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Meningococcal disease in most western countries is mainly caused by serogroup B. Despite the availability of successful meningococcal serogroup C conjugate vaccines, there is no effective vaccine against serogroup B. Efficacy trials with outer membrane vesicle (OMV) vaccines were ineffective and are complicated by the high variability of its main component, porin A. Several new approaches to either optimizing these OMV vaccines or searching for new, highly conserved antigens are therefore being investigated. The completion of the meningococcal genome sequence has provided new challenges. This review summarizes recent developments in the search for a broadly protective meningococcal serogroup B vaccine.
We describe an 11-year-old girl suffering from recurrent meningitis with a complete absence of the seventh component of complement (C7). Diagnosis was established by haemolytic titration and western blotting. The patient's serum lacked the 85 kDa C7 chain. Haemolytic activity of serum was reconstituted with either pooled normal human serum or with purified C7. The relatives (parents and one sister) had half-normal levels of both immunochemically and functionally determined C7, indicating a heterozygous state for C7 deficiency.
OBJECTIVE: To study the epidemiologic and aetiologic features of meningitis in children in Hong Kong. METHODOLOGY: A retrospective study of 85 children resident in the New Territory East region of Hong Kong admitted to a teaching Hospital because of meningitis during a 9 year period. RESULTS: Mycobacterium tuberculosis was the most common aetiological agent accounting for 13 cases (15.3%). Other bacteria accounted for 41 cases (48%); among these one fifth were caused by Haemophilus influenzae type b. The overall admission rates for tuberculous meningitis in Chinese children were 0.76/100,000 (95% CI 0.25-1.78) and 0.42/100,000 (CI 0.19-0.8) per year, respectively, for under 5 year olds and under 15 year olds. The overall annual incidence rates of bacterial meningitis other than tuberculous were 5.2/100,000 (CI 3.72-7.43) and 1.6/100,000 (CI 1.14-2.29) for Chinese children under 5 years and under 15 years, respectively. The annual incidence of H. influenzae meningitis in Chinese children under 5 years old was low at 1.1/100,000 (0.43-2.2). All five cases of meningococcal meningitis were in Vietnamese children (under 5 years of age incidence: 13.0/100,000 per year, CI 4.2-30.3). There were no cases of meningococcal meningitis in Chinese children during the 9 year period. CONCLUSION: M. tuberculosis was the most common aetiological agent of meningitis in Hong Kong children. The incidence of haemophilus or meningococcal meningitis was very low.
Immunodiagnosis is very useful especially in cases where bacteriological diagnosis cannot be made because of the high sensitivity of Neisseria meningitidis. A sensitive reaction is described for the detection of antimeningococcal antibodies using as antigen a latex suspension specifically sensitized with saline extracts from N. meningitidis groups A, B and C. The results prove the genus, species and serotype specificity of this reaction. The method is quick and easy to carry out, even in laboratories which do not possess elaborate equipment. The latex-antigen has the advantages of stability and possibility of standardization.
Neisseria meningitidis group C type 2b, P1.2, P1.5 caused an outbreak of four cases, two of whom were members of an agricultural college in Devon, and two outside contacts of students who were documented carriers of the outbreak strain. The identification of the outbreak was made more difficult by the fact that none of the three cases first linked with the college was culture positive and indeed only one of these was actually a member of the college. Carriage of the outbreak strain was significantly associated with residence in college and enrollment on one particular course. The question was raised of whether in outbreaks of this type control measures should be extended beyond the confines of the affected institution.
The usual laboratory of bacteriology has an essential role in isolation, bacteriological diagnostic and testing of resistance towards antibiotics of gonococcal infections. Searching of beta-Lactamase will be carried out when inhibition diameters around penicillinase C disks will be inferior to 18 mm. The specialized laboratory will bring along useful information through the study of epidemiologic markers: auxotyping, plasmid characterization (connection with african types (2.6 and 3.7 M-daltons) and with South-East Asia (2.6; 4.5 and 24.5 M-daltons) and eventually serotypings by using proteins from outer-membrane. A similar action will be taken by all laboratories of bacteriology: isolation, identification, susceptibility searching and serogrouping from meningococci isolated from rhinopharynx and from C.S.F. or from blood culture. Eight groups whose specificities are carried by capsular polysaccharides are actually described (A, B, C, X, Y, Z, 29E and W135). The electrosyneresis will be useful when bacteria will not be possible to isolate. Serotyping techniques whose importance is essential are still depending on specialized laboratory.
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