Clonal Distribution of Invasive Neisseria meningitidis Serogroup C Strains Circulating from 1976 to 2005 in Greater São Paulo, Brazil

Meningococcal disease is characterized by cyclic fluctuations in incidence, serogroup distribution, and antigenic profiles. In greater São Paulo, Brazil, there has been a constant increase in the incidence of serogroup C meningococcal disease since the late 1980s. To gain an understanding of changes in serogroup C meningococcal disease over three decades in greater São Paulo, Brazil, 1,059 invasive Neisseria meningitidis serogroup C isolates from 1976 and 2005 were analyzed. Three major clone complexes, sequence type (ST)-11, ST-8, and ST-103, were identified by multilocus sequence typing, and the isolates were characterized by serotyping and 16S rRNA typing. During the 30-year period, there were two major antigenic replacements: from 2a:P1.(5,2) to 2b:P1.3 and subsequently to 23:P1.14-6. All strains of clone ST-103 were characterized as serotype 23 and serosubtype P1.14-6. The origin of 23:P1.14-6 ST-103 complex strains is unknown, but efforts are needed to monitor its spread and define its virulence. The antigenic replacements we observed likely represent a mechanism to sustain meningococcal disease in the population as immunity to circulating strains accumulated

Genetic structure of Neisseria meningitidis serogroup C epidemic strains in South Brazil

In the present study we report the results of an analysis, based on serotyping, multilocus enzyme electrophoresis (MEE), and ribotyping of N. meningitidis serogroup C strains isolated from patients with meningococcal disease (MD) in Rio Grande do Sul (RS) and Santa Catarina (SC) States, Brazil, as the Center of Epidemiology Control of Ministry of Health detected an increasing of MD cases due to this serogroup in the last two years (1992-1993). We have demonstrated that the MD due to N.meningitidis serogroup C strains in RS and SC States occurring in the last 4 years were caused mainly by one clone of strains (ET 40), with isolates indistinguishable by serogroup, serotype, subtype and even by ribotyping. One small number of cases that were not due to an ET 40 strains, represent closely related clones that probably are new lineages generated from the ET 40 clone referred as ET 11A complex. We have also analyzed N.meningitidis serogroup C strains isolated in the greater São Paulo in 1976 as representative of the first post epidemic year in that region. The ribotyping method, as well as MEE, could provide useful information about the clonal characteristics of those isolates and also of strains isolated in south Brazil. The strains from 1976 have more similarity with the actual endemic than epidemic strains, by the ribotyping, sulfonamide sensitivity, and MEE results. In conclusion, serotyping with monoclonal antibodies (C:2b:P1.3), MEE (ET 11 and ET 11A complex), and ribotyping by using ClaI restriction enzyme (Rb2), were useful to characterize these epidemic strains of N.meningitidis related to the increased incidence of MD in different States of south Brazil. It is mostly probable that these N.meningitidis serogroup C strains have poor or no genetic corelation with 1971-1975 epidemic serogroup C strains. The genetic similarity of members of the ET 11 and ET 11A complex were confirmed by the ribotyping method by using three restriction endonucleases.No presente estudo, nós reportamos os resultados de uma análise, baseada na sorotipagem, multilocus enzimático (MEE) e ribotipagem de N. meningitidis sorogrupo C isoladas de paciente com doença meningocócica no Rio Grande do Sul (RS) e Santa Catarina (SC), onde o Centro de Controle Epidemiológico do Ministério da Saúde detectou um aumento do número de casos de doença meningocócica (DM) devido a este sorogrupo nos últimos 2 anos (1992-1993). Nós demonstramos que a DM devido a cepas de N. meningitidis sorogrupo C no RS e SC que ocorreram nos últimos 4 anos foi devido principalmente por um clone (ET 40), com isolados indistinguíveis por sorogrupo, sorotipo, subtipo e até por ribotipagem. Um pequeno número de casos que não foram devidos a cepas do ET 40 representaram um grupo geneticamente relacionado, que provavelmente é uma nova linhagem gerada do clone ET 40, referido como complexo ET 11 A. Nós também analisamos cepas de N. meningitidis sorogrupo C isoladas na grande São Paulo em 1976 como um grupo representativo do primeiro ano pós-epidêmico na região. A ribotipagem, bem como MEE, puderam fornecer informações sobre as características clonais das cepas isoladas no período pós-epidêmico e também no Sul do Brasil. As cepas de 1976 possuem mais similaridades com as cepas endêmicas atuais do que com as cepas epidêmicas (1992-1993) por ribotipagem, sensibilidade a sulfonamida e MEE. Em conclusão, sorotipagem com anticorpos monoclonais (C:2b:P1.3), MEE (complexo ET11 e ET11A) e ribotipagem usando a enzima de restrição ClaI, foram úteis em caracterizar estas cepas epidêmicas de N. meningitidis relacionadas com o aumento da incidência da DM em diferentes estados do sul do Brasil. É muito provável que estas cepas de N. meningitidis sorogrupo C possuam pouca ou nenhuma correlação genética com as cepas epidêmicas sorogrupo C de 1971-1975. A similaridade genética dos membros do complexo ET 11 e ET 11A foram confirmadas por ribotipagem usando-se 3 enzimas de restrição