ArticleThe Lancet. Infectious diseases2018
Outbreak of Neisseria meningitidis serogroup C outside the meningitis belt-Liberia, 2017: an epidemiological and laboratory investigation.
Article in The Lancet. Infectious diseases, 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 16 papers.
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16 citing papers in PubMed.
- Emergence of pneumococcal meningitis outbreak in Northern Togo in 2023, lessons learned and challenges.BMC public health · 2026Article
- Acute febrile illness surveillance using TaqMan Array Cards in two urban health facilities, Monrovia, Liberia, December 2018-March 2020.PLoS neglected tropical diseases · 2026Article
- Genomic Diversity and Antimicrobial Susceptibility of Invasive Neisseria meningitidis in South Africa, 2016-2021.The Journal of infectious diseases · 2024Article
- Spread of the meningococci group C isolates of the clonal complex 10217 beyond the African meningitis belt.IJID regions · 2024Article
- Investigating outbreaks of initially unknown aetiology in complex settings: findings and recommendations from 10 case studies.International health · 2023Review
- Antimicrobial susceptibility profiles and genotyping ofFrontiers in microbiology · 2023Article
- Neisseria meningitidis Serogroup C Clonal Complex 10217 Outbreak in West Kpendjal Prefecture, Togo 2019.Microbiology spectrum · 2022Article
- Meningococcal Disease Outbreaks: A Moving Target and a Case for Routine Preventative Vaccination.Infectious diseases and therapy · 2021Review
- Toward Establishing Integrated, Comprehensive, and Sustainable Meningitis Surveillance in Africa to Better Inform Vaccination Strategies.The Journal of infectious diseases · 2021Article
- Bacterial Meningitis in Children: Neurological Complications, Associated Risk Factors, and Prevention.Microorganisms · 2021Review
- A Narrative Review of the Molecular Epidemiology and Laboratory Surveillance of Vaccine Preventable Bacterial Meningitis Agents:Microorganisms · 2021Review
- The Epidemiology of Meningococcal Disease and Carriage, Genotypic Characteristics and Antibiotic Resistance ofFrontiers in microbiology · 2021Article
- Participatory Design and Process Testing to Optimize Utility, Usability, and Acceptability of a Mobile Game for Promoting Evidence-Driven Public Health Decision-Making in Resource-Constrained Settings.Frontiers in digital health · 2021Article
- Web-Based Genome Analysis of Bacterial Meningitis Pathogens for Public Health Applications Using the Bacterial Meningitis Genomic Analysis Platform (BMGAP).Frontiers in genetics · 2020Article
- Epidemiology of Bacterial Meningitis in the Nine Years Since Meningococcal Serogroup A Conjugate Vaccine Introduction, Niger, 2010-2018.The Journal of infectious diseases · 2019Article
- Future Directions for Meningitis Surveillance and Vaccine Evaluation in the Meningitis Belt of Sub-Saharan Africa.The Journal of infectious diseases · 2019Review
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Funding
Abstract
backgroundOn April 25, 2017, a cluster of unexplained illnesses and deaths associated with a funeral was reported in Sinoe County, Liberia. Molecular testing identified Neisseria meningitidis serogroup C (NmC) in specimens from patients. We describe the epidemiological investigation of this cluster and metagenomic characterisation of the outbreak strain.
methodsWe collected epidemiological data from the field investigation and medical records review. Confirmed, probable, and suspected cases were defined on the basis of molecular testing and signs or symptoms of meningococcal disease. Metagenomic sequences from patient specimens were compared with 141 meningococcal isolate genomes to determine strain lineage.
findings28 meningococcal disease cases were identified, with dates of symptom onset from April 21 to April 30, 2017: 13 confirmed, three probable, and 12 suspected. 13 patients died. Six (21%) patients reported fever and 23 (82%) reported gastrointestinal symptoms. The attack rate for confirmed and probable cases among funeral attendees was 10%. Metagenomic sequences from six patient specimens were similar to a sequence type (ST) 10217 (clonal complex [CC] 10217) isolate genome from Niger, 2015. Multilocus sequencing identified five of seven alleles from one specimen that matched ST-9367, which is represented in the PubMLST database by one carriage isolate from Burkina Faso, in 2011, and belongs to CC10217.
interpretationThis outbreak featured high attack and case fatality rates. Clinical presentation was broadly consistent with previous meningococcal disease outbreaks, but predominance of gastrointestinal symptoms was unusual compared with previous African meningitis epidemics. The outbreak strain was genetically similar to NmC CC10217, which caused meningococcal disease outbreaks in Niger and Nigeria. CC10217 had previously been identified only in the African meningitis belt.
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