title: Global epidemiology of capsular group W meningococcal disease (1970-2015): Multifocal emergence and persistence of hypervirulent sequence type (ST)-11 clonal complex.
abstract: Following an outbreak in Mecca Saudi Arabia in 2000, meningococcal strains expressing capsular group W (W) emerged as a major cause of invasive meningococcal disease (IMD) worldwide. The Saudi Arabian outbreak strain (Hajj clone) belonging to the ST-11 clonal complex (cc11) is similar to W cc11 causing occasional sporadic disease before 2000. Since 2000, W cc11 has caused large meningococcal disease epidemics in the African meningitis belt and endemic disease in South America, Europe and China. Traditional molecular epidemiologic typing suggested that a majority of current W cc11 burden represented global spread of the Hajj clone. However, recent whole genome sequencing (WGS) analyses revealed significant genetic heterogeneity among global W cc11 strains. While continued spread of the Hajj clone occurs in the Middle East, the meningitis belt and South Africa have co-circulation of the Hajj clone and other unrelated W cc11 strains. Notably, South America, the UK, and France share a genetically distinct W cc11 strain. Other W lineages persist in low numbers in Europe, North America and the meningitis belt. In summary, WGS is helping to unravel the complex genomic epidemiology of group W meningococcal strains. Wider application of WGS and strengthening of global IMD surveillance is necessary to monitor the continued evolution of group W lineages.
authors.affiliation: Infectious Diseases Epidemiology Research Unit, University of Pittsburgh, A525 Crabtree Hall,130 Desoto Street, Pittsburgh, PA 15261,USA.
authors.forename: Mustapha M
authors.initials: MM
authors.lastname: Mustapha
authors.affiliation: Infectious Diseases Epidemiology Research Unit, University of Pittsburgh, A525 Crabtree Hall,130 Desoto Street, Pittsburgh, PA 15261,USA.
authors.forename: Jane W
authors.initials: JW
authors.lastname: Marsh
authors.affiliation: Infectious Diseases Epidemiology Research Unit, University of Pittsburgh, A525 Crabtree Hall,130 Desoto Street, Pittsburgh, PA 15261,USA. Electronic address: lharriso@pitt.edu.
authors.forename: Lee H
authors.initials: LH
authors.lastname: Harrison
mesh_terms: D015373:Bacterial Typing Techniques; D004196:Disease Outbreaks; D014943:Global Health; D006801:Humans; D015994:Incidence; D008589:Meningococcal Infections / Q000453:epidemiology* / Q000382:microbiology; D017720:Molecular Epidemiology; D038582:Neisseria meningitidis, Serogroup W-135 / Q000145:classification*; D012703:Serotyping
keywords: Molecular epidemiology; Neisseria meningitidis; Surveillance; W135; Whole genome sequencing