Increase of invasive meningococcal disease by serogroup W in Santa Catarina, state of South of Brazil, 2017 to 2018.

  • Vaccine preventable diseases
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Meningococcal disease (IMD) in Brazil is considered endemic (incidence rate of 0.5 cases/100,000 inhabitants) with sporadic outbreaks. In 2017 and 2018 the most prevalent serogroups were: C(59.0%), B(28.0%), W(9.0%) and Y(3.0%). The circulation of serogroup W is located in some Brazilian states. In the coastal range of the state of Santa Catarina, in the period 2015-2016, 11 cases of IMD were recorded by serogroup W and in the period 2017-2018, 52 cases, representing an increase of 372.7%. Objectives of the study were to characterize the DMI profile by serogroup W and to analyze the prognostic factors for deaths and sequelae.

Retrospective cohort study, considering confirmed cases of IMD from January 1, 2017 to December 31, 2018. Nonserogrouped cases were excluded. The exposed were cases of IMD serogroup W and the unexposed belonged to the other serogroups. We reviewed the medical records and interviewed cases or guardians. The measure of association used was relative risk (RR) with 95% CI for death outcomes and sequelae.

The study included 113 IMD cases, 52 (46%) of serogroup W. Of these, 55.8% were female and 12 died (lethality rate:23.1%). IMD serogroup W Incidence rate at <5 years was 5.01 cases / 100,000 inhabitants.W:2a:P1.2 strain was more frequent. No case had ACWY vaccine. 21 IDM serogroup W(40.4%) had sequelae. Prognostic factor for sequelae was complications during hospitalization-acute renal failure (RR:2.21;95%CI:1.74-2.79;p-value:0.003); for deaths were: having IMD by serogroup W aged 15-29 years (RR:3.86;95%CI:1.25-11.90,p-value:0.015) and meningococcemia (RR:3.91,95%CI:1.61-9.49;p-value:0.001).

There was an increase in serogroup W, a high incidence in children <5 years and a high mortality rate in adolescents and young adults, which should be monitored. The ACWY vaccine should be considered for children under 5 and individuals aged 15-29. Risk factors may help in selecting patients who need the most appropriate care and most intensive supportive therapy.

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