Programmpunkt

14:00

Titel: Recurring invasive meningococcal infections – quantifying the risk
ID: 20/RKV
Art: Abstractautor
Session: Workshop 04
Molecular Epidemiology of Infectious Diseases (StAG RK, FG MS)

Referent: Manuel Krone (Würzburg)


Abstract - Text

Introduction

Invasive meningococcal disease (IMD) is a rare condition with a high case fatality rate. While most affected patients appear to suffer from only a single episode in their life span, there is anecdotal evidence for recurrent infection [1]. The incidence of recurring IMD, however, has not been quantified. The National Reference Laboratory (NRL) for meningococci has analyzed 5,822 cases of meningococcal disease in the past 16 years, which offers the opportunity to retrospectively quantify the risk of recurrent infection.

Aim of the study

To assess the risk of recurring invasive meningococcal infections in Germany.

Methods

Patients living in Germany with IMD that were registered by the NRL between 2002 and 2017 as part of the laboratory surveillance program were analyzed. IMD was assumed for cases, where Neisseria meningitidis was detected by culture or PCR from blood or cerebrospinal fluid. A recurring IMD was defined as the detection of N. meningitidis in a following sample from the same patient after an interval of at least 30 days. Patient identity was assessed by comparison of month of birth, sex, and county of living. In some cases, identity was reported beforehand by senders.

Results

Out of the 5,583 patients with an average observation period of 9.14 years, 13 suffered a second episode and one a third IMD episode. Assuming an average lethality of 9.6 % [2], the risk of a recurring IMD was 30.3 per 100,000 person years of survivors of the first episode compared to an average general incidence of IMD of 0.9 per 100,000 in the observation period (Source: https://survstat.rki.de/). The median interval from the first to the second episode was 1.64 years. Rare serogroups (Y: 21 %, W: 14 %, W: 7 %, Z: 3 %, E: 3 %, non-groupable: 3 %) were more common in patients with recurring IMD. The same strain has not been observed more than once in a patient.

Discussion

Surviving IMD patients are at a more than 30-fold risk of IMD compared to the general population. Increased risk might be caused by undiagnosed complement deficiencies. The study most likely underestimates the risk of recurrent infection. Therefore, a joint analysis of statutory notification data will be initiated with the RKI. The high risk of re-infection argues for vaccination of IMD patients following survival of disease.

References

  1. Hildenhagen, O. et al., Dtsch Med Wochenschr, 1985. 110(39): p. 1498-501.
  2. Hellenbrand, W., Epidemiologisches Bulletin, 2016. 43: p. 471-84.