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    Meningokokken und Haemophilus Influenzae

    Data of the German Reference Centre for Meningococci 2009

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    1) Introduction

    The German Reference Centre for Meningococci (NRZM) is assigned by the RKI to perform laboratory surveillance of invasive meningococcal disease (IMD). In the year 2009 535 samples were processed from 471 individuals. The NRZM detected Neisseria meningitidis in 402 individuals; in 379 of 402 menincococci were detected in primary sterile materials (379 thus represents the number of IMD verified by NRZM). In contrast 486 cases of IMD were reported to RKI as of 27.1.2010 (cf. SurvStat@RKI). These figures reflect an almost unchanced incidence rate of IMD compared to 2008 (rates in 2009 were 0,59/100.000 according to reported data). Since the NRZM reports all processed cases to health authorities, one can assume that 78% of reported cases were analysed by NRZM (this rate was 87% in 2008). In 78 patients confirmation of IMD was exclusively done with molecular methods.

    The proportion of serogroup C cases remained unchanged with 22.0%, whereas the proportion of serogroup B slightly decreased to 67.8%. Meningococci of serogroups Y and W-135 caused 6.6% and 3.2% of IMD, respectively.

    Apart from the serogroup PorA und FetA are important targets for finetyping (cf. our previous reports 2008, 2007, 2006, 2005 und 2004). In 2009 148 distinct serogroup-PorA-FetA combinations (= finetypes) where described. The most common finetypes were B:P1.7-2,4:F1-5 (16.2% of IMD) and C:P1.5,2:F3-3 (12.0%). B:P1.7,16:F3-3, B:P1.18-1,3:F1-5 and Y:P1.5-2,10-1:F4-1 caused 3,6% of IMD each (see below).

    2) Serogroup distribution according to states

    BW: Baden-Württemberg, BY: Bayern, BE: Berlin, BB: Brandenburg, HB: Bremen, HH: Hamburg, HE: Hessen, MV: Mecklenburg-Vorpommern, NI: Niedersachsen, NW: Nordrhein-Westfalen, RP: Rheinland-Pfalz, SL: Saarland, SN: Sachsen, ST: Sachsen-Anhalt, SH: Schleswig-Holstein, TH: Thüringen, Au: patient lives abroad, unk: unknown. The table comprises 376 cases. Serogroup could not be determined in three cases.

    3) Serogruppenverteilung aufgeschlüsselt nach Altersgruppen

    4) Distribution of PorA-types, characterized by variable regions VR1 and VR2

    5) Distribution of outer membrane protein FetA, characterized by it's variable region

    6) Distribution of finetypes according to age groups

    7) Antibiotic susceptibility of viable strains (according to Clinical and Laboratory Standards Institute)

    One penicillin-resistant strain was isolated from non-invasive material (sputum). Rate of penicillin-intermediate strains slightly rose to 18.5%. Typical mutations in the penA gene were found in 18 (32%) of 57 intermediate strains.

    8) Geographical distributions

    serogroup B cases (pink triangles) *
    serogroup C cases (yellow triangles) *
    B:P1.7-2,4:F1-5 (blue circles) *
    C:P1.5,2:F3-3 (orange circles) *
    ET-15 (nur kulturell positive Fälle) (braune Dreiecke)

    Note: distribution of serogroups C and B is similar, yet serogroup C is slightly more common in the south. Accumulation of B:P1.7-2,4:F1-5 in western NRW continues throughout 2009. In southern Bavaria C:P1.5,2:F3-3 caused several flare-ups. ET-15 meningococci caused only 9 cases of IMD (ET-15, however, is likely underestimated, since only viable strains are tested).
    Maps marked with an asterisk (*) were generated using EpiScanGIS.

    9) Publications of the NRZM

    Original articles:

       

    1. Elias, J., L. Schouls, I. van de Pol, W.C. Keijzers, D.R. Martin, A. Glennie, P. Oster, M. Frosch, U. Vogel, and A. van der Ende. Vaccine Preventability of Meningococcal Clone, Greater Aachen Region, Germany. Emerg. Infect. Dis. Im Druck.
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    3. Claus, H., Stummeyer, K., Batzilla, J., Mühlenhoff, M., Vogel, U. 2009. Amino acid 310 determines the donor substrate specificity of serogroup W-135 and Y capsule polymerases of Neisseria meningitidis. Molecular Microbiology, 71(4):960-71.
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    Review articles:

       

    1. Vogel, U., J. Elias, H. Claus, and M. Frosch. 2009. Laboratory diagnosis of Neisseria meningitidis from the viewpoint of the German Reference Laboratory. J Lab Med 33(5):245–253.
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    3. Vogel, U. and Frosch, M. 2009. Moraxellen. In: Burkhardt, Medizinische Mikrobiologie (2. Auflage). Ed: Neumeister, Geiss, Braun, Kimmig. Thieme, Stuttgart, Chapter. 20.2. p. 428-430.
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    5. Vogel, U. and Frosch, M. (Eds.) Akute bakterielle Meningitis. Uni-med Verlag, Bremen. 2. Auflage. 2009.
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    7. Vogel, U., Schoen, J. Elias. Population Genetics of Neisseria meningitidis. In: Bacterial Population Genetics in Infectious Diseases. Ed.: Robinson, Falush, Feil. Wiley. Im Druck.
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    9. Vogel, U., J. Elias, W. Hellenbrand. Epidemiologie der Meningokokkeninfektion in Deutschland. Kinderärztliche Praxis. Im Druck.
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    11. Schroten, H. (Koordniator), und Adam, R., Ehrhard, I., Frosch, M., Heininger, U., Noack, R., Rüggeberg, J-., Scholz, H., Tenenbaum, T., Vogel, U., Zenz, W. (Mitarbeiter) Meningokokken-Infektionen. In: DGPI Handbuch, 5. Auflage, Hrsg.: Sacholz, H. et al., Georg-Thieme-Verlag, 2009, S. 368-372

    Disclaimer: the above data were generated with federal funds (RKI). Scientific use is prohibited without prior written consent by NRZM or RKI. Commercial use is strictly prohibited. Inclusion of figures or tables in talks or oral presentations is not allowed.

    Version 1.2 © NRZM 2010