Giuseppe
Emeritus
[Source: PLoS ONE, full text: (LINK). Abstract, edited.]
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The Changing Epidemiology of Meningococcal Disease in Quebec, Canada, 1991?2011: Potential Implications of Emergence of New Strains
Rodica Gilca<SUP>1</SUP><SUP>,</SUP><SUP>2</SUP><SUP>,</SUP><SUP>3</SUP><SUP>*</SUP>, Genevi?ve Deceuninck<SUP>2</SUP>, Brigitte Lefebvre<SUP>4</SUP>, Raymond Tsang<SUP>5</SUP>, Rachid Amini<SUP>1</SUP>, Vladimir Gilca<SUP>1</SUP><SUP>,</SUP><SUP>2</SUP><SUP>,</SUP><SUP>3</SUP>, Monique Douville-Fradet<SUP>1</SUP><SUP>,</SUP><SUP>2</SUP><SUP>,</SUP><SUP>3</SUP>, France Markowski<SUP>6</SUP>, Philippe De Wals<SUP>1</SUP><SUP>,</SUP><SUP>2</SUP><SUP>,</SUP><SUP>3</SUP>
<SUP></SUP>
1 Institut national de sant? publique du Qu?bec, Quebec City, Quebec, Canada, 2 Public Health Research Unit, Quebec University Hospital Centre, Quebec City, Quebec, Canada, 3 Department of Social and Preventive Medicine, Faculty of Medicine, Laval University, Quebec City, Quebec, Canada, 4 Laboratoire de Sant? Publique du Qu?bec, Institut national de sant? publique du Qu?bec, Sainte-Anne-de-Bellevue, Quebec, Canada, 5 National Microbiology Laboratory, Public Health Agency of Canada, Winnipeg, Manitoba, Canada, 6 Ministry of Health and Social Services, Quebec, Canada
Abstract
Background
In order to inform meningococcal disease prevention strategies, we analysed the epidemiology of invasive meningococcal disease (IMD) in the province of Quebec, Canada, 10 years before and 10 years after the introduction of serogroup C conjugate vaccination.
Methodology
IMD cases reported to the provincial notifiable disease registry in 1991?2011 and isolates submitted for laboratory surveillance in 1997?2011 were analysed. Serogrouping, PCR testing and assignment of isolates to sequence types (ST) by using multilocus sequence typing (MLST) were performed.
Results
Yearly overall IMD incidence rates ranged from 2.2?2.3/100,000 in 1991?1992 to 0.49/100,000 in 1999?2000, increasing to 1.04/100,000 in 2011. Among the 945 IMD cases identified by laboratory surveillance in 1997?2011, 68%, 20%, 8%, and 3% were due to serogroups B, C, Y, and W135, respectively. Serogroup C IMD almost disappeared following the implementation of universal childhood immunization with monovalent C conjugate vaccines in 2002. Serogroup B has been responsible for 88% of all IMD cases and 61% of all IMD deaths over the last 3 years. The number and proportion of ST-269 clonal complex has been steadily increasing among the identified clonal complexes of serogroup B IMD since its first identification in 2003, representing 65% of serogroup B IMD in 2011. This clonal complex was first introduced in adolescent and young adults, then spread to other age groups.
Conclusion
Important changes in the epidemiology of IMD have been observed in Quebec during the last two decades. Serogroup C has been virtually eliminated. In recent years, most cases have been caused by the serogroup B ST-269 clonal complex. Although overall burden of IMD is low, the use of a vaccine with potential broad-spectrum coverage could further reduce the burden of disease. Acceptability, feasibility and cost-effectiveness studies coupled with ongoing clinical and molecular surveillance are necessary in guiding public policy decisions.
Citation: Gilca R, Deceuninck G, Lefebvre B, Tsang R, Amini R, et al. (2012) The Changing Epidemiology of Meningococcal Disease in Quebec, Canada, 1991?2011: Potential Implications of Emergence of New Strains. PLoS ONE 7(11): e50659. doi:10.1371/journal.pone.0050659
Editor: Martyn Kirk, The Australian National University, Australia
Received: May 15, 2012; Accepted: October 26, 2012; Published: November 29, 2012
Copyright: ? 2012 Gilca et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Funding: The authors have no support or funding to report.
Competing interests: The authors have the following conflicts: RG received a research grant for unrelated study from Pfizer; PDW received research grants, honoraria and reimbursements of travel expenses from vaccine manufacturers Glaxo-Smith-Kline, Novartis, Sanofi Pasteur, Merck and Pfizer; VG received research grants, honoraria and/or reimbursements of travel expenses from Novartis, Glaxo-Smith-Kline, Merck and Pfizer; GD, BL, RT, RA, MDF, and FM have declared that no competing interests exist. This does not alter the authors? adherence to all the PLOS ONE policies on sharing data and materials.
* E-mail: rodica.gilca@ssss.gouv.qc.ca
-Rodica Gilca<SUP>1</SUP><SUP>,</SUP><SUP>2</SUP><SUP>,</SUP><SUP>3</SUP><SUP>*</SUP>, Genevi?ve Deceuninck<SUP>2</SUP>, Brigitte Lefebvre<SUP>4</SUP>, Raymond Tsang<SUP>5</SUP>, Rachid Amini<SUP>1</SUP>, Vladimir Gilca<SUP>1</SUP><SUP>,</SUP><SUP>2</SUP><SUP>,</SUP><SUP>3</SUP>, Monique Douville-Fradet<SUP>1</SUP><SUP>,</SUP><SUP>2</SUP><SUP>,</SUP><SUP>3</SUP>, France Markowski<SUP>6</SUP>, Philippe De Wals<SUP>1</SUP><SUP>,</SUP><SUP>2</SUP><SUP>,</SUP><SUP>3</SUP>
<SUP></SUP>
1 Institut national de sant? publique du Qu?bec, Quebec City, Quebec, Canada, 2 Public Health Research Unit, Quebec University Hospital Centre, Quebec City, Quebec, Canada, 3 Department of Social and Preventive Medicine, Faculty of Medicine, Laval University, Quebec City, Quebec, Canada, 4 Laboratoire de Sant? Publique du Qu?bec, Institut national de sant? publique du Qu?bec, Sainte-Anne-de-Bellevue, Quebec, Canada, 5 National Microbiology Laboratory, Public Health Agency of Canada, Winnipeg, Manitoba, Canada, 6 Ministry of Health and Social Services, Quebec, Canada
Abstract
Background
In order to inform meningococcal disease prevention strategies, we analysed the epidemiology of invasive meningococcal disease (IMD) in the province of Quebec, Canada, 10 years before and 10 years after the introduction of serogroup C conjugate vaccination.
Methodology
IMD cases reported to the provincial notifiable disease registry in 1991?2011 and isolates submitted for laboratory surveillance in 1997?2011 were analysed. Serogrouping, PCR testing and assignment of isolates to sequence types (ST) by using multilocus sequence typing (MLST) were performed.
Results
Yearly overall IMD incidence rates ranged from 2.2?2.3/100,000 in 1991?1992 to 0.49/100,000 in 1999?2000, increasing to 1.04/100,000 in 2011. Among the 945 IMD cases identified by laboratory surveillance in 1997?2011, 68%, 20%, 8%, and 3% were due to serogroups B, C, Y, and W135, respectively. Serogroup C IMD almost disappeared following the implementation of universal childhood immunization with monovalent C conjugate vaccines in 2002. Serogroup B has been responsible for 88% of all IMD cases and 61% of all IMD deaths over the last 3 years. The number and proportion of ST-269 clonal complex has been steadily increasing among the identified clonal complexes of serogroup B IMD since its first identification in 2003, representing 65% of serogroup B IMD in 2011. This clonal complex was first introduced in adolescent and young adults, then spread to other age groups.
Conclusion
Important changes in the epidemiology of IMD have been observed in Quebec during the last two decades. Serogroup C has been virtually eliminated. In recent years, most cases have been caused by the serogroup B ST-269 clonal complex. Although overall burden of IMD is low, the use of a vaccine with potential broad-spectrum coverage could further reduce the burden of disease. Acceptability, feasibility and cost-effectiveness studies coupled with ongoing clinical and molecular surveillance are necessary in guiding public policy decisions.
Citation: Gilca R, Deceuninck G, Lefebvre B, Tsang R, Amini R, et al. (2012) The Changing Epidemiology of Meningococcal Disease in Quebec, Canada, 1991?2011: Potential Implications of Emergence of New Strains. PLoS ONE 7(11): e50659. doi:10.1371/journal.pone.0050659
Editor: Martyn Kirk, The Australian National University, Australia
Received: May 15, 2012; Accepted: October 26, 2012; Published: November 29, 2012
Copyright: ? 2012 Gilca et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Funding: The authors have no support or funding to report.
Competing interests: The authors have the following conflicts: RG received a research grant for unrelated study from Pfizer; PDW received research grants, honoraria and reimbursements of travel expenses from vaccine manufacturers Glaxo-Smith-Kline, Novartis, Sanofi Pasteur, Merck and Pfizer; VG received research grants, honoraria and/or reimbursements of travel expenses from Novartis, Glaxo-Smith-Kline, Merck and Pfizer; GD, BL, RT, RA, MDF, and FM have declared that no competing interests exist. This does not alter the authors? adherence to all the PLOS ONE policies on sharing data and materials.
* E-mail: rodica.gilca@ssss.gouv.qc.ca
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