Impact of COVID-19 Containment Strategies and Meningococcal Conjugate ACWY Vaccination on Meningococcal Carriage in Adolescents

Mark McMillan, Jana Bednarz, Lex E X Leong, Andrew Lawrence, Helen S Marshall, Mark McMillan, Jana Bednarz, Lex E X Leong, Andrew Lawrence, Helen S Marshall

Abstract

Objectives: To examine if COVID-19 containment strategies were associated with reduced pharyngeal carriage of meningococci in adolescents. Also, to observe if carriage prevalence of meningococcal A, C, W and Y differed in meningococcal conjugate ACWY vaccinated and unvaccinated adolescents.

Design: Repeat cross-sectional study of pharyngeal carriage.

Setting: In 2020, recruitment commenced from February to March (pre-COVID-19) and recommenced from August to September (during COVID-19 measures) in South Australia.

Participants: Eligible participants were between 17 and 25 years of age and completed secondary school in South Australia in 2019.

Results: A total of 1338 school leavers were enrolled in 2020, with a mean age of 18.6 years (standard deviation 0.6). Pharyngeal carriage of disease-associated meningococci was higher during the COVID-19 period compared with the pre-COVID-19 period (41/600 [6.83%] vs. 27/738 [3.66%]; adjusted odds ratio [aOR], 2.03; 95% CI: 1.22-3.39; P = 0.01). Nongroupable carriage decreased during COVID period (1.67% vs. 3.79%; aOR, 0.45; 95% CI: 0.22-0.95). Pharyngeal carriage of groups A, C, W and Y was similar among school leavers vaccinated with meningococcal conjugate ACWY (7/257 [2.72%]) compared with those unvaccinated (29/1081 [2.68%]; aOR, 0.86; 95% CI: 0.37-2.02; P = 0.73). Clonal complex 41/44 predominated in both periods.

Conclusions: Meningococcal carriage prevalence was not impacted by public health strategies to reduce severe acute respiratory syndrome coronavirus 2 transmission and is unlikely to be the mechanism for lower meningococcal disease incidence. As international travel resumes and influenza recirculates, clinicians must remain vigilant for signs and symptoms of meningococcal disease. Vaccinating people at the highest risk of invasive meningococcal disease remains crucial despite containment strategies.

Trial registration: ClinicalTrials.gov NCT03419533.

Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.

Figures

Figure 1.
Figure 1.
Timeline of COVID-19 restrictions in South Australia from January 25, to August 3, 2020.
Figure 2.
Figure 2.
GrapeTree analysis using cgMLST v1.0 on the PubMLST.org/neisserria website of 64 meningococci isolated from the 106 meningococcal positive participants by (A) genogroup; (B) cc. Open circles indicate isolates with no value (ie, unassigned to a cc).

References

    1. Hatoun J, Correa ET, Donahue SMA, et al. . Social distancing for COVID-19 and diagnoses of other infectious diseases in children. Pediatrics. 2020;146:e2020006460.
    1. McMillan M, Koehler AP, Lawrence A, et al. . B part of it school leaver study: a repeat cross-sectional study to assess the impact of increasing coverage with meningococcal B (4CMenB) vaccine on carriage of Neisseria meningitidis. J Infect Dis. 2022;225:637–649.
    1. MacLennan JM, Rodrigues CMC, Bratcher HB, et al. . Meningococcal carriage in periods of high and low invasive meningococcal disease incidence in the UK: comparison of UKMenCar1-4 cross-sectional survey results. Lancet Infect Dis. 2021;21:677–687.
    1. McMillan M, Walters L, Sullivan T, et al. . Impact of meningococcal B (4CMenB) vaccine on pharyngeal Neisseria meningitidis carriage density and persistence in adolescents. Clin Infect Dis. 2021;73:e99–e106.
    1. Sharma K, Chiu C, Wood N. Meningococcal vaccines in Australia: a 2019 update. Aust Prescr. 2019;42:131–135.
    1. Maiden MC, Stuart JM; UK Meningococcal Carraige Group. Carriage of serogroup C meningococci 1 year after meningococcal C conjugate polysaccharide vaccination. Lancet. 2002;359:1829–1831.
    1. Daugla DM, Gami JP, Gamougam K, et al. . Effect of a serogroup A meningococcal conjugate vaccine (PsA-TT) on serogroup A meningococcal meningitis and carriage in Chad: a community study [corrected]. Lancet. 2014;383:40–47.
    1. McMillan M, Chandrakumar A, Wang HLR, et al. . Effectiveness of meningococcal vaccines at reducing invasive meningococcal disease and pharyngeal Neisseria meningitidis carriage: a systematic review and meta-analysis. Clin Infect Dis. 2021;73:e609–e619.
    1. National Notifiable Diseases Surveillance System. 2021. Available at: . Accessed March 19, 2021.
    1. Lahra MM, Enriquez R. Australian gonococcal surveillance programme annual report, 2016. Commun Dis Intell (2018). 2018;42:S2209–6051(18)00013.
    1. Brueggemann AB, Jansen van Rensburg MJ, Shaw D, et al. . Changes in the incidence of invasive disease due to Streptococcus pneumoniae, Haemophilus influenzae, and Neisseria meningitidis during the COVID-19 pandemic in 26 countries and territories in the invasive respiratory infection surveillance initiative: a prospective analysis of surveillance data. Lancet Digit Health. 2021;3:e360–e370.
    1. Jacobs JH, Viboud C, Tchetgen ET, et al. . The association of meningococcal disease with influenza in the United States, 1989-2009. PLoS One. 2014;9:e107486.
    1. George CR, Booy R, Nissen MD, et al. . The decline of invasive meningococcal disease and influenza in the time of COVID-19: the silver linings of the pandemic playbook. Med J Aust. 2022;216:504–507.
    1. Paireau J, Chen A, Broutin H, et al. . Seasonal dynamics of bacterial meningitis: a time-series analysis. Lancet Glob Health. 2016;4:e370–e377.
    1. Salomon A, Berry I, Tuite AR, et al. . Influenza increases invasive meningococcal disease risk in temperate countries. Clin Microbiol Infect. 2020;26:1257.e1–1257.e7.
    1. Cartwright KA, Jones DM, Smith AJ, et al. . Influenza A and meningococcal disease. Lancet. 1991;338:554–557.
    1. Marshall HS, McMillan M, Koehler AP, et al. . Meningococcal B vaccine and meningococcal carriage in adolescents in Australia. N Engl J Med. 2020;382:318–327.
    1. Jordens JZ, Heckels JE. A novel porA-based real-time PCR for detection of meningococcal carriage. J Med Microbiol. 2005;54(Pt 5):463–466.
    1. McMillan M, Walters L, Mark T, et al. . B Part of It study: a longitudinal study to assess carriage of Neisseria meningitidis in first year university students in South Australia. Hum Vaccin Immunother. 2019;15:987–994.
    1. Jolley KA, Maiden MC. BIGSdb: Scalable analysis of bacterial genome variation at the population level. BMC Bioinformatics. 2010;11:595.
    1. Storen R, Corrigan N. COVID-19: a chronology of state and territory government announcements (up until 30 June 2020) 2020. Available at: . Accessed March 9, 2021.
    1. Miller M, Callinan S, Livinston M. A Timeline of Alcohol-Relevant Restrictions During the COVID-19 Pandemic. Centre for Alcohol Policy Research; 2020.
    1. Sullivan SG, Carlson S, Cheng AC, et al. . Where has all the influenza gone? The impact of COVID-19 on the circulation of influenza and other respiratory viruses, Australia, March to September 2020. Euro Surveill. 2020;25:2001847.
    1. Caugant DA. Genetics and evolution of Neisseria meningitidis: importance for the epidemiology of meningococcal disease. Infect Genet Evol. 2008;8:558–565.
    1. Yazdankhah SP, Caugant DA. Neisseria meningitidis: an overview of the carriage state. J Med Microbiol. 2004;53(Pt 9):821–832.
    1. Lahra MM, Enriquez R. Australian meningococcal surveillance programme annual report, 2016. Commun Dis Intell Q Rep. 2017;41:E369–E382.
    1. Pollard AJ, Frasch C. Development of natural immunity to Neisseria meningitidis. Vaccine. 2001;19:1327–1346.
    1. Maiden MC, Ibarz-Pavón AB, Urwin R, et al. . Impact of meningococcal serogroup C conjugate vaccines on carriage and herd immunity. J Infect Dis. 2008;197:737–743.

Source: PubMed

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