title: Comparative long-term adverse effects elicited by invasive group B and C meningococcal infections.
abstract: BACKGROUND
  Given the identity between Neisseria meningitidis serogroup B (MenB) capsular polysaccharide (polysialic acid; PSA) and PSA found on neural cell adhesion molecules, it has been proposed that infection with MenB or vaccination with PSA may be associated with subsequent autoimmune or neurological disease.
  
  
  METHODS
  We conducted 2 studies. The first was a retrospective nationwide study of invasive meningococcal disease (IMD) in Iceland (with 541 subjects) during the period 1975-2004, and we cross referenced this cohort with databases with respect to subsequent diagnosis of autoimmune disorders. A follow-up study involving 120 survivors of IMD was performed. The study included 70 patients with a history of MenB and 50 patients with N. meningitidis serogroup C (MenC) infection, who served as control subjects. Participants answered standardized questionnaires (Beck's Depression Inventory [BDI] II, Depression Anxiety Stress Scales [DASS], and Patient Health Questionnaire [PHQ]), and serum levels of immunoglobulin (Ig) G against MenB and MenC capsular polysaccharides were measured.
  
  
  RESULTS
  The nationwide cohort had 9166 patient-years of follow up. No evidence of increased autoimmunity was found to be associated with MenB, compared with MenC. In the follow-up study, patients were evaluated 16.6 years after the infection, representing 2022 patient-years of observation. Comparable rates of most complications were recorded, but MenC infections were associated with arthritis (P = .008) and migraine headaches (P = .01) more frequently than were MenB infections. No difference was observed with respect to scores on BDI-II, DASS, or PHQ. IgG anti-MenB and anti-MenC capsular polysaccharide levels were not related to patient complaints.
  
  
  CONCLUSIONS
  This study does not support the hypothesis that MenB infection may predispose to autoimmunity. MenC infections are associated with a higher prevalence of arthritis and migraine headaches. No evidence of antibody-associated pathology was detected at long-term follow-up.
authors.affiliation: Department of Medicine, The National University Hospital of Iceland, Reykjavik, Iceland. magnusgo@landspitali.is
authors.forename: Magnus
authors.initials: M
authors.lastname: Gottfredsson
authors.forename: Ingi K
authors.initials: IK
authors.lastname: Reynisson
authors.forename: Ragnar F
authors.initials: RF
authors.lastname: Ingvarsson
authors.forename: Hafrun
authors.initials: H
authors.lastname: Kristjansdottir
authors.forename: Martina V
authors.initials: MV
authors.lastname: Nardini
authors.forename: Jon F
authors.initials: JF
authors.lastname: Sigurdsson
authors.forename: Rachel
authors.initials: R
authors.lastname: Schneerson
authors.forename: John B
authors.initials: JB
authors.lastname: Robbins
authors.forename: Mark A
authors.initials: MA
authors.lastname: Miller
mesh_terms: D000293:Adolescent; D000328:Adult; D000907:Antibodies, Bacterial / Q000097:blood; D001168:Arthritis / Q000453:epidemiology / Q000209:etiology; D001327:Autoimmune Diseases / Q000453:epidemiology* / Q000209:etiology; D002648:Child; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007055:Iceland / Q000453:epidemiology; D007074:Immunoglobulin G / Q000097:blood; D008297:Male; D008585:Meningitis, Meningococcal / Q000150:complications* / Q000453:epidemiology* / Q000382:microbiology; D008875:Middle Aged; D008881:Migraine Disorders / Q000453:epidemiology / Q000209:etiology; D009422:Nervous System Diseases / Q000453:epidemiology* / Q000209:etiology; D012189:Retrospective Studies; D011795:Surveys and Questionnaires; D055815:Young Adult
chemical_list: D000907:Antibodies, Bacterial; D007074:Immunoglobulin G