauri A, Ramsay ME, Brehony C, Jolley KA, Maiden MC, Heuberger S, Frosch M. A surveillance network for meningococcal disease in Europe. FEMS Microbiol Rev. 2007 Jan;31(1):27-36.
Fox, A.J., Taha, M.K., and Vogel, U. 2007. Standardized non-culture techniques recommended for European reference laboratories. FEMS Microbiol. Rev. 31(1):84-8.
Claus, H., Vogel, U., Swiderek, S., Frosch, M., and Schoen, S. 2007. Microarray analyses of meningococcal genome composition and gene regulation: review of the recent literature. FEMS Microbiol. Rev. 31(1):43-51.
Alonso JM, Gilmet G, Rouzic EM, Nassif X, Plotkin SA, Ramsay M, Siegrist CA, Stephens DS, Teyssou R, Vogel U. 2007. Workshop on vaccine pressure and Neisseria meningitidis, Annecy, France, 9-11. March 2005. Vaccine. 22;25(21):4125-9.
Schoen, C., Joseph, B., Claus, H., Vogel, U., Frosch, M. 2007. Living in a changing environment: insights into host adaptation in Neisseria meningitidis from comparative genomics. Int J Med Microbiol. 2007 Nov;297(7-8):601-13.
Vogel, U. 2007. Meningokokkenerkrankungen in Deutschland. MedReport 31(16):3
Schröter, M., Hellenbrand, W., Elias, J., van der Ende, A., ter Waarbeek, H., Ziemer, B., Oster, P., Heuser, G., Wegener, W., Kirchner-Homoet, B., Baumeister, H.-G. and Vogel, U. 2007. Meningokokkenerkrankungen in Nordrhein-Westfalen: Erste Erfahrungen mit einer intensivierten grenzüberschreitenden Surveillance. Rheinisches Ärzteblatt. 5/2007
Elias, J., Reinhardt, M., Hautmann, W., Harms, I., Oppermann, H., Schröter, M., Hellenbrand, W., Oster, P., Kurzai, O., Taha, M.K., Nossal, R., Frosch, M., Vogel, U. 2007. 3. Würzburger Workshop zur Epidemiologie, Prävention und Therapie der invasiven Meningokokkenerkrankung 2006. Gesundheitswesen. 69(4):256-62