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      Meningococcal Disease in China

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          Abstract

          Neisseria meningitides is one of the leading causes of bacterial meningitis. The epidemio-logy of invasive meningococcal disease varies in different countries and regions. This review summarizes the available data from China describing the burden of meningococcal disease, N. meningitidis serogroups, and vaccination programs. Meningococcal serogroup A (MenA) was predominant for several decades in China. However, since 2000, invasive meningococcal disease caused by MenC, MenW, or MenB has increased. MenC, belonging to a hyperinvasive clonal sequence type ST-4821 (CC4821), emerged in Anhui Province and was subsequently disseminated over two-thirds of all Chinese provinces. Serogroup W (CC11) is endemic and causes death. Serogroup B (CC4821) originated from serogroup C (CC4821) via a capsular switching mechanism. Polysaccharide A and C meningococcal vaccines have been introduced into national routine immunization programs and have effectively reduced invasive meningococcal disease. However, the vaccination strategy must be revised based on the epidemic trends in meningococcal disease in China.

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          Most cited references35

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          Multilocus sequence typing of bacteria.

          Multilocus sequence typing (MLST) was proposed in 1998 as a portable, universal, and definitive method for characterizing bacteria, using the human pathogen Neisseria meningitidis as an example. In addition to providing a standardized approach to data collection, by examining the nucleotide sequences of multiple loci encoding housekeeping genes, or fragments of them, MLST data are made freely available over the Internet to ensure that a uniform nomenclature is readily available to all those interested in categorizing bacteria. At the time of writing, over thirty MLST schemes have been published and made available on the Internet, mostly for pathogenic bacteria, although there are schemes for pathogenic fungi and some nonpathogenic bacteria. MLST data have been employed in epidemiological investigations of various scales and in studies of the population biology, pathogenicity, and evolution of bacteria. The increasing speed and reduced cost of nucleotide sequence determination, together with improved web-based databases and analysis tools, present the prospect of increasingly wide application of MLST.
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            Global epidemiology of meningococcal disease.

            As reviewed in this paper, meningococcal disease epidemiology varies substantially by geographic area and time. The disease can occur as sporadic cases, outbreaks, and large epidemics. Surveillance is crucial for understanding meningococcal disease epidemiology, as well as the need for and impact of vaccination. Despite limited data from some regions of the world and constant change, current meningococcal disease epidemiology can be summarized by region. By far the highest incidence of meningococcal disease occurs in the meningitis belt of sub-Saharan Africa. During epidemics, the incidence can approach 1000 per 100,000, or 1% of the population. Serogroup A has been the most important serogroup in this region. However, serogroup C disease has also occurred, as has serogroup X disease and, most recently, serogroup W-135 disease. In the Americas, the reported incidence of disease, in the range of 0.3-4 cases per 100,000 population, is much lower than in the meningitis belt. In addition, in some countries such as the United States, the incidence is at an historical low. The bulk of the disease in the Americas is caused by serogroups C and B, although serogroup Y causes a substantial proportion of infections in some countries and W-135 is becoming increasingly problematic as well. The majority of meningococcal disease in European countries, which ranges in incidence from 0.2 to 14 cases per 100,000, is caused by serogroup B strains, particularly in countries that have introduced serogroup C meningococcal conjugate vaccines. Serogroup B also predominates in Australia and New Zealand, in Australia because of the control of serogroup C disease through vaccination and in New Zealand because of a serogroup B epidemic. Based on limited data, most disease in Asia is caused by serogroup A and C strains. Although this review summarizes the current status of meningococcal disease epidemiology, the dynamic nature of this disease requires ongoing surveillance both to provide data for vaccine formulation and vaccine policy and to monitor the impact of vaccines following introduction.
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              Description and Nomenclature of Neisseria meningitidis Capsule Locus

              Pathogenic Neisseria meningitidis isolates contain a polysaccharide capsule that is the main virulence determinant for this bacterium. Thirteen capsular polysaccharides have been described, and nuclear magnetic resonance spectroscopy has enabled determination of the structure of capsular polysaccharides responsible for serogroup specificity. Molecular mechanisms involved in N. meningitidis capsule biosynthesis have also been identified, and genes involved in this process and in cell surface translocation are clustered at a single chromosomal locus termed cps. The use of multiple names for some of the genes involved in capsule synthesis, combined with the need for rapid diagnosis of serogroups commonly associated with invasive meningococcal disease, prompted a requirement for a consistent approach to the nomenclature of capsule genes. In this report, a comprehensive description of all N. meningitidis serogroups is provided, along with a proposed nomenclature, which was presented at the 2012 XVIIIth International Pathogenic Neisseria Conference.
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                Author and article information

                Contributors
                Journal
                Infectious Diseases and Translational Medicine
                Infect. Dis. Transl. Med.
                Infect. Dis. Transl. Med.
                International Biological and Medical Journals Publishing House Co., Limited (Room E16, 3/f, Yongda Commercial Building, No.97, Bonham Stand (Sheung Wan), HongKong )
                2411-2917
                10 April 2016
                10 April 2016
                : 2
                : 1
                : 48-54
                Affiliations
                From the National Institute for Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, State Key Laboratory for Infectious Disease Prevention and Control, Beijing 102206, China; Collaborative Innovation Center for the Diagnosis and Treatment of Infectious Diseases, Hangzhou 310003, China
                From the National Institute for Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, State Key Laboratory for Infectious Disease Prevention and Control, Beijing 102206, China
                Author notes
                Correspondence to: Zhujun Shao, Email: shaozhujun@ 123456icdc.cn .
                Article
                10.11979/idtm.201601007
                4e860e1b-6e3c-4c37-a17a-9884e5f46a68

                This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 Unported License. To view a copy of this license, visit http://creativecommons.org/licenses/by/4.0/

                Page count
                Figures: 0, Tables: 0, References: 44, Pages: 7
                Product
                Categories
                Review

                Medicine,Infectious disease & Microbiology
                China,Meningococcal disease,Meningococcal vaccine
                Medicine, Infectious disease & Microbiology
                China, Meningococcal disease, Meningococcal vaccine

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