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Stenmark, B., Hellmark, B. & Söderquist, B. (2019). Genomic analysis of Staphylococcus capitis isolated from blood cultures in neonates at a neonatal intensive care unit in Sweden. European Journal of Clinical Microbiology and Infectious Diseases, 38(11), 2069-2075
Open this publication in new window or tab >>Genomic analysis of Staphylococcus capitis isolated from blood cultures in neonates at a neonatal intensive care unit in Sweden
2019 (English)In: European Journal of Clinical Microbiology and Infectious Diseases, ISSN 0934-9723, E-ISSN 1435-4373, Vol. 38, no 11, p. 2069-2075Article in journal (Refereed) Published
Abstract [en]

Emergence of a genetically distinct, multidrug-resistant Staphylococcus capitis clone (NRCS-A) present in neonatal intensive care units has recently been extensively reported. The aims of the present study were to investigate which clones of S. capitis isolated from blood in a Swedish neonatal intensive care unit (NICU) have been present since 1987 and to investigate whether the NRCS-A clone has disseminated in Sweden. All S. capitis isolates from blood cultures of neonates (≤ 28 days of age) between 1987 and 2017 (n = 46) were whole-genome sequenced, and core genome multilocus sequence typing (cgMLST) was performed. Single-nucleotide polymorphism (SNP)-based phylogenetic relationships between the S. capitis isolates and in silico predictions of presence of genetic traits specific to the NRCS-A clone were identified. Furthermore, antibiotic susceptibility testing, including screening for heterogeneous glycopeptide-intermediate resistance, was performed. Thirty-five isolates clustered closely to the isolates previously determined as belonging to the NRCS-A clone and had fewer than 81 core genome loci differences out of 1063. Twenty-one of these isolates were multidrug resistant. The NRCS-A clone was found in 2001. Six pairs of isolates had differences of fewer than two SNPs. Genetic traits associated with the NRCS-A clone such as nsr, ebh, tarJ, and CRISPR were found in all 35 isolates. The increasing incidence of S. capitis blood cultures of neonates is predominantly represented by the NRSC-A clone at our NICU in Sweden. Furthermore, there were indications of transmission between cases; adherence to basic hygiene procedures and surveillance measures are thus warranted.

Place, publisher, year, edition, pages
Springer, 2019
Keywords
Coagulase negative staphylococci, NRCS-A clone, Neonatal intensive care unit, S. capitis, Whole-genome sequencing
National Category
Infectious Medicine
Identifiers
urn:nbn:se:oru:diva-75811 (URN)10.1007/s10096-019-03647-3 (DOI)000491944700010 ()31396832 (PubMedID)2-s2.0-85070296964 (Scopus ID)
Note

Funding Agencies:

Örebro County Research Council 

Örebro University 

Available from: 2019-08-23 Created: 2019-08-23 Last updated: 2019-11-15Bibliographically approved
Magnusson, C., Stegger, M., Hellmark, B., Stenmark, B. & Söderquist, B. (2019). Staphylococcus aureus isolates from nares of orthopaedic patients in Sweden are mupirocin susceptible [Letter to the editor]. Infectious Diseases, 51(6), 475-478
Open this publication in new window or tab >>Staphylococcus aureus isolates from nares of orthopaedic patients in Sweden are mupirocin susceptible
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2019 (English)In: Infectious Diseases, ISSN 2374-4235, E-ISSN 2374-4243, Vol. 51, no 6, p. 475-478Article in journal, Letter (Refereed) Published
Place, publisher, year, edition, pages
Taylor & Francis, 2019
National Category
Infectious Medicine
Identifiers
urn:nbn:se:oru:diva-73786 (URN)10.1080/23744235.2019.1593500 (DOI)000466685100001 ()30985251 (PubMedID)2-s2.0-85064501385 (Scopus ID)
Note

Funding Agency:

Nyckelfonden at Örebro University Hospital  OLL-248651

Available from: 2019-04-16 Created: 2019-04-16 Last updated: 2019-10-14Bibliographically approved
Acevedo, R., Bai, X., Borrow, R., Caugant, D. A., Carlos, J., Ceyhan, M., . . . Zhu, B. (2019). The Global Meningococcal Initiative meeting on prevention of meningococcal disease worldwide: Epidemiology, surveillance, hypervirulent strains, antibiotic resistance and high-risk populations. Expert Review of Vaccines, 18(1), 15-30
Open this publication in new window or tab >>The Global Meningococcal Initiative meeting on prevention of meningococcal disease worldwide: Epidemiology, surveillance, hypervirulent strains, antibiotic resistance and high-risk populations
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2019 (English)In: Expert Review of Vaccines, ISSN 1476-0584, E-ISSN 1744-8395, Vol. 18, no 1, p. 15-30Article, review/survey (Refereed) Published
Abstract [en]

Introduction: The 2018 Global Meningococcal Initiative (GMI) meeting focused on evolving invasive meningococcal disease (IMD) epidemiology, surveillance, and protection strategies worldwide, with emphasis on emerging antibiotic resistance and protection of high-risk populations. The GMI is comprised of a multidisciplinary group of scientists and clinicians representing institutions from several continents.

Areas covered: Given that the incidence and prevalence of IMD continually varies both geographically and temporally, and surveillance systems differ worldwide, the true burden of IMD remains unknown. Genomic alterations may increase the epidemic potential of meningococcal strains. Vaccination and (to a lesser extent) antimicrobial prophylaxis are the mainstays of IMD prevention. Experiences from across the globe advocate the use of conjugate vaccines, with promising evidence growing for protein vaccines. Multivalent vaccines can broaden protection against IMD. Application of protection strategies to high-risk groups, including individuals with asplenia, complement deficiencies and human immunodeficiency virus, laboratory workers, persons receiving eculizumab, and men who have sex with men, as well as attendees at mass gatherings, may prevent outbreaks. There was, however, evidence that reduced susceptibility to antibiotics was increasing worldwide.

Expert commentary: The current GMI global recommendations were reinforced, with several other global initiatives underway to support IMD protection and prevention.

Place, publisher, year, edition, pages
Taylor & Francis Group, 2019
Keywords
Antibiotic resistance, bacterial meningitis, conjugate vaccine, epidemiology, immunization program, meningococcal disease, Neisseria meningitidis, polysaccharide vaccine, serogroup, surveillance, vaccine
National Category
Immunology in the medical area
Identifiers
urn:nbn:se:oru:diva-71531 (URN)10.1080/14760584.2019.1557520 (DOI)000454834100002 ()30526162 (PubMedID)2-s2.0-85059541906 (Scopus ID)
Note

Funding Agency:

Sanofi Pasteur

Available from: 2019-01-17 Created: 2019-01-17 Last updated: 2019-03-26Bibliographically approved
Stenmark, B., Hellmark, B. & Söderquist, B. (2018). Increase of S. capitis in neonates with bacteremia in Sweden due to the emergence of a multidrug-resistant clone. In: : . Paper presented at 28th European Congress of Clinical Microbiology and Infectious Diseases, Madrid, Spain, 21-24 April, 2018.
Open this publication in new window or tab >>Increase of S. capitis in neonates with bacteremia in Sweden due to the emergence of a multidrug-resistant clone
2018 (English)Conference paper, Poster (with or without abstract) (Refereed)
Abstract [en]

Background: Staphylococcus capitis has traditionally been considered a commensal due to its low pathogenicity in healthy adults; however, it has been shown to cause 20% of all cases of neonatal sepsis in neonatal intensive care units (NICUs). In addition, S. capitis strains with reduced susceptibility to last line anti-staphylococcal agents such as vancomycin and linezolid are emerging in NICUs. The aim of this study was to characterize S. capitis isolated from blood in a Swedish NICU and to investigate if the multidrug-resistant clone NRCS-A has disseminated in Sweden.

Materials/methods: All S. capitis isolates from neonatal blood cultures collected at Örebro University Hospital during 1987 to the 1st of March 2017 (n=42), were included. Several more episodes of neonatal sepsis with growth of coagulase-negative staphylococci were registered during this time period but probably considered as contaminants and therefore not preserved. Antibiotic susceptibility testing was performed using standardized disc diffusion method on cefoxitin, fusidic acid, clindamycin, erythromycin, gentamicin, rifampicin, trimethroprim/sulfamethoxazole and norfloxacin. Isolates resistant to ≥3 antibiotics were defined as multidrug-resistant. The isolates were whole genome sequenced using the Nextera XT kit (Illumina) on a MiSeq (Illumina). Single nucleotide polymorphisms found with the online tool REALPHY 1.12 in the alignments of shared homologous sites with the reference (the S. capitis NRCS-A strain CR01) were used to create phylogenetic trees.

Results: Seventeen isolates out of the 42 isolates (40%) were multidrug-resistant (resistant to fusidic acid, cefoxitin and gentamicin) and 33 out of the 42 isolates (79%) clustered with the multi-resistant NRCS-A clone (Figure 1). The earliest isolate within the NRCS-A cluster was from 2001.

Conclusions: Although prevalent since 2001, the increase of S. capitis in neonates with bacteremia since 2010 in Örebro county is mainly due to the dissemination of the multidrug-resistant NRCS-A clone and therefore warrants increased surveillance of the epidemiology and etiology of neonatal sepsis to prevent the spread of this clone.

National Category
Infectious Medicine
Identifiers
urn:nbn:se:oru:diva-67258 (URN)
Conference
28th European Congress of Clinical Microbiology and Infectious Diseases, Madrid, Spain, 21-24 April, 2018
Available from: 2018-06-14 Created: 2018-06-14 Last updated: 2019-03-26Bibliographically approved
Stenmark, B., Eriksson, L., Anton, B., Fomenkov, A., Tooming-Klunderud, A., Thulin Hedberg, S., . . . Mölling, P. (2018). Methylome comparison of two meningococcal sub-lineages of serogroup Y cc23. In: : . Paper presented at 21st International Pathogenic Neisseria Conference (IPNC), Pacific Grove, CA, USA, September 23-28, 2018.
Open this publication in new window or tab >>Methylome comparison of two meningococcal sub-lineages of serogroup Y cc23
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2018 (English)Conference paper, Poster (with or without abstract) (Refereed)
Abstract [en]

Introduction: A significant increase in invasive meningococcal disease (IMD) due to serogroup Y Neisseria meningitidis (MenY) ST-23 clonal complex (cc23) emerged in the United States during the 1990s, spreading to Europe shortly thereafter. The largest increase was observed in Sweden with incidence proportions up to 53%. Genome analysis of all MenY isolates causing IMD between 1995 to 2012 in Sweden revealed that a distinct strain (YI) and more specifically a subtype (1) of this strain was found to be responsible for the increase of MenY IMD in Sweden [1]. In this study, we compared the methylomes of subtype 1 to the less successful subtype 2, using Single Molecule Real-Time (SMRT) sequencing technology.

Methods: Ten genomes belonging to subtype 1 (n=7) and 2 (n=3) and one MenY genome without connection to a specific lineage were sequenced using SMRT sequencing on a PacBio®RS II. The analysis platform SMRT Portal v2 was used to identify modified positions and for the genome-wide analysis of modified motifs. DNA methyltransferase genes associated with the different methyltransferase recognition motifs identified were searched using SEQWARE. The modification-dependent restriction endonucleases MspJI and FspEI were used to determine the m5C recognition sites of the active m5C methylases in the strains.

Results: The genome-wide analysis of the methylomes identified two m6A modified motifs: GATC and CACNNNNNTAC, but the latter was only found in isolates belonging to subtype 2 due to a transposase inserted in the candidate gene in subtype 1 strains: a Type I restriction system specificity protein (NEIS2535). The motif CACNNNNNTAC was only found in one other meningococcal isolate in REBASE, belonging to cc23, suggesting that this is a cc23 specific motif. Eleven putative restriction modification (RM) systems were found when comparing the sequences of all 11 genomes to DNA methyltransferase genes in REBASE. Five m5C genes were predicted, however, only three of these corresponding to the motifs: GCRYGC, GGNNCC and CCAGR were confirmed as active using MspJI and FspEI cleavage. The apparent CCAGR motif may be the result of two methylases, one recognizing CCWGG and the other CCAGA, but this will have to be verified.

Conclusion: These results are consistent with previous studies [2] that have shown that the composition of different RM systems are clade specific suggesting that the unique RM system of cc23 isolates will most likely result in a specific DNA methylation pattern unique to this particular cc. However, although the majority of methyltransferases were shared between the two subtypes, there was one difference in a m6A modified motif between these two highly similar cc23 subtypes, which may lead to an altered gene expression pattern.

National Category
Infectious Medicine
Identifiers
urn:nbn:se:oru:diva-69386 (URN)
Conference
21st International Pathogenic Neisseria Conference (IPNC), Pacific Grove, CA, USA, September 23-28, 2018
Available from: 2018-10-08 Created: 2018-10-08 Last updated: 2019-03-26Bibliographically approved
Jacobsson, S., Stenmark, B., Hedberg, S. T., Mölling, P. & Fredlund, H. (2018). Neisseria meningitidis carriage in Swedish teenagers associated with the serogroup W outbreak at the World Scout Jamboree, Japan 2015. Acta Pathologica, Microbiologica et Immunologica Scandinavica (APMIS), 126(4), 337-341
Open this publication in new window or tab >>Neisseria meningitidis carriage in Swedish teenagers associated with the serogroup W outbreak at the World Scout Jamboree, Japan 2015
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2018 (English)In: Acta Pathologica, Microbiologica et Immunologica Scandinavica (APMIS), ISSN 0903-4641, E-ISSN 1600-0463, Vol. 126, no 4, p. 337-341Article in journal (Refereed) Published
Abstract [en]

The aims of the study were to estimate the carrier state of Neisseria meningitidis in Swedish teenagers and its association with an outbreak at the World Scout Jamboree in 2015 as well as to compare sensitivity of throat versus nasopharyngeal swab for optimal detection of carriage. In total, 1 705 samples (cultures n = 32, throat swabs n = 715, nasopharyngeal swabs n = 958) from 1 020 Jamboree participants were collected and sent to the National Reference Laboratory for Neisseria meningitidis for culture and molecular analysis. The overall positivity for N. meningitidis was 8% (83/1 020), whereas 2% (n = 22) belonged to a known sero/genogroup while the majority (n = 61) were non-groupable. Throat sample is clearly the sampling method of choice, in 56 individuals where both throat and nasopharynx samples were taken, N. meningitidis was detected in both throat and nasopharynx in eight individuals, in 46 individuals N. meningitidis was only detected in the throat and in two individuals only in the nasopharynx. Carriage studies are important to provide knowledge of the current epidemiology and association between carrier isolates and disease-causing isolates in a given population. Therefore, planning for a carriage study in Sweden is in progress.

Place, publisher, year, edition, pages
Wiley-Blackwell Publishing Inc., 2018
Keywords
Neisseria meningitidis; serogroup W; World Scout Jamboree; carriage
National Category
Occupational Health and Environmental Health Immunology in the medical area Microbiology in the medical area
Identifiers
urn:nbn:se:oru:diva-65835 (URN)10.1111/apm.12819 (DOI)000428351400009 ()29543345 (PubMedID)2-s2.0-85044426003 (Scopus ID)
Note

Funding Agencies:

Örebro County Council Research Committee  

Foundation for Medical Research at Örebro University Hospital, Sweden  

Available from: 2018-03-16 Created: 2018-03-16 Last updated: 2019-03-26Bibliographically approved
Eriksson, L., Hedberg, S. T., Jacobsson, S., Fredlund, H., Mölling, P. & Stenmark, B. (2018). Whole-Genome Sequencing of Emerging Invasive Neisseria meningitidis Serogroup W in Sweden. Journal of Clinical Microbiology, 56(4), Article ID e01409-17.
Open this publication in new window or tab >>Whole-Genome Sequencing of Emerging Invasive Neisseria meningitidis Serogroup W in Sweden
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2018 (English)In: Journal of Clinical Microbiology, ISSN 0095-1137, E-ISSN 1098-660X, Vol. 56, no 4, article id e01409-17Article in journal (Refereed) Published
Abstract [en]

Invasive disease caused by Neisseria meningitidis serogroup W (MenW) has historically had a low incidence in Sweden, with an average incidence of 0.03 case/100,000 population from 1995 to 2014. In recent years, a significant increase in the incidence of MenW has been noted in Sweden, to an average incidence of 0.15 case/100,000 population in 2015 to 2016. In 2017 (1 January to 30 June), 33% of invasive meningococcal disease cases (7/21 cases) were caused by MenW. In the present study, all invasive MenW isolates from Sweden collected in 1995 to June 2017 (n = 86) were subjected to whole-genome sequencing to determine the population structure and to compare isolates from Sweden with historical and international cases. The increase of MenW in Sweden was determined to be due to isolates belonging to the South American sublineage of MenW clonal complex 11, namely, the novel U.K. 2013 lineage. This lineage was introduced in Sweden in 2013 and has since been the dominant lineage of MenW.

Place, publisher, year, edition, pages
American Society for Microbiology, 2018
Keywords
CC11, Neisseria meningitidis, invasive meningococcal disease, serogroup W, whole-genome sequencing
National Category
Infectious Medicine
Identifiers
urn:nbn:se:oru:diva-66477 (URN)10.1128/JCM.01409-17 (DOI)000429718700010 ()29321195 (PubMedID)2-s2.0-85044717735 (Scopus ID)
Note

Funding Agencies:

Örebro County Council Research Committee

Nyckelfonden

Wellcome Trust

European Union

Available from: 2018-04-13 Created: 2018-04-13 Last updated: 2019-03-26Bibliographically approved
Säll, O., Stenmark, B., Glimåker, M., Jacobsson, S., Mölling, P., Olcén, P. O. & Fredlund, H. (2017). Clinical presentation of invasive disease caused by Neisseria meningitidis serogroup Y in Sweden, 1995 to 2012. Epidemiology and Infection, 145(10), 2137-2143
Open this publication in new window or tab >>Clinical presentation of invasive disease caused by Neisseria meningitidis serogroup Y in Sweden, 1995 to 2012
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2017 (English)In: Epidemiology and Infection, ISSN 0950-2688, E-ISSN 1469-4409, Vol. 145, no 10, p. 2137-2143Article in journal (Refereed) Published
Abstract [en]

Over the period 1995-2012, the incidence of invasive meningococcal disease (IMD) caused by Neisseria meningitidis serogroup Y (NmY) increased significantly in Sweden. This is mainly due to the emergence of a predominant cluster named strain type YI subtype 1, belonging to the ST-23 clonal complex (cc). The aim of this study was to examine the clinical picture of patients with invasive disease caused by NmY and to analyse whether the predominant cluster exhibits certain clinical characteristics that might explain the increased incidence. In this retrospective observational study, the medical records available from patients with IMD caused by Nm serogroup Y in Sweden between 1995 and 2012 were systematically reviewed. Patient characteristics, in-hospital findings and outcome were studied and differences between the dominating cluster and other isolates were analysed. Medical records from 175 of 191 patients were retrieved. The median age was 62 years. The all-cause mortality within 30 days of admission was 9% (15/175) in the whole material; 4% (2/54) in the cohort with strain type YI subtype 1 and 11% (12/121) among patients with other isolates. Thirty-three per cent of the patients were diagnosed with meningitis, 19% with pneumonia, 10% with arthritis and 35% were found to have bacteraemia but no apparent organ manifestation. This survey included cases with an aggressive clinical course as well as cases with a relatively mild clinical presentation. There was a trend towards lower mortality and less-severe disease in the cohort with strain type YI subtype 1 compared with the group with other isolates.

Place, publisher, year, edition, pages
Cambridge University Press, 2017
Keywords
Invasive meningococcal disease, meningococcal disease, Neisseria meningitidis, Neisseria meningitidis serogroup Y, Sweden
National Category
Infectious Medicine Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:oru:diva-58934 (URN)10.1017/S0950268817000929 (DOI)000404243900018 ()28478773 (PubMedID)2-s2.0-85018441510 (Scopus ID)
Note

Funding Agency:

Region Örebro County Research Committee 

Available from: 2017-08-21 Created: 2017-08-21 Last updated: 2019-03-26Bibliographically approved
Stenmark, B., Eriksson, L., Rydbeck, H., Roberts, J., Tooming-Klunderud, A., Thulin Hedberg, S. & Mölling, P. (2017). Complete genome and methylome comparison of two Neisseria meningitidis serogroup Y subtypes. In: 2nd ASM Conference on Rapid Applied Microbial Next-Generation Sequencing and Bioinformatic Pipelines: Final Program with Abstracts. Paper presented at 2nd ASM Conference on Rapid Applied Microbial Next-Generation Sequencing and Bioinformatic Pipelines, Washington DC, USA, October 8-11, 2017 (pp. 32-33). Washington, DC: American Society for Microbiology
Open this publication in new window or tab >>Complete genome and methylome comparison of two Neisseria meningitidis serogroup Y subtypes
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2017 (English)In: 2nd ASM Conference on Rapid Applied Microbial Next-Generation Sequencing and Bioinformatic Pipelines: Final Program with Abstracts, Washington, DC: American Society for Microbiology , 2017, p. 32-33Conference paper, Poster (with or without abstract) (Other academic)
Abstract [en]

Background: A significant increase in invasive meningococcal disease (IMD) due to serogroup Y Neisseria meningitidis (MenY) strains emerged in the United States during the 1990s spreading to Europe shortly thereafter. The largest increase was observed in Sweden with incidence proportions up to 53%. cgMLST of all MenY isolates causing IMD between 1995 to 2012 in Sweden revealed that a distinct strain (YI) and more specifically a subtype (1) of this strain was found to be responsible for the increase of MenY IMD in Sweden [1]. The aim was to compare the complete genome and methylome of subtype 1 to the less successful subtype 2 using Single Molecule Real-Time (SMRT) sequencing technology.

Methods: Ten genomes belonging to subtype 1 (n=7) and 2 (n=3) and one MenY genome without connection to a specific strain were sequenced using SMRT sequencing on a PacBio®RS II. SMRT Portal v2 was used to identify modified positions and for the genome-wide analysis of modified motifs. DNA methyltransferase genes associated with the different methyltransferase recognition motifs identified were searched using the Restriction Enzyme Database REBASE (rebase.neb.com).

Results: Genomic comparison of the two MenY subtypes revealed that these possessed highly similar genomes, only two genes encoding hypothetical proteins were present in subtype 2 but absent in subtype 1. There were 99 genes with allelic differences and non-synonymous differences were found in genes implicated in adhesion, lipooligosaccharides (LOS) production, pilin production and iron acquisition. The genome-wide analysis of the methylome identified three modified motifs: GATC, GGNNCC and CACNNNNNTAC, the latter was only found in isolates belonging to subtype 2 and a trans-posase was found inserted in the candidate enzyme: a type I restriction system specificity protein (NEIS2535). In general, modifications were found in both cytosine and adenine bases although the latter, 6mA, was the most frequent modification in all isolates and more predominant among subtype 2. Many inactive restriction modification systems were present; however, in order to reveal more active sys-tems, further analysis on 5mC is needed.

Conclusion: Our preliminary results indicate that there is a difference in methylation motifs as well as positional distribution of modifications between the two MenY subtypes. Since no differences were found in the presence of genes potentially involved in pathogenicity between the two subtypes, and it has been previously established that there was rather a tendency of a milder clinical picture among IMD caused by subtype 1 [2], the emergence of subtype 1 was most probably due to increased transmission or that the human population was more immunologically naïve to this subtype.

References: 1. Törös B et al. J Clin Microbiol 2015, 53(7):2154-2162. 2. Säll O et al.Epidemiol Infect 2017, 145(10):2137-2143.

Place, publisher, year, edition, pages
Washington, DC: American Society for Microbiology, 2017
National Category
Infectious Medicine
Identifiers
urn:nbn:se:oru:diva-63312 (URN)
Conference
2nd ASM Conference on Rapid Applied Microbial Next-Generation Sequencing and Bioinformatic Pipelines, Washington DC, USA, October 8-11, 2017
Available from: 2017-12-12 Created: 2017-12-12 Last updated: 2019-03-26Bibliographically approved
Thulin Hedberg, S., Mölling, P., Stenmark, B., Unemo, M., Sundqvist, M., Lepp, T., . . . Jacobsson, S. (2017). Invasive meningococcal disease in Sweden 2016. In: 14th Congress of the EMGM, European Meningococcal and Haemophilus Disease Society: Book of Abstracts. Paper presented at 14th Congress of the EMGM, European Meningococcal and Haemophilus Disease Society (EMGM 2017), Prague, Czech Republic, September 18-21, 2017 (pp. 69-69). Prague: The European Meningococcal and Haemophilus Disease Society EMGM
Open this publication in new window or tab >>Invasive meningococcal disease in Sweden 2016
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2017 (English)In: 14th Congress of the EMGM, European Meningococcal and Haemophilus Disease Society: Book of Abstracts, Prague: The European Meningococcal and Haemophilus Disease Society EMGM , 2017, p. 69-69Conference paper, Poster (with or without abstract) (Other academic)
Abstract [en]

Invasive meningococcal disease (IMD) is notifiable in Sweden. The reporting system comprises of mandatory notification of cases and mandatory laboratory notification of samples to the Public Health Agency of Sweden, Stockholm. All samples are sent to the National Reference Laboratory for Pathogenic Neisseria, Örebro for further typing and surveillance.

In 2016, 62 cases of IMD (incidence 0.6/100 000 population) were reported in Sweden. Among the patients 58 % were females and 42 % males, aged from 1 month to95 years with mean age of 42 years. The incidence was highest, as in previous years, in the age group 15-19 years (2.1/100 000 population) followed by elderly ≥80 years (1.8/100 000 population) and infants ≤1 year (1.7/100 000 population). The case fatality rate increased in 2016 to 12.9 % compared with 7.5 % in 2015, eight people died from the disease (MenW, n=3; MenY, n=2; MenB, n=2 and MenC n=1). None of the IMD cases in 2016 had any epidemiological linkage.

All 62 cases of IMD were laboratory confirmed: 54 were culture-confirmed, three PCR-confirmed and in five cases further typing data are missing because no samples were sent to the National Reference Laboratory for Pathogenic Neisseria. The serogroup distribution was MenW (n=18, 31.5 %), MenY (n=18, 31.5 %), MenB (n=10, 17.5 %), MenC (n=10, 17.5 %) and one non-groupable isolate. The W:P1.5,2:F1-1:ST11 (cc11) (n=15) were predominant among the culture-confirmed meningococci during 2016 followed by Y:P1.5-2,10-1:F4-1:ST23 (cc23) (n=7) och Y:P1.5-1,2-2:F5-8:ST23 (cc23) (n=6). Antibiotic susceptibility testing was performed with Gradient test (Etest, BioMerieux). Decreased susceptibility to penicillin was seen in 30 % of the isolates (MIC >0,064 mg/L) of which one was resistant (MIC=0.5 mg/L). One of the isolates with decreased susceptibility to penicillin was also resistant to ciprofloxacin (MIC=0.125 mg/L). All other isolates were susceptible to cefotaxime, chloramphenicol, ciprofloxacin, rifampicin and meropenem. No β-lactamase producing isolates has so far been found in Sweden.

To conclude, the incidence of IMD continues to be relatively low in Sweden, however, a shift in the serogroup distribution of N. meningitidisin Sweden is ongoing; the previously dominating disease-causing MenB and MenC have been replaced, first by MenY which emerged in 2009 and since 2015 also by MenW. MenW has gone from only causing invasive disease in a few, 0-6 cases per year from 1990 onwards, to now being the dominating serogroup together with MenY in Sweden 2016.

Place, publisher, year, edition, pages
Prague: The European Meningococcal and Haemophilus Disease Society EMGM, 2017
National Category
Infectious Medicine
Identifiers
urn:nbn:se:oru:diva-63320 (URN)978-80-906662-3-8 (ISBN)
Conference
14th Congress of the EMGM, European Meningococcal and Haemophilus Disease Society (EMGM 2017), Prague, Czech Republic, September 18-21, 2017
Available from: 2017-12-12 Created: 2017-12-12 Last updated: 2019-03-26Bibliographically approved
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