Keywords
Invasive meningococcal diseases;
Epidemiology;
Surveillance system;
Anti-meningococcal vaccination strategies
Epidemiology;
Surveillance system;
Anti-meningococcal vaccination strategies
Abstract
Introduction. Invasive meningococcal disease (IMD) is one of the most severe vaccine-preventable diseases not yet under control. In Italy, although different anti-meningococcal vaccines are available, their offer among regions is heterogeneous. The aim of this study is to describe the epidemiology of IMD in Italy based on analysis of national surveillance data for 2011–2017 to optimize the vaccination strategy.
Methods: IMD surveillance data from the Italian National Health Institute were analysed. Microsoft Excel was used to present trend analysis, stratifying by age and serogroups.
Results: In Italy, during the period 2011–2017, the incidence of IMD increased from 0.25 cases/100,000 inhabitants in 2011 to 0.33 cases/100,000 in 2017. Most cases after 2012 were caused by non-B serogroups. The highest number of cases for the whole period occurred in people aged 25–64 years. The number of cases in those aged 25–64 years increased steadily after 2013 (36 cases in 2011, 79 in 2017), mostly due to non-B serogroups, representing more than 65% of cases in those aged 25+ years.
Conclusions: In the period from 2011 to 2017, the incidence of IMDs increased in Italy. The increase, although probably due to better surveillance, highlights the high level of circulation of non-B serogroups and the importance of the disease in the adult population. Our analysis supports an anti-meningococcal vaccination plan in Italy that should include the highest number of preventable serogroups and be aimed at vaccinating the whole population through a multicohort strategy.
References
[1] Centres for Disease Control and Prevention (CDC). Meningococcal disease. In: Hamborsky J, Kroger A, Wolfe C, editors. Epidemiology and prevention of vaccine-preventable diseases. 13th ed. Washington, DC: Public Health Foundation; 2015, p. 231–46.
[2] Soriano-Gabarró M, Wolter J, Hogea C, Vyse A. Carriage of Neisseria meningitidis in Europe: a review of studies undertaken in the region. Expert Rev Anti Infect Ther 2011;9:761–74. doi:10.1586/eri.11.89.
[3] Christensen H, May M, Bowen L, Hickman M, Trotter CL. Meningococcal carriage by age: a systematic review and meta-analysis. Lancet Infect Dis 2010;10:853–61. doi:10.1016/S1473-3099(10)70251-6.
[4] Manchanda V, Gupta S, Bhalla P. Meningococcal disease: history, epidemiology, pathogenesis, clinical manifestations, diagnosis, antimicrobial susceptibility and prevention. Indian J Med Microbiol 2006;24:7–19. doi:10.4103/0255-0857.19888.
[5] Olbrich KJ, Müller D, Schumacher S, Beck E, Meszaros K, Koerber F. Systematic review of invasive meningococcal disease: sequelae and quality of life impact on patients and their caregivers. Infect Dis Ther 2018;7:421–38. doi:10.1007/s40121-018-0213-2.
[6] Halperin SA, Bettinger JA, Greenwood B, Harrison LH, Jelfs J, Ladhani SN, McIntyre P, Ramsay ME, Sáfadi MAP. The changing and dynamic epidemiology of meningococcal disease. Vaccine 2012;30:B26–36. doi:10.1016/j.vaccine.2011.12.032.
[7] Acevedo R, Bai X, Borrow R, Caugant DA, Carlos J, Ceyhan M, Christensen H, Climent Y, De Wals P, Dinleyici EC, Echaniz-Aviles G, Hakawi A, Kamiya H, Karachaliou A, Lucidarme J, Meiring S, Mironov K, Sáfadi MAP, Shao Z, Smith V, Steffen R, Stenmark B, Taha M-K, Trotter C, Vázquez JA, Zhu B. The Global Meningococcal Initiative meeting on prevention of meningococcal disease worldwide: epidemiology, surveillance, hypervirulent strains, antibiotic resistance and high-risk populations. Expert Rev Vaccines 2019;18:15–30. doi:10.1080/14760584.2019.1557520.
[8] European Centre for Disease Prevention and Control (ECDC). Invasive meningococcal disease. Annual Epidemiological Report for 2017. Stockholm: ECDC; 2019.
[9] Whittaker R, Dias JG, Ramliden M, Ködmön C, Economopoulou A, Beer N, Pastore Celentano L. The epidemiology of invasive meningococcal disease in EU/EEA countries, 2004–2014. Vaccine 2017;35:2034–41. doi:10.1016/j.vaccine.2017.03.007.
[10] Harrison LH, Trotter CL, Ramsay ME. Global epidemiology of meningococcal disease. Vaccine 2009;27:B51–63. doi:10.1016/j.vaccine.2009.04.063.
[11] Kriz P, Wieffer H, Holl K, Rosenlund M, Budhia S, Vyse A. Changing epidemiology of meningococcal disease in Europe from the mid-20th to the early 21st century. Expert Rev Vaccines 2011;10:1477–86. doi:10.1586/erv.11.117.
[12] Harrison LH, Shutt KA, Schmink SE, Marsh JW, Harcourt BH, Wang X, Whitney AM, Stephens DS, Cohn AA, Messonnier NE, Mayer LW. Population structure and capsular switching of invasive Neisseria meningitidis isolates in the pre–meningococcal conjugate vaccine era—United States, 2000–2005. J Infect Dis 2010;201:1208–24. doi:10.1086/651505.
[13] Tzeng YL, Thomas J, Stephens DS. Regulation of capsule in Neisseria meningitidis. Crit Rev Microbiol 2016;42:759–72. doi:10.3109/1040841X.2015.1022507.
[14] Stefanelli P, Fazio C, Neri A, Sofia T, Mastrantonio P. First report of capsule replacement among electrophoretic type 37 Neisseria meningitidis strains in Italy. J Clin Microbiol 2003;41:5783–6. doi:10.1128/JCM.41.12.5783-5786.2003.
[15] Swartley JS, Marfin AA, Edupuganti S, Liu LJ, Cieslaku P, Perkins B, Wenger JD, Stephens DS. Capsule switching of Neisseria meningitidis. Proc Natl Acad Sci U S A 1997;94:271–6. doi:10.1073/pnas.94.1.271.
[16] Stefanelli P, Fazio C, Vacca P, Palmieri A, Ambrosio L, Neri A, Piana A, Castiglia P, Argiolas F, Santus S, Masala L, Steri G, Riccardo F, Iannazzo S, Maraglino FP, D’Amario C, Rezza G. An outbreak of severe invasive meningococcal disease due to a capsular switched Neisseria meningitidis hypervirulent strain B:cc11. Clin Microbiol Infect 2019;25:111.e1–4. doi:10.1016/j.cmi.2018.07.014.
[17] Centers for Disease Control and Prevention (CDC). Meningococcal risk factors 2019. Available at; https://www.cdc.gov/meningococcal/about/risk-factors.html. Accessed on March 23, 2020.
[18] Duan C, Linder H, Huremović D. Societal, public, and [emotional] epidemiological aspects of a pandemic. In: Huremović D, editor. Psychiatry of pandemics. Cham: Springer International Publishing; 2019, p. 45–53. doi:10.1007/978-3-030-15346-5_4.
[19] Dettori M, Arru B, Azara A, Piana A, Mariotti G, Camerada MV, Stefanelli P, Rezza G, Castiglia P. In the digital era, is community outrage a feasible proxy indicator of emotional epidemiology? The case of meningococcal disease in Sardinia, Italy. Int J Environ Res Public Health 2018;15:1–8. doi:10.3390/ijerph15071512.
[20] Mustapha MM, Marsh JW, Harrison LH. Global epidemiology of capsular group W meningococcal disease (1970-2015): multifocal emergence and persistence of hypervirulent sequence type (ST)-11 clonal complex. Vaccine 2016;34:1515–23. doi:10.1016/j.vaccine.2016.02.014.
[21] Ladhani SN, Beebeejaun K, Lucidarme J, Campbell H, Gray S, Kaczmarski E, Ramsay ME, Borrow R. Increase in endemic Neisseria meningitidis capsular group W sequence type 11 complex associated with severe invasive disease in England and Wales. Clin Infect Dis 2015;60:578–85. doi:10.1093/cid/ciu881.
[22] Lucidarme J, Scott KJ, Ure R, Smith A, Lindsay D, Stenmark B, Jacobsson S, Fredlund H, Cameron JC, Smith-Palmer A, McMenamin J, Gray SJ, Campbell H, Ladhani S, Findlow J, Molling P, Borrow R. An international invasive meningococcal disease outbreak due to a novel and rapidly expanding serogroup w strain, Scotland and Sweden, July to August 2015. Eurosurveillance 2016;21. doi:10.2807/1560-7917.ES.2016.21.45.30395.
[23] Azzari C, Nieddu F, Moriondo M, Indolfi G, Canessa C, Ricci S, Bianchi L, Serranti D, Poggi GM, Resti M. Underestimation of invasive meningococcal disease in Italy. Emerg Infect Dis 2016;22:469–75. doi:10.3201/eid2203.150928.
[24] Pezzotti P, Bellino S, Riccardo F, Lucaroni F, Cerquetti M, Pantosti A, Rezza G, Stefanelli P. Vaccine preventable invasive bacterial diseases in Italy: a comparison between the national surveillance system and recorded hospitalizations, 2007–2016. Vaccine 2019;37:41–8. doi:10.1016/j.vaccine.2018.11.047.
[25] Vespa Presa J, Abalos MG, Sini de Almeida R, Cane A. Epidemiological burden of meningococcal disease in Latin America: a systematic literature review. Int J Infect Dis 2019;85:37–48. doi:10.1016/j.ijid.2019.05.006.
[26] Giorgi Rossi P, Mantovani J, Ferroni E, Forcina A, Stanghellini E, Curtale F, Borgia P. Incidence of bacterial meningitis (2001-2005) in Lazio, Italy: the results of an integrated surveillance system. BMC Infect Dis 2009;9. doi:10.1186/1471-2334-9-13.
[27] Guiducci S, Moriondo M, Nieddu F, Ricci S, De Vitis E, Casini A, Poggi GM, Indolfi G, Resti M, Azzari C. Culture and real-time polymerase chain reaction sensitivity in the diagnosis of invasive meningococcal disease: does culture miss less severe cases? PLoS One 2019;14:e0212922. doi:10.1371/journal.pone.0212922.
[28] Baldovin T, Lazzari R, Cocchio S, Furlan P, Bertoncello C, Saia M, Russo F, Baldo V. Invasive meningococcal disease in the Veneto region of Italy: a capture-recapture analysis for assessing the effectiveness of an integrated surveillance system. BMJ Open 2017;7. doi:10.1136/bmjopen-2016-012478.
[29] European Centre for Disease Prevention and Control (ECDC). Surveillance systems overview for 2017. 2018. Available at: https://www.ecdc.europa.eu/en/publications-data/surveillance-systems-overview-2017. Accessed on January 27, 2020.
[30] European Centre for Disease Prevention and Control (ECDC). Introduction to the Annual Epidemiological Report. 2017. Available at: https://www.ecdc.europa.eu/en/annual-epidemiological-reports/methods. Accessed on January 27, 2020.
[31] World Health Organization. Meningococcal meningitis 2018. Available at: https://www.who.int/en/news-room/fact-sheets/detail/meningococcal-meningitis. Accessed on November 23, 2019.
[32] Vuocolo S, Balmer P, Gruber WC, Jansen KU, Anderson AS, Perez JL, York LJ. Vaccination strategies for the prevention of meningococcal disease. Hum Vaccines Immunother 2018;14:1203–15. doi:10.1080/21645515.2018.1451287.
[33] Ministero della Salute. Piano Nazionale Prevenzione Vaccinale (PNPV) 2017-2019. Rome: Ministero della Salute; 2017.
[34] Istituto Superiore di Sanità. Sorveglianza delle malattie batteriche invasive in Italia. Rapporto consolidato 2017. Rome: Istituto Superiore di Sanità; 2018.
[35] Istituto Superiore di Sanità. Dati di sorveglianza delle malattie batteriche invasive aggiornati al 3 aprile 2017. Rome: Istituto Superiore di Sanità; 2017.
[36] Istituto Superiore di Sanità. Protocollo per la sorveglianza nazionale delle malattie invasive da meningococco, pneumococco ed emofilo e delle meningiti batteriche in Italia. Rome: Istituto Superiore di Sanità; 2018.
[37] Stefanelli P, Fazio C, Neri A, Ciammaruconi A, Balocchini E, Anselmo A, Azzari C, Rossolini GM, Vacca P, Fortunato A, Palozzi A, Fillo S, Lista F, Moriondo M, Nieddu F, Rezza G. Genome-based study of a spatio-temporal cluster of invasive meningococcal disease due to Neisseria meningitidis serogroup C, clonal complex 11. J Infect 2016;73:136–44. doi:10.1016/j.jinf.2016.05.003.
[38] Menichetti F, Fortunato S, Ricci A, Salani F, Ripoli A, Tascini C, Fusco FM, Mencarini J, Bartoloni A, Di Pietro M. Invasive meningococcal disease due to group C N. meningitidis ST11 (cc11): the Tuscany cluster 2015–2016. Vaccine 2018;36:5962–6. doi:10.1016/j.vaccine.2018.08.050.
[39] Miglietta A, Innocenti F, Pezzotti P, Riccobono E, Moriondo M, Pecile P, Nieddu F, Rossolini GM, Azzari C, Balocchini E, Rezza G, Voller F, Stefanelli P. Carriage rates and risk factors during an outbreak of invasive meningococcal disease due to Neisseria meningitidis serogroup C ST-11 (cc11) in Tuscany, Italy: a cross-sectional study. BMC Infect Dis 2019;19:29. doi:10.1186/s12879-018-3598-3.
[40] Regione Toscana. Delibera n.571 del 27-04-2015. Prevenzione della diffusione del meningococco C in Toscana. Aggiornamento calendario e direttive aprile 2015. 2015.
[41] Heinsbroek E, Ladhani S, Gray S, Guiver M, Kaczmarski E, Borrow R, Ramsay M. Added value of PCR-testing for confirmation of invasive meningococcal disease in England. J Infect 2013;67:385–90. doi:10.1016/j.jinf.2013.06.007.
[42] Neri A, Pezzotti P, Fazio C, Vacca P, D’Ancona FP, Caporali MG, Stefanelli P. Epidemiological and molecular characterization of invasive meningococcal disease in Italy, 2008/09-2012/13. PLoS One 2015;10:e0139376. doi:10.1371/journal.pone.0139376.
[43] Regione Emilia-Romagna. Delibera Giunta Regionale N. 427 del 05/04/2017. Approvazione del Piano Regionale di Prevenzione Vaccinale 2017. 2017:1–30.
[44] Regione Puglia. Calendario vaccinale per la vita 2017. Available at: https://www.vaccinarsinpuglia.org/assets/uploads/files/calendario-vaccinale-Puglia-2017.pdf. Accessed on January 22, 2020.
[45] VaccinarSì in Sicilia. Nuovo calendario vaccinale siciliano. - VaccinarSì in Sicilia 2017. Available at: https://www.vaccinarsinsicilia.org/notizie/2017/11/nuovo-calendario-vaccinale-siciliano. Accessed on December 4, 2019.
[46] Costantino C, Restivo V, Ventura G, D’Angelo C, Randazzo MA, Casuccio N, Palermo M, Casuccio A, Vitale F. Increased vaccination coverage among adolescents and young adults in the district of Palermo as a result of a public health strategy to counteract an ‘epidemic panic.’ Int J Environ Res Public Health 2018;15. doi:10.3390/ijerph15051014.
[47] Presa J, Findlow J, Vojicic J, Williams S, Serra L. Epidemiologic trends, global shifts in meningococcal vaccination guidelines, and data supporting the use of MenACWY-TT vaccine: a review. Infect Dis Ther 2019;8:307–33. doi:10.1007/s40121-019-0254-1.
[48] Knol MJ, Ruijs WLM, Antonise-Kamp L, de Melker HE, van der Ende A. Implementation of MenACWY vaccination because of ongoing increase in serogroup W invasive meningococcal disease, the Netherlands, 2018. Eurosurveillance 2018;23. doi:10.2807/1560-7917.ES.2018.23.16.18-00158.
[49] Regione Toscana. Vaccinazioni - Campagna contro il meningococco C n.d. Available at: http://www.regione.toscana.it/-/campagna-contro-il-meningococco-c. Accessed on November 23, 2019.
[50] Pezzotti P, Miglietta A, Neri A, Fazio C, Vacca P, Voller F, Rezza G, Stefanelli P. Meningococcal C conjugate vaccine effectiveness before and during an outbreak of invasive meningococcal disease due to Neisseria meningitidis serogroup C/cc11, Tuscany, Italy. Vaccine 2018;36:4222–7. doi:10.1016/j.vaccine.2018.06.002.
[51] Ministero della Salute. Circolare n. 5783 del 1° marzo 2016 Malattia invasiva da Meningococco C in Toscana - Potenziamento della segnalazione di casi e indicazioni per chi si reca in Toscana. 2016. Available at: http://www.trovanorme.salute.gov.it/norme/renderNormsanPdf?anno=0&codLeg=54329&parte=1%20&serie=. Accessed January 22, 2020.
[52] Ministero della Salute. Regione Toscana ha intensificato offerta vaccinazione meningite 2016. Available at: http://www.salute.gov.it/portale/news/p3_2_4_1_1.jsp?lingua=italiano&menu=salastampa&p=comunicatistampa&id=4724. Accessed on December 3, 2019.
[53] VaccinarSì. Calendario vaccinale per la vita 2019. 2019. Available at: https://www.vaccinarsi.org/notizie/2019/07/calendario-vaccinale-per-la-vita-2019. Accessed on January 22, 2020.
[2] Soriano-Gabarró M, Wolter J, Hogea C, Vyse A. Carriage of Neisseria meningitidis in Europe: a review of studies undertaken in the region. Expert Rev Anti Infect Ther 2011;9:761–74. doi:10.1586/eri.11.89.
[3] Christensen H, May M, Bowen L, Hickman M, Trotter CL. Meningococcal carriage by age: a systematic review and meta-analysis. Lancet Infect Dis 2010;10:853–61. doi:10.1016/S1473-3099(10)70251-6.
[4] Manchanda V, Gupta S, Bhalla P. Meningococcal disease: history, epidemiology, pathogenesis, clinical manifestations, diagnosis, antimicrobial susceptibility and prevention. Indian J Med Microbiol 2006;24:7–19. doi:10.4103/0255-0857.19888.
[5] Olbrich KJ, Müller D, Schumacher S, Beck E, Meszaros K, Koerber F. Systematic review of invasive meningococcal disease: sequelae and quality of life impact on patients and their caregivers. Infect Dis Ther 2018;7:421–38. doi:10.1007/s40121-018-0213-2.
[6] Halperin SA, Bettinger JA, Greenwood B, Harrison LH, Jelfs J, Ladhani SN, McIntyre P, Ramsay ME, Sáfadi MAP. The changing and dynamic epidemiology of meningococcal disease. Vaccine 2012;30:B26–36. doi:10.1016/j.vaccine.2011.12.032.
[7] Acevedo R, Bai X, Borrow R, Caugant DA, Carlos J, Ceyhan M, Christensen H, Climent Y, De Wals P, Dinleyici EC, Echaniz-Aviles G, Hakawi A, Kamiya H, Karachaliou A, Lucidarme J, Meiring S, Mironov K, Sáfadi MAP, Shao Z, Smith V, Steffen R, Stenmark B, Taha M-K, Trotter C, Vázquez JA, Zhu B. The Global Meningococcal Initiative meeting on prevention of meningococcal disease worldwide: epidemiology, surveillance, hypervirulent strains, antibiotic resistance and high-risk populations. Expert Rev Vaccines 2019;18:15–30. doi:10.1080/14760584.2019.1557520.
[8] European Centre for Disease Prevention and Control (ECDC). Invasive meningococcal disease. Annual Epidemiological Report for 2017. Stockholm: ECDC; 2019.
[9] Whittaker R, Dias JG, Ramliden M, Ködmön C, Economopoulou A, Beer N, Pastore Celentano L. The epidemiology of invasive meningococcal disease in EU/EEA countries, 2004–2014. Vaccine 2017;35:2034–41. doi:10.1016/j.vaccine.2017.03.007.
[10] Harrison LH, Trotter CL, Ramsay ME. Global epidemiology of meningococcal disease. Vaccine 2009;27:B51–63. doi:10.1016/j.vaccine.2009.04.063.
[11] Kriz P, Wieffer H, Holl K, Rosenlund M, Budhia S, Vyse A. Changing epidemiology of meningococcal disease in Europe from the mid-20th to the early 21st century. Expert Rev Vaccines 2011;10:1477–86. doi:10.1586/erv.11.117.
[12] Harrison LH, Shutt KA, Schmink SE, Marsh JW, Harcourt BH, Wang X, Whitney AM, Stephens DS, Cohn AA, Messonnier NE, Mayer LW. Population structure and capsular switching of invasive Neisseria meningitidis isolates in the pre–meningococcal conjugate vaccine era—United States, 2000–2005. J Infect Dis 2010;201:1208–24. doi:10.1086/651505.
[13] Tzeng YL, Thomas J, Stephens DS. Regulation of capsule in Neisseria meningitidis. Crit Rev Microbiol 2016;42:759–72. doi:10.3109/1040841X.2015.1022507.
[14] Stefanelli P, Fazio C, Neri A, Sofia T, Mastrantonio P. First report of capsule replacement among electrophoretic type 37 Neisseria meningitidis strains in Italy. J Clin Microbiol 2003;41:5783–6. doi:10.1128/JCM.41.12.5783-5786.2003.
[15] Swartley JS, Marfin AA, Edupuganti S, Liu LJ, Cieslaku P, Perkins B, Wenger JD, Stephens DS. Capsule switching of Neisseria meningitidis. Proc Natl Acad Sci U S A 1997;94:271–6. doi:10.1073/pnas.94.1.271.
[16] Stefanelli P, Fazio C, Vacca P, Palmieri A, Ambrosio L, Neri A, Piana A, Castiglia P, Argiolas F, Santus S, Masala L, Steri G, Riccardo F, Iannazzo S, Maraglino FP, D’Amario C, Rezza G. An outbreak of severe invasive meningococcal disease due to a capsular switched Neisseria meningitidis hypervirulent strain B:cc11. Clin Microbiol Infect 2019;25:111.e1–4. doi:10.1016/j.cmi.2018.07.014.
[17] Centers for Disease Control and Prevention (CDC). Meningococcal risk factors 2019. Available at; https://www.cdc.gov/meningococcal/about/risk-factors.html. Accessed on March 23, 2020.
[18] Duan C, Linder H, Huremović D. Societal, public, and [emotional] epidemiological aspects of a pandemic. In: Huremović D, editor. Psychiatry of pandemics. Cham: Springer International Publishing; 2019, p. 45–53. doi:10.1007/978-3-030-15346-5_4.
[19] Dettori M, Arru B, Azara A, Piana A, Mariotti G, Camerada MV, Stefanelli P, Rezza G, Castiglia P. In the digital era, is community outrage a feasible proxy indicator of emotional epidemiology? The case of meningococcal disease in Sardinia, Italy. Int J Environ Res Public Health 2018;15:1–8. doi:10.3390/ijerph15071512.
[20] Mustapha MM, Marsh JW, Harrison LH. Global epidemiology of capsular group W meningococcal disease (1970-2015): multifocal emergence and persistence of hypervirulent sequence type (ST)-11 clonal complex. Vaccine 2016;34:1515–23. doi:10.1016/j.vaccine.2016.02.014.
[21] Ladhani SN, Beebeejaun K, Lucidarme J, Campbell H, Gray S, Kaczmarski E, Ramsay ME, Borrow R. Increase in endemic Neisseria meningitidis capsular group W sequence type 11 complex associated with severe invasive disease in England and Wales. Clin Infect Dis 2015;60:578–85. doi:10.1093/cid/ciu881.
[22] Lucidarme J, Scott KJ, Ure R, Smith A, Lindsay D, Stenmark B, Jacobsson S, Fredlund H, Cameron JC, Smith-Palmer A, McMenamin J, Gray SJ, Campbell H, Ladhani S, Findlow J, Molling P, Borrow R. An international invasive meningococcal disease outbreak due to a novel and rapidly expanding serogroup w strain, Scotland and Sweden, July to August 2015. Eurosurveillance 2016;21. doi:10.2807/1560-7917.ES.2016.21.45.30395.
[23] Azzari C, Nieddu F, Moriondo M, Indolfi G, Canessa C, Ricci S, Bianchi L, Serranti D, Poggi GM, Resti M. Underestimation of invasive meningococcal disease in Italy. Emerg Infect Dis 2016;22:469–75. doi:10.3201/eid2203.150928.
[24] Pezzotti P, Bellino S, Riccardo F, Lucaroni F, Cerquetti M, Pantosti A, Rezza G, Stefanelli P. Vaccine preventable invasive bacterial diseases in Italy: a comparison between the national surveillance system and recorded hospitalizations, 2007–2016. Vaccine 2019;37:41–8. doi:10.1016/j.vaccine.2018.11.047.
[25] Vespa Presa J, Abalos MG, Sini de Almeida R, Cane A. Epidemiological burden of meningococcal disease in Latin America: a systematic literature review. Int J Infect Dis 2019;85:37–48. doi:10.1016/j.ijid.2019.05.006.
[26] Giorgi Rossi P, Mantovani J, Ferroni E, Forcina A, Stanghellini E, Curtale F, Borgia P. Incidence of bacterial meningitis (2001-2005) in Lazio, Italy: the results of an integrated surveillance system. BMC Infect Dis 2009;9. doi:10.1186/1471-2334-9-13.
[27] Guiducci S, Moriondo M, Nieddu F, Ricci S, De Vitis E, Casini A, Poggi GM, Indolfi G, Resti M, Azzari C. Culture and real-time polymerase chain reaction sensitivity in the diagnosis of invasive meningococcal disease: does culture miss less severe cases? PLoS One 2019;14:e0212922. doi:10.1371/journal.pone.0212922.
[28] Baldovin T, Lazzari R, Cocchio S, Furlan P, Bertoncello C, Saia M, Russo F, Baldo V. Invasive meningococcal disease in the Veneto region of Italy: a capture-recapture analysis for assessing the effectiveness of an integrated surveillance system. BMJ Open 2017;7. doi:10.1136/bmjopen-2016-012478.
[29] European Centre for Disease Prevention and Control (ECDC). Surveillance systems overview for 2017. 2018. Available at: https://www.ecdc.europa.eu/en/publications-data/surveillance-systems-overview-2017. Accessed on January 27, 2020.
[30] European Centre for Disease Prevention and Control (ECDC). Introduction to the Annual Epidemiological Report. 2017. Available at: https://www.ecdc.europa.eu/en/annual-epidemiological-reports/methods. Accessed on January 27, 2020.
[31] World Health Organization. Meningococcal meningitis 2018. Available at: https://www.who.int/en/news-room/fact-sheets/detail/meningococcal-meningitis. Accessed on November 23, 2019.
[32] Vuocolo S, Balmer P, Gruber WC, Jansen KU, Anderson AS, Perez JL, York LJ. Vaccination strategies for the prevention of meningococcal disease. Hum Vaccines Immunother 2018;14:1203–15. doi:10.1080/21645515.2018.1451287.
[33] Ministero della Salute. Piano Nazionale Prevenzione Vaccinale (PNPV) 2017-2019. Rome: Ministero della Salute; 2017.
[34] Istituto Superiore di Sanità. Sorveglianza delle malattie batteriche invasive in Italia. Rapporto consolidato 2017. Rome: Istituto Superiore di Sanità; 2018.
[35] Istituto Superiore di Sanità. Dati di sorveglianza delle malattie batteriche invasive aggiornati al 3 aprile 2017. Rome: Istituto Superiore di Sanità; 2017.
[36] Istituto Superiore di Sanità. Protocollo per la sorveglianza nazionale delle malattie invasive da meningococco, pneumococco ed emofilo e delle meningiti batteriche in Italia. Rome: Istituto Superiore di Sanità; 2018.
[37] Stefanelli P, Fazio C, Neri A, Ciammaruconi A, Balocchini E, Anselmo A, Azzari C, Rossolini GM, Vacca P, Fortunato A, Palozzi A, Fillo S, Lista F, Moriondo M, Nieddu F, Rezza G. Genome-based study of a spatio-temporal cluster of invasive meningococcal disease due to Neisseria meningitidis serogroup C, clonal complex 11. J Infect 2016;73:136–44. doi:10.1016/j.jinf.2016.05.003.
[38] Menichetti F, Fortunato S, Ricci A, Salani F, Ripoli A, Tascini C, Fusco FM, Mencarini J, Bartoloni A, Di Pietro M. Invasive meningococcal disease due to group C N. meningitidis ST11 (cc11): the Tuscany cluster 2015–2016. Vaccine 2018;36:5962–6. doi:10.1016/j.vaccine.2018.08.050.
[39] Miglietta A, Innocenti F, Pezzotti P, Riccobono E, Moriondo M, Pecile P, Nieddu F, Rossolini GM, Azzari C, Balocchini E, Rezza G, Voller F, Stefanelli P. Carriage rates and risk factors during an outbreak of invasive meningococcal disease due to Neisseria meningitidis serogroup C ST-11 (cc11) in Tuscany, Italy: a cross-sectional study. BMC Infect Dis 2019;19:29. doi:10.1186/s12879-018-3598-3.
[40] Regione Toscana. Delibera n.571 del 27-04-2015. Prevenzione della diffusione del meningococco C in Toscana. Aggiornamento calendario e direttive aprile 2015. 2015.
[41] Heinsbroek E, Ladhani S, Gray S, Guiver M, Kaczmarski E, Borrow R, Ramsay M. Added value of PCR-testing for confirmation of invasive meningococcal disease in England. J Infect 2013;67:385–90. doi:10.1016/j.jinf.2013.06.007.
[42] Neri A, Pezzotti P, Fazio C, Vacca P, D’Ancona FP, Caporali MG, Stefanelli P. Epidemiological and molecular characterization of invasive meningococcal disease in Italy, 2008/09-2012/13. PLoS One 2015;10:e0139376. doi:10.1371/journal.pone.0139376.
[43] Regione Emilia-Romagna. Delibera Giunta Regionale N. 427 del 05/04/2017. Approvazione del Piano Regionale di Prevenzione Vaccinale 2017. 2017:1–30.
[44] Regione Puglia. Calendario vaccinale per la vita 2017. Available at: https://www.vaccinarsinpuglia.org/assets/uploads/files/calendario-vaccinale-Puglia-2017.pdf. Accessed on January 22, 2020.
[45] VaccinarSì in Sicilia. Nuovo calendario vaccinale siciliano. - VaccinarSì in Sicilia 2017. Available at: https://www.vaccinarsinsicilia.org/notizie/2017/11/nuovo-calendario-vaccinale-siciliano. Accessed on December 4, 2019.
[46] Costantino C, Restivo V, Ventura G, D’Angelo C, Randazzo MA, Casuccio N, Palermo M, Casuccio A, Vitale F. Increased vaccination coverage among adolescents and young adults in the district of Palermo as a result of a public health strategy to counteract an ‘epidemic panic.’ Int J Environ Res Public Health 2018;15. doi:10.3390/ijerph15051014.
[47] Presa J, Findlow J, Vojicic J, Williams S, Serra L. Epidemiologic trends, global shifts in meningococcal vaccination guidelines, and data supporting the use of MenACWY-TT vaccine: a review. Infect Dis Ther 2019;8:307–33. doi:10.1007/s40121-019-0254-1.
[48] Knol MJ, Ruijs WLM, Antonise-Kamp L, de Melker HE, van der Ende A. Implementation of MenACWY vaccination because of ongoing increase in serogroup W invasive meningococcal disease, the Netherlands, 2018. Eurosurveillance 2018;23. doi:10.2807/1560-7917.ES.2018.23.16.18-00158.
[49] Regione Toscana. Vaccinazioni - Campagna contro il meningococco C n.d. Available at: http://www.regione.toscana.it/-/campagna-contro-il-meningococco-c. Accessed on November 23, 2019.
[50] Pezzotti P, Miglietta A, Neri A, Fazio C, Vacca P, Voller F, Rezza G, Stefanelli P. Meningococcal C conjugate vaccine effectiveness before and during an outbreak of invasive meningococcal disease due to Neisseria meningitidis serogroup C/cc11, Tuscany, Italy. Vaccine 2018;36:4222–7. doi:10.1016/j.vaccine.2018.06.002.
[51] Ministero della Salute. Circolare n. 5783 del 1° marzo 2016 Malattia invasiva da Meningococco C in Toscana - Potenziamento della segnalazione di casi e indicazioni per chi si reca in Toscana. 2016. Available at: http://www.trovanorme.salute.gov.it/norme/renderNormsanPdf?anno=0&codLeg=54329&parte=1%20&serie=. Accessed January 22, 2020.
[52] Ministero della Salute. Regione Toscana ha intensificato offerta vaccinazione meningite 2016. Available at: http://www.salute.gov.it/portale/news/p3_2_4_1_1.jsp?lingua=italiano&menu=salastampa&p=comunicatistampa&id=4724. Accessed on December 3, 2019.
[53] VaccinarSì. Calendario vaccinale per la vita 2019. 2019. Available at: https://www.vaccinarsi.org/notizie/2019/07/calendario-vaccinale-per-la-vita-2019. Accessed on January 22, 2020.