426. Clinical and Microbiological Characteristics of Serogroup B Invasive Meningococcal Disease in the Province of Quebec, Canada
Session: Poster Abstract Session: Pediatric Infections
Thursday, October 3, 2013
Room: The Moscone Center: Poster Hall C
Background:

Since 2003, the emergence of a new clonal complex (ST 269) responsible of serogroup B invasive meningococcal diseases (IMD-B) in the province of Quebec, lead us to assess clinical features and microbiological characteristics.

Methods:

Medical records of laboratory confirmed cases of IMD-B between 2003 and 2010 in the province of Quebec were reviewed through a standardized questionnaire. For each age group, clinical presentation, fatality rates and frequency of sequelae were calculated according to the major clonal complexes.

Results: Over the 7 year period, 303 cases (148 females – 47.1 %) were included with a median age of 16.8 years. Overall, 5.1 % patients died and 21.4% of survivors had sequelae at hospital discharge. Most relevant clinical and microbiological characteristics are summarized in the following table.

Age group

< 1 year

(N=51)

1-14 years

(N=74)

15-21 years

(N=89)

≥ 22 years

(N=89)

Total

(N=303)

Clinical presentation of IMD-B n (%)

- Cutaneous

- Neurological

- Hemodynamic disorders

Sequelae† n (%)

Death‡ n (%)

18 (35.3)

22 (43.1)

33 (64.2)

15/48 (31.3)

3/51 (5.9)

55 (74.3)

59 (79.7)

55 (74.3)

14/68 (20.6)

4/72 (5.6)

52 (58.4)

85 (95.5)*

64 (71.9)

15/85 (17.7)

2/87 (2.3)

31 (34.8)

72 (80.9)

54 (60.7)

16/79(20.3)

6/85(7.1)

156 (51.5)

238 (78.5)

206 (68.0)

60/280 (21.4)

15/295 (5.1)

Clonal Complex n (%)

- ST 269

- ST 41/44

- Other

11 (21.6)

29 (56.8)

11 (21.6)

43 (58.1)

17 (23)

14 (18.9)

66 (74.2) *

10 (11.2)

13 (14.6)

52 (58.4)

20 (22.5)

17 (19.1)

172 (56.7)

76 (25.1)

55 (18.2)

* P< 0.001  Denominators: † known survivors, ‡ known vital outcome

Over the study period, 82% of cases were caused by ST 269 and ST 41/44. The proportion of ST 269 increased significantly from 41% to 75% (p<0.02). Neurological presentations as well as ST 269 were more frequently found in adolescents than in other groups (P<0.001). No association was found between clonal complex and clinical outcome.

Conclusion: Since 2003, the ST 269 clonal complex is emerging in the province of Quebec. It affects predominantly subjects in the 15-21 years age group and is more commonly associated with neurological symptoms.

Bruce Tapiéro, M.D, Pediatrics, Infectious Diseases division, CHU Sainte Justine - Université de Montreal, Montreal, QC, Canada, Lena Coïc, M.D, CHU Sainte Justine- Université de Montreal, Montreal, QC, Canada, Philippe Ovetchkine, MD MSc, Department of Pediatrics, Division of Infectious Diseases, CHU Sainte-Justine – University of Montreal, Montreal, QC, Canada, Adela Barbados, MD, Infectious Diseases Division, CHU Sainte Justine, Montreal, QC, Canada, Jean Batiste Le Meur, MSc, Department of Social and Preventive Medicine, Laval University, Quebec, QC, Canada, Brigitte Lefèbvre, PhD, Quebec Public Health Laboratory, Sainte Anne de Bellevue, QC, Canada and Philippe De Wals, MD, PHD, Univ. Laval, Quebec, QC, Canada

Disclosures:

B. Tapiéro, None

L. Coïc, None

P. Ovetchkine, None

A. Barbados, None

J. B. Le Meur, None

B. Lefèbvre, None

P. De Wals, GlaxoSmithKline: Grant Investigator and Scientific Advisor, Consulting fee and Research grant
Novartis: Grant Investigator and Scientific Advisor, Reimbursement travel expenses and Research grant
Pfizer: Grant Investigator, Grant recipient

See more of: Pediatric Infections
See more of: Poster Abstract Session

Findings in the abstracts are embargoed until 12:01 a.m. PST, Oct. 2nd with the exception of research findings presented at the IDWeek press conferences.