title: Epidemiology, molecular characterization and antibiotic resistance of Neisseria meningitidis from patients ≤15 years in Manhiça, rural Mozambique.
abstract: BACKGROUND
  The epidemiology of meningococcal disease in Mozambique and other African countries located outside the "meningitis belt" remains widely unknown. With the event of upcoming vaccines microbiological and epidemiological information is urgently needed.
  
  
  METHODS
  Prospective surveillance for invasive bacterial infections was conducted at the Manhiça District hospital (rural Mozambique) among hospitalized children below 15 years of age. Available Neisseria meningitidis isolates were serogrouped and characterized by Multilocus Sequence Typing (MLST). Antibiotic resistance was also determined.
  
  
  RESULTS
  Between 1998 and 2008, sixty-three cases of confirmed meningococcal disease (36 meningitis, 26 sepsis and 1 conjunctivitis) were identified among hospitalized children. The average incidence rate of meningococcal disease was 11.6/100,000 (8/100,000 for meningitis and 3.7/100,000 for meningococcemia, respectively). There was a significant rise on the number of meningococcal disease cases in 2005-2006 that was sustained till the end of the surveillance period. Serogroup was determined for 43 of the 63 meningococcal disease cases: 38 serogroup W-135, 3 serogroup A and 2 serogroup Y. ST-11 was the most predominant sequence type and strongly associated with serogroup W-135. Two of the three serogroup A isolates were ST-1, and both serogroup Y isolates were ST-175. N. meningitidis remained highly susceptible to all antibiotics used for treatment in the country, although the presence of isolates presenting intermediate resistance to penicillin advocates for continued surveillance.
  
  
  CONCLUSIONS
  Our data show a high rate of meningococcal disease in Manhiça, Mozambique, mainly caused by serogroup W-135 ST-11 strains, and advocates for the implementation of a vaccination strategy covering serogroup W-135 meningococci in the country.
authors.affiliation: Centre de Recerca en Salut Internacional de Barcelona, Universitat de Barcelona, Barcelona, Spain. anabelen.ibarz@cresib.cat
authors.forename: Ana Belén
authors.initials: AB
authors.lastname: Ibarz-Pavón
authors.forename: Luis
authors.initials: L
authors.lastname: Morais
authors.forename: Betuel
authors.initials: B
authors.lastname: Sigaúque
authors.forename: Inacio
authors.initials: I
authors.lastname: Mandomando
authors.forename: Quique
authors.initials: Q
authors.lastname: Bassat
authors.forename: Ariel
authors.initials: A
authors.lastname: Nhacolo
authors.forename: Llorenç
authors.initials: L
authors.lastname: Quintó
authors.forename: Montse
authors.initials: M
authors.lastname: Soriano-Gabarró
authors.forename: Pedro L
authors.initials: PL
authors.lastname: Alonso
authors.forename: Anna
authors.initials: A
authors.lastname: Roca
mesh_terms: D000293:Adolescent; D016470:Bacteremia; D001826:Body Fluids / Q000382:microbiology; D002648:Child; D002675:Child, Preschool; D024881:Drug Resistance, Bacterial; D006801:Humans; D015994:Incidence; D007223:Infant; D008589:Meningococcal Infections / Q000453:epidemiology* / Q000382:microbiology; D008826:Microbial Sensitivity Tests; D009073:Mozambique / Q000453:epidemiology; D009345:Neisseria meningitidis / Q000145:classification / Q000235:genetics / Q000302:isolation & purification / Q000502:physiology*; D012424:Rural Population / Q000706:statistics & numerical data*; D012703:Serotyping