Dr Claudia O’Rourke1, Dr Kathryn Wilks2
1General Paediatrics, Sunshine Coast University Hospital, Birtinya, Australia,
2Infectious Diseases and Microbiology, Sunshine Coast University Hospital, Birtinya, Australia
The human bacterial pathogen Neisseria meningitidis remains a considerable health threat worldwide, but progress is being made towards disease control. Meningococcal C disease in Australia has seen a large and sustained reduction in incidence since the meningococcal C conjugate vaccine was introduced to the National Immunisation Schedule in 2003. The last 5 years, however, have documented a significant increase in serogroup Y and serogroup W invasive meningococcal disease. Nearly all of the serogroup Y meningococci isolated have been genotyped as belonging to clonal complex 23 (cc23), a hypervirulent strain that was responsible for unprecedented levels of serogroup Y disease in parts of the United States and Europe. Fortunately, Australia has proactive public health departments and a national meningococcal database and surveillance program. In response to these changes, targeted state-based immunisation programs using a quadrivalent (A,C,W,Y) meningococcal conjugate vaccine will commence from mid-2017.
Here we describe a rare case of serogroup Y primary meningococcal arthritis in a child, the third such case in the literature worldwide. We further review the epidemiology of Neisseria meningitidis, the effect of serogroup and genotype on incidence and pathogenicity, and how other countries have used the quadrivalent vaccine and to what effect.
While prompt diagnosis and treatment are critical in lessening the morbidity and mortality of meningococcal disease, vaccines are ultimately required for disease control. Active surveillance for serogroup-specific and genotype-specific patterns of disease is vital to understanding meningococcal trends over time and making optimal recommendations for vaccines and other prevention strategies.
Claudia is a junior paediatric doctor who has an avid interest in infectious diseases and how to control them.