review of meningococcal laboratory surveillance brazil · ana paula lemos meningitis, pneumonia and...
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Meningococcal Surveillance Effectivess Workshop
11 -12 August, 2015
Ana Paula LemosMeningitis, Pneumonia and Pneumococcal Diseases
Adolfo Lutz Institute, São Paulo, Brazil
Review of Meningococcal Laboratory Surveillance
Brazil
0
20
40
60
80
100
Non Identified
Other etiology
Spn
Hi
Men
Bacterial meningitis by etiology, São Paulo, 2002-2013
%
Sentinel ProgramSentinel ProgramSource www.cve.saude.sp.gov.br/htm/cve_meni.htlm
50%
29%25%
Diagnostic criteria for meningococcal diseaseBrazil, 2014
Source COVER-SINAM/DEVEP/SVS/MSUpdated 12-02-2015
Collection Men strains IAL 398/317 = 80 % of cultures of Men reported
Culture
CIE
Latex
Clinic
Gram Stain
Clinic Epidemiologic
RT PCR
missing data
25,89 % (n=398)
2,08 % (n=32)
20,17 % (n=310)
4,24 % (n=65)
13,40 % (n=206)
2,47 % (n=38)
20,04 % (n=308)
11,71 % (n=180)
n=1,537 MD cases
Prevalence of serogroups by culture-confirmed of MD by year, Brazil, 2000-2014, all ages
año
Source : Adolfo Lutz Institute (IAL), São Paulo, BrazilVaccine MCC conjugate
by Lemos, AP
0%
20%
40%
60%
80%
100%
2000 2002 2004 2006 2008 2010 2012 2014
year
Y
W
C
B
Meningococcal C conjugate vaccination after 3 years of vaccine introduction into routine immunization in Brazil : A time series analysis
by Andrade, ALSS
12,999 8862,616
SINAN15,615
IAL3,502
Distribution of all meningococcal disease casesin SINAN and IAL databases. Brazil, 2008 to 2013
Presented at ESPID, Leipzig, May 12-16,2015
Distribution of MD cases in Brazil, by age group and notification year
After 2010, the decrease in MD cases is mostly due to the age groups of 3-11m 12 – 23 m (after 2010), and of 2-4 years (after 2011). In 2008, 39.3% of MD occurred in children less than five years of age. This proportion decreased to 24.9% in 2013
Presented at ESPID, Leipzig, May 12-16,2015 by Andrade, ALSS
2000-2013No. MD cases from MH n= 41,392No. MD culture-confirmed n= 12,516 (30%)No. meningococcal isolates n = 9,824 (72.7%)
No. N. meningitidis strains from laboratory based-surveillance by geographic region, 2000 – 2013 (No. 9,824)
by Gorla, MCO
North : 304 (3.2%)
Northeast: 1,990 (21.1%)
South : 1,190 (12.6% )
Central-West : 719 (7.6%)
Southeast : 6,104 (64.6%)
0
5
10
15
20
25
30
35
40
45
50
Penicilina (RI) Ceftriaxona (R ) Cloranfenicol (R ) Rifampicina (R ) Ciproloxacin (R )
2006
2007
2008
2009
2010
2011
2012
2013
% o
f st
rain
s
Antimicrobial Susceptibility of Neisseria meningitidis, Brazil, 2006-2013
PorA types among invasive MenB strains, Brazil 2010
0.0
10.0
20.0
30.0
40.0
50.0
60.0
70.0
porA typing among MenC, W and Y strains, Brazil 2012
0%
20%
40%
60%
80%
100% 5-2,10-1
5-11,10-13
5-1,2-2
22,9
21,4
19,15
18-1,30-2
18-1,3
5,2
22,14-6
5,2
18-1,3
22,9
Lemos, AP
22,14-6
C W Y
Unpublished data
0%
20%
40%
60%
80%
100%
2.43
2.25
2.22
2.21
2.16
1.679
1.13
1.679
Variation composition of fhbp among MenC, W and Y strains, Brazil 2012
Lemos, AP
2.252.43
1.13
2.25
2.21
2.16
C W Y Gorla, et al. Poster presented at: 32nd Annual Meeting of European Society for Paediatric Infectious Diseases (ESPID); May 6-10, 2014; Dublin, Ireland.
Variation composition of nadA among MenC, W and Y strains, Brazil 2012
0%
20%
40%
60%
80%
100%
3.8
3.7
2.6
1.1
no
Lemos, AP
2.6
3.7
3.8
1.1
3.8
C W Y
Unpublished data
Variation composition of NHBA among MenC, W and Y strains, Brazil 2012
0%
20%
40%
60%
80%
100% 620
53
29
24
20
9
7
6
3
Lemos, AP
24 29
20
6
C W Y
Gorla, et al. Poster presented at: 32nd Annual Meeting of European Society for Paediatric Infectious Diseases (ESPID); May 6-10, 2014; Dublin, Ireland.
Distribution of clonal complexes among MenC, W and Y strains, Brazil 2012
Lemos, AP
0%
20%
40%
60%
80%
100%
na
cc 32
cc 174
cc 22
cc 23
cc 11
cc 103
cc 103 cc 11
na
cc 174
cc 32
C W Y
1. Gorla, et al. Poster presented at: 32nd Annual Meeting of European Society for Paediatric Infectious Diseases (ESPID); May 6-10, 2014; Dublin, Ireland. 2. Unpublished data
Distribution of hipervirulent lineages causing outbreaks or epidemics in Brazil by period of time
A:4,21P1.10
subgroup I
C:2a:P1.2 ET37 Complex/
ST 11 Complex
A:4,21:P1.9
subgroup III
B:4,7:P1.19.15; ET 5 Complex/
ST-32 Complex
C:2b:P1.3 Cluster A4/
ST-8 Complex
C:23:P1.14-6
ST-103 Complex
1960s 1970s 1980s 1990s 2000s
Caugant, D. A. 1998. APMIS 106:505-525; Sacchi, C. T. et al. 1992 J. Clin. Microbiol. 30:1282-1286; Sacchi, C. T. et al. 1992 J. Clin Microbiol 30:1734-1738; Lemos, A. P. S. et al. 2006 J. Med. Microbiol. 55: 751-757; Lemos, A.P.S. et al. 2007 J. Clin Microbiol 45:1266-1273
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