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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Background:
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.

Methods:
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.

Results:
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).

Conclusion:
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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