Shalom Ben-Shimol, Noga Givon-Lavi, David Greenberg, Michal Stein, Orli Megged, Avihu Bar-Yochai, Shahar Negari, Ron Dagan and on behalf of the Israel Bacteremia and Meningitis Active Surveillance Group

Background Empiric treatment of pneumococcal meningitis includes ceftriaxone with vancomycin to overcome ceftriaxone resistant disease. The addition of vancomycin bears a risk of adverse events, including increased antibiotic resistance. We assessed antibiotic resistance rates in pneumococcal meningitis before and after pneumococcal conjugate vaccine (PCV) implementation. Methods All pneumococcal meningitis episodes in children aged 5 years and younger, from 2004 to 2016, were extracted from the nationwide bacteremia and meningitis surveillance database. For comparison purposes, we defined pre-PCV period as 2004–2008 and PCV13 period as 2014–2016. Minimal inhibitory concentration (MIC) > 0.06 and > 0.5 μg/mL were defined as penicillin and ceftriaxone resistance, respectively. Results Overall, 325 episodes were identified. Pneumococcal meningitis incidence rates declined non-significantly by 17%, comparing PCV13 and pre-PCV periods. Throughout the study, 90% of isolates were tested for antibiotic susceptibility, with 26.6%, 2.1% and 0% of isolates resistant to penicillin, ceftriaxone and vancomycin, respectively. Mean proportions (± SD) of meningitis caused by penicillin-resistant pneumococci were 40.5% ± 8.0% and 9.6% ± 7.4% in the pre-PCV and the PCV13 periods, respectively, resulting in an overall 83.9% reduction (odd ratio:0.161; 95% confidence interval: 0.059–0.441) in penicillin resistance rates. The proportions of meningitis caused by ceftriaxone resistant pneumococci were 5.0% ± 0.8% in the pre-PCV period, but no ceftriaxone resistant isolates were identified since 2010. Conclusions PCV7/PCV13 sequential introduction resulted in > 80% reduction of penicillin- resistant pneumococcal meningitis and complete disappearance of ceftriaxone resistant disease. These trends should be considered by the treating physician when choosing an empiric treatment for pneumococcal meningitis.…

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Other Human Disease -- United StatesAbstract--------"Rat lungworm (_Angiostrongylus cantonensis_), a parasitic nematode that can cause eosinophilic meningitis in humans, was 1st detected in New Orleans, Louisiana, USA, in the mid-1980s and now appears to be widespread in the southeastern United States. We assessed the distribution, prevalence, and intensity of _A. cantonensis_ infection in New Orleans by examining lung biopsy samples of rodents trapped at 96 sites in 9 areas in Orleans Parish and 1 area in neighboring St…

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Meningitis -- ChinaAbstract--------Angiostrongyliasis is a foodborne parasitic disease caused by the nematode _Angiostrongylus cantonensis_ that can lead to eosinophilic meningitis (EM) or meningoencephalitis in humans._A. cantonensis_ is prevalent in the Pacific Islands. In recent years, a large number of outbreaks and severe cases have occurred. Several species of mollusk, such as snails and slugs, act as intermediate and paratenic hosts of _A. cantonensis_.In this study, 2 cases of EM were found…

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West Nile Virus -- GreeceGreek health officials have reported 21 additional confirmed human West Nile virus (WNV) cases during the past week, bringing the country total to 43 in 2018. Of the total, 35 presented with neuro-invasive disease (WNND, encephalitis and/or meningitis and/or acute flaccid paralysis) and 8 cases with mild symptoms (febrile syndrome). No deaths have been reported.In Europe, since the beginning of the 2018 transmission season, as of 2 Aug 2018, 111 human cases have been reported in the…

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West Nile Virus -- RomaniaIn a follow-up on the West Nile virus (WNV) situation in Romania, the National Center for Communicable Disease Surveillance and Control reported (computer translated) since the start of surveillance on [2 May 2018], 23 meningitis/meningo-encephalitis have been reported due to West Nile virus infection and a death in the case of a 79-year-old patient who had comorbidities.Officials say the cases in Romania are sporadic and there is currently no risk of an epidemic.In addition to Romania…

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Tuberculosis, Antimicrobial resistance, Hepatitis B, Hepatitis E, Mycobacteria, non-TB, HIV/AIDS, Schistosomiasis, Meningitis, Diphtheria, MERS, Sexually Transmitted Infection, Other Human Disease, Diarrhea, Scrub Typhus, Tularemia -- EthiopiaEditorialThe preventable tragedy of diphtheria in the 21st centuryInt J Infect Dis. 2018 (June); 71: 122-123.LH Blumberg, MA Prieto, JV Diaz, MJ Blanco, B Valle, C Pla, et alPerspectiveHealthcare worker exposure to Middle East respiratory syndrome coronavirus (MERS-CoV): Revision of screening strategies urgently neededInt J Infect Dis. 2018 (June); 71: 113-116.Hala Amer, Abdulrahman S Alqahtani, Faisal Alaklobi, Juhaina Altayeb, Ziad A Memish.Original…

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Other Human Disease -- United Kingdom- Tests for enterovirus infection are typically only undertaken on individuals admitted to hospital with conditions such as chest infections and meningitis. Although enterovirus infection is not notifiable, PHE receives reports of confirmed enterovirus infection from NHS laboratories, and offers specialist typing for very serious cases - including children with AFP.- A total of 12 cases of AFP have been associated with an enterovirus. EV-D68 has been detected in 8, EV-C104 in 1, and…

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Meningitis - Neisseria -- IrelandA rare form of deadly meningitis is on the rise in Ireland following a pattern seen in other countries, disease specialists have revealed.The number of cases of the [_Neisseria meningitidis_ serogroup] W strain has increased from one in the year 2014 to 12 last year [2018]. There has also been an increase in [meningococcal] meningitis [serogroup] Y over the same period, up from 3 to 8 (See: ).Neither strain is currently included in the vaccines to protect against meningitis [that] are…

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Meningitis - Neisseria -- KazakhstanEpidemiological situation on meningococcal infection:Since the beginning of 2018, 59 cases of meningococcal infection have been registered in the Republic of Kazakhstan, including 21 cases among children under 14 years of age. 13 of them have died: Almaty -- 6 cases; in Almaty region -- 4 cases; in South Kazakhstan -- 2 cases; and in Kyzylorda region -- 1 case.The situation is under the control of the Ministry of Health.--communicated by:Irene Lai, MDInternational SOSGlobal…

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Meningitis - Neisseria -- NigeriaAs the dry season begins, we expect an increase in the number of cerebrospinal meningitis (CSM) cases in Nigeria. This is the 1st SitRep [situation report] for the 2018/2019 seasons.The National Technical Working Group for Cerebrospinal Meningitis has been improving [the] level of preparedness ahead of the 2018/2019 meningitis season. States in the meningitis belt were formally placed on alert on [8 Nov 2018].As at epi-week 50, 8 new suspected cases were reported from Katsina…

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Meningitis - Neisseria -- United States"The purpose of declaring an outbreak is to determine when appropriate public health interventions should be considered. In contrast to previous guidance in which a threshold of 3 cases of the same serogroup with an attack rate of more than 10 cases per 100 000 population during a 3- month period was used to define both organization- and community-based outbreaks, the current guidance does not recommend the use of an absolute threshold. However, the following thresholds can be considered as…

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West Nile Virus -- RomaniaFive citizens in Romania have been diagnosed with meningitis caused by the West Nile virus.The Romanian Ministry of Health recommends to local authorities to take pest control measures as soon as possible to prevent the spreading of the virus, stiri.tvr.ro reported, adding that 80 percent of the people that were infected or get infected have no symptoms.The only signs and tangible proof that something might be seriously wrong are high fever and headaches. In this case, specialists…

Helen Findlow, Helen Campbell, Jay Lucidarme, Nick Andrews, Ezra Linley, Shamez Ladhani and Ray Borrow

Background In 1999, the United Kingdom (UK) was the first country to introduce meningococcal group C (MenC) conjugate vaccination. This vaccination programme has evolved with further understanding, new vaccines and changing disease epidemiology. Aim To characterise MenC disease and population protection against MenC disease in England. Methods Between 1998/99–2015/16, surveillance data from England for laboratory-confirmed MenC cases were collated; using the screening method, we updated vaccine effectiveness (VE) estimates. Typing data and genomes were obtained from the Meningitis Research Foundation Meningococcus Genome Library and PubMLST Neisseria database. Phylogenetic network analysis of MenC cc11 isolates was undertaken. We compared bactericidal antibody assay results using anonymised sera from 2014 to similar data from 1996–1999, 2000–2004 and 2009. Results MenC cases fell from 883 in 1998/99 (1.81/100,000 population) to 42 cases (0.08/100,000 population) in 2015/16. Lower VE over time since vaccination was observed after infant immunisation (p = 0.009) and a single dose at 1–4 years (p = 0.03). After vaccination at 5–18 years, high VE was sustained for ≥ 8 years; 95.0% (95% CI: 76.0– 99.5%). Only 25% (75/299) children aged 1–14 years were seroprotected against MenC disease in 2014. Recent case isolates mostly represented two cc11 strains. Conclusion High quality surveillance has furthered understanding of MenC vaccines and improved schedules, maximising population benefit. The UK programme provides high direct and indirect protection despite low levels of seroprotection in some age groups. High-resolution characterisation supports ongoing surveillance of distinct MenC cc11 lineages.…

Eeva K Broberg, Benedetto Simone, Josep Jansa and the EU/EEA Member State contributors

An upsurge in Echovirus 30 (E30) infections, associated with meningitis/meningoencephalitis, has been observed in Denmark, Germany, the Netherlands, Norway and Sweden in the period April to September 2018, compared with 2015–2017. In total, 658 E30 infections among 4,537 enterovirus infections were detected in 15 countries between January and September 2018 and affected mainly newborns and 26–45 year-olds. National public health institutes are reminded to remain vigilant and inform clinicians of the ongoing epidemic.…