Epidemiology of invasive meningococcal disease in Greece, 2006–2016
The present study describes the epidemiology of invasive meningococcal disease (IMD) in Greece for the period 2006–2016. Combined data from notified and laboratory-confirmed IMD cases were obtained from the two involved National Centres (Epidemiology and Reference Laboratory). Laboratory identification and typing was carried out by both conventional (culture) and molecular methods (PCR, MLST, PorA, and FetA typing). A total of 796 IMD cases were notified; of those, 720 (91%) were laboratory confirmed. Overall, a decline on the annual incidence of confirmed cases was observed, ranging from 0.91 (2006) to 0.47 (2016) /100,000. A similar trend was observed in most age groups especially in children 0–4 years (7.7 to 2.9/100,000), with the exception of an increase in the incidence rate in adults > 20 years (0.21 to 0.32/100,000). The overall case fatality rate was 6.5% (52/796), annual range 2–13%. Among 658 strains which were typed by sero/genogroup, 80% were identified as MenB (annual range 65–92%); however, a decline was observed in MenB incidence from 5.3 (2006) to 2.7 (2016), among infants and toddlers, while MenW (1%), MenY (2%), and MenA (1%) remained low. During the 11 years, the annual incidence of IMD declined by 50%, especially in the 0–4-year age group, due mainly to MenB. Continuous surveillance of IMD is important for the development of future vaccination and public health policies.
KeywordsInvasive meningococcal disease (IMD) Epidemiology Clonal complex porA fetA Antimicrobial susceptibility
The authors would like to thank Prof Aftab Jasir for critical reviewing and colleagues from hospitals all over Greece for sending samples.
Partial data have been presented previously at the ESCAIDE 2018-European Scientific Conference on Applied Infectious Disease Epidemiology (Malta, 21–23 Nov 2018).
Anastasia Flountzi (AF) analysis and interpretation of data, drafting of manuscript. Theano Georgakopoulou (TG) acquisition of data, analysis and interpretation of data, critical revision. Sooria Balasegaram (SB) analysis and interpretation of data, drafting of manuscript. Konstantinos Kesanopoulos (KK) acquisition of data. Athanasia Xirogianni (AX) acquisition of data. Anastasia Papandreou (AP) acquisition of data. Georgina Tzanakaki (GT) study conception and design, acquisition of data, critical revision.
Compliance with ethical standards
Ethic approval was not required since depersonalized data from notifiable disease registry and laboratory findings were used.
Conflict of interest
The authors declare that they have no conflict of interest.
- 1.Guiddir T, Gros M, Hong E, Terrade A, Denizon M, Deghmane AE, Taha MK (2018) Unusual initial abdominal presentations of invasive meningococcal disease. Clin Infect Dis. https://doi.org/10.1093/cid/ciy257.
- 5.Knuf M, Romain O, Kindler K et al (2013) Immunogenicity and safety of the quadrivalent meningococcal serogroups a, C, W-135 and Y tetanus toxoid conjugate vaccine (MenACWY-TT) in 2-10-year-old children: results of an open, randomised, controlled study. Eur J Pediatr 172(5):601–612CrossRefGoogle Scholar
- 6.Parikh SR, Newbold L, Slater S, Stella M, Moschioni M et al (2017) Meningococcal serogroup B strain coverage of the multicomponent 4CMenB vaccine with corresponding regional distribution and clinical characteristics in England, Wales, and Northern Ireland, 2007-08 and 2014-15: a qualitative and quantitative assessment. Lancet Infect Dis 17(7):754–762CrossRefGoogle Scholar
- 8.Kafetzis DA, Stamboulidis KN, Tzanakaki G, Kourea Kremastinou J, Skevaki CL, Konstantopoulos A, Tsolia M (2007) Meningococcal group C disease in Greece during 1993-2006: the impact of an unofficial single-dose vaccination scheme adopted by most paediatricians. Clin Microbiol Infect 13(5):550–552CrossRefGoogle Scholar
- 9.Georgakopoulou T, Menegas D, Katsioulis A, Theodoridou M, Kremastinou J, Hadjichristodoulou C (2017) A cross-sectional vaccination coverage study in preschool children attending nurseries-kindergartens: implications on economic crisis effect. Hum Vaccin Immunother 13(1):190–197CrossRefGoogle Scholar
- 10.Tzanakaki G, Markou F, Kesanopoulos K, Levidiotou S, Pangalis A, Tsolia M et al (2006) Phenotypic assessment of Neisseria meningitidis isolates obtained from patients with invasive meningococcal disease in Greece, 1993-2003: implications for serogroup B vaccines based on PorA serosubtype antigens. Vaccine 24(6):819–825CrossRefGoogle Scholar
- 11.Tzanakaki G, Tsopanomichalou M, Kesanopoulos K, Matzourani R, Sioumala M, Tabaki A, Kremastinou J (2005) Simultaneous single-tube PCR assay for the detection of Neisseria meningitidis, Haemophilus influenzae type b and Streptococcus pneumoniae. Clin Microbiol Infect 11(5):386–390CrossRefGoogle Scholar
- 16.European Centre for Disease Prevention and Control. Surveillance Atlas for Infectious Diseases. https://atlas.ecdc.europa.eu/public/index.aspx
- 19.Knol MJ, Hahné SJM, Lucidarme J, Campbell H, de Melker HE, Gray SJ, Borrow R et al (2017t) Temporal associations between national outbreaks of meningococcal serogroup W and C disease in the Netherlands and England: an observational cohort study. Lancet Public Health 2(10):e473–e482CrossRefGoogle Scholar
- 21.Krone M, Gray S, Abad R, Skoczyńska A, Stefanelli P, van der Ende A, Tzanakaki G et al (2019) Increase of invasive meningococcal serogroup W disease in Europe, 2013 to 2017. Euro Surveill 24(14):1800245. https://doi.org/10.2807/1560-7917.ES.2019.24.14.1800245 CrossRefGoogle Scholar
- 22.Bröker M, Emonet S, Fazio C, Jacobsson S, Koliou M, Kuusi M et al (2015) Meningococcal serogroup Y disease in Europe: continuation of high importance in some European regions in 2013. Hum Vaccin Immunother 11(9):2281–2286. https://doi.org/10.1080/21645515.2015.1051276.
- 24.Abad R, Medina V, Stella M, Boccadifuoco G, Comanducci M, Bambini S, Muzzi A, Vázquez JA (2016) Predicted strain coverage of a new meningococcal multicomponent vaccine (4CMenB) in Spain: analysis of the differences with other European countries. PLoS One 11(3):e0150721Google Scholar
- 25.Tzanakaki G, Hong E, Kesanopoulos K, Xirogianni A, Bambini S, Orlandi L, Comanducci M, Muzzi A, Taha MK (2014) Diversity of Greek meningococcal serogroup B isolates and estimated coverage of the 4CMenB meningococcal vaccine. BMC Microbiol 14:111. https://doi.org/10.1186/1471-2180-14-111 CrossRefGoogle Scholar
- 29.Parent du Chatelet I, Deghmane AE, Antona D, Hong E, Fonteneau L, Taha MK, Lévy-Bruhl D (2017 Jun) Characteristics and changes in invasive meningococcal disease epidemiology in France, 2006-2015. J Inf Secur 74(6):564–574. https://doi.org/10.1016/j.jinf.2017.02.011