title: An international invasive meningococcal disease outbreak due to a novel and rapidly expanding serogroup W strain, Scotland and Sweden, July to August 2015.
abstract: The 23rd World Scout Jamboree in 2015 took place in Japan and included over 33,000 scouts from 162 countries. Within nine days of the meeting ending, six cases of laboratory-confirmed invasive serogroup W meningococcal disease occurred among scouts and their close contacts in Scotland and Sweden. The isolates responsible were identical to one-another by routine typing and, where known (4 isolates), belonged to the ST-11 clonal complex (cc11) which is associated with large outbreaks and high case fatality rates. Recent studies have demonstrated the need for high-resolution genomic typing schemes to assign serogroup W cc11 isolates to several distinct strains circulating globally over the past two decades. Here we used such schemes to confirm that the Jamboree-associated cases constituted a genuine outbreak and that this was due to a novel and rapidly expanding strain descended from the strain that has recently expanded in South America and the United Kingdom. We also identify the genetic differences that define the novel strain including four point mutations and three putative recombination events involving the horizontal exchange of 17, six and two genes, respectively. Noteworthy outcomes of these changes were antigenic shifts and the disruption of a transcriptional regulator.
authors.affiliation: Meningococcal Reference Unit, Public Health England, Manchester, United Kingdom.
authors.forename: Jay
authors.initials: J
authors.lastname: Lucidarme
authors.affiliation: Scottish Haemophilus, Legionella, Meningococcus and Pneumococcus Reference Laboratory, Glasgow Royal Infirmary, Glasgow, United Kingdom.
authors.forename: Kevin J
authors.initials: KJ
authors.lastname: Scott
authors.affiliation: Scottish Haemophilus, Legionella, Meningococcus and Pneumococcus Reference Laboratory, Glasgow Royal Infirmary, Glasgow, United Kingdom.
authors.forename: Roisin
authors.initials: R
authors.lastname: Ure
authors.affiliation: Scottish Haemophilus, Legionella, Meningococcus and Pneumococcus Reference Laboratory, Glasgow Royal Infirmary, Glasgow, United Kingdom.|College of Medical, Veterinary & Life Sciences, Glasgow Dental Hospital & School, University of Glasgow, Glasgow, United Kingdom.
authors.forename: Andrew
authors.initials: A
authors.lastname: Smith
authors.affiliation: Scottish Haemophilus, Legionella, Meningococcus and Pneumococcus Reference Laboratory, Glasgow Royal Infirmary, Glasgow, United Kingdom.
authors.forename: Diane
authors.initials: D
authors.lastname: Lindsay
authors.affiliation: National Reference Laboratory for Pathogenic Neisseria, Department of Laboratory Medicine, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
authors.forename: Bianca
authors.initials: B
authors.lastname: Stenmark
authors.affiliation: National Reference Laboratory for Pathogenic Neisseria, Department of Laboratory Medicine, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
authors.forename: Susanne
authors.initials: S
authors.lastname: Jacobsson
authors.affiliation: National Reference Laboratory for Pathogenic Neisseria, Department of Laboratory Medicine, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
authors.forename: Hans
authors.initials: H
authors.lastname: Fredlund
authors.affiliation: NHS National Services Scotland, Health Protection Scotland, Glasgow, United Kingdom.
authors.forename: J Claire
authors.initials: JC
authors.lastname: Cameron
authors.affiliation: NHS National Services Scotland, Health Protection Scotland, Glasgow, United Kingdom.
authors.forename: Alison
authors.initials: A
authors.lastname: Smith-Palmer
authors.affiliation: NHS National Services Scotland, Health Protection Scotland, Glasgow, United Kingdom.
authors.forename: Jim
authors.initials: J
authors.lastname: McMenamin
authors.affiliation: Meningococcal Reference Unit, Public Health England, Manchester, United Kingdom.
authors.forename: Steve J
authors.initials: SJ
authors.lastname: Gray
authors.affiliation: Immunisation Department, Public Health England, London, United Kingdom.
authors.forename: Helen
authors.initials: H
authors.lastname: Campbell
authors.affiliation: Immunisation Department, Public Health England, London, United Kingdom.
authors.forename: Shamez
authors.initials: S
authors.lastname: Ladhani
authors.affiliation: Meningococcal Reference Unit, Public Health England, Manchester, United Kingdom.
authors.forename: Jamie
authors.initials: J
authors.lastname: Findlow
authors.affiliation: National Reference Laboratory for Pathogenic Neisseria, Department of Laboratory Medicine, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
authors.forename: Paula
authors.initials: P
authors.lastname: Mölling
authors.affiliation: Meningococcal Reference Unit, Public Health England, Manchester, United Kingdom.
authors.forename: Ray
authors.initials: R
authors.lastname: Borrow
mesh_terms: D015373:Bacterial Typing Techniques; D004196:Disease Outbreaks; D005798:Genes, Bacterial; D016679:Genome, Viral; D005838:Genotype; D014943:Global Health; D006801:Humans; D008589:Meningococcal Infections / Q000453:epidemiology* / Q000382:microbiology*; D017720:Molecular Epidemiology; D038582:Neisseria meningitidis, Serogroup W-135 / Q000145:classification / Q000235:genetics* / Q000302:isolation & purification* / Q000472:pathogenicity; D010802:Phylogeny; D012606:Scotland / Q000453:epidemiology; D065288:Serogroup; D012703:Serotyping; D013548:Sweden / Q000453:epidemiology; D014195:Travel; D014774:Virulence / Q000235:genetics
keywords: Neisseria meninigitidis; World; bacterial infections; epidemiology; meningococcal disease; molecular methods; outbreaks; surveillance