Meningitis Research Foundation’s 10th international conference opened with a moving talk from GB Paralympian and MRF ambassador Aaron Phipps. This patient’s perspective of meningococcal disease certainly set the scene for the international audience of nearly 300 clinicians, researchers and public health professionals gathered at the Royal Society of Medicine in London.
Over the two days, presentations from globally renowned experts addressed the most important issues of the day, including meningococcal, pneumococcal and Group B Streptococcal (GBS) prevention strategies, prospects for herd protection, advances from research and issues in the clinical management of sepsis and meningitis.
The packed programme of plenary sessions began with a look at current issues in clinical management of meningitis and sepsis, including a review of the new UK Joint Specialist Societies’ Guideline on Acute Meningitis and Meningococcal Sepsis in Adults, two weeks ahead of its official launch. A treatment algorithm for the early management of suspected meningitis and meningococcal sepsis in hospital has been updated in accordance with the new guideline and is available free from MRF (www.meningitis.org).
In a session dedicated to Group B Streptococcus and neonatal infection, delegates heard that Malawian children with neonatal sepsis without overt meningitis have a 6.6-fold increased risk of developmental delay at 1 year of age, whilst meningitis was associated with a 17-fold increased risk. Back in the UK setting, we learned that incidence and case fatality rates of bacterial meningitis in UK neonates are unchanged over the last two decades. An in-depth study of healthcare delivery for children < 90 days old with bacterial meningitis has demonstrated unacceptable variation in clinical management. Lessons learned from this UK study are being packaged as a treatment algorithm and educational e-tool aimed at junior doctors. The session ended with a presentation about prospects for the prevention of GBS, with a maternal vaccine currently under development by GSK.
The programme then moved on to meningococcal carriage and herd protection. Data presented by Professor Sir Brian Greenwood showed that the introduction of serogroup A meningococcal vaccine (MenAfriVac) in Chad substantially reduced carriage rates and halted an epidemic caused by the bacterium. The subsequent talk considered how herd protection contributed to the huge success of the MenC conjugate vaccines in the UK and presented preliminary evidence that the decline in meningococcal disease in the UK since 2001 is likely the result of substantially reduced carriage rates. There was lively debate about whether immunisation against meningococcal B disease should be immediately introduced for adolescents, the main carriers of the bacteria.
‘Preventing pneumococcal disease’ was the focus of the final plenary session of day one, where delegates heard that, although highly successful UK PVC7 and PVC13 programmes have resulted in an overall reduction in invasive pneumococcal disease, this reduction is now being eroded by progressive increases in non-PVC13 serotypes and a surprising recent increase in Serotype 19A, which should be covered by PVC13. Novel pneumococcal protein vaccines currently under development (many in Phase II trials) could be used in the future to address the issue of replacement disease.
Day two opened with a fascinating presentation about the genomic techniques used to characterise a novel and highly virulent MenW ST-11 strain currently causing a year on year increase in disease cases in the UK. A later talk revealed that this same MenW strain recently expanded in Chile leading to the introduction of the MenACWY vaccine for all Chilean 9 month to 5 year olds from 2012. Although the vaccine provided direct protection for the targeted age group, no herd protection was observed in unvaccinated age groups and overall incidence rates remained similar in 2013 and 2014. This data has helped inform vaccination schedules in other countries. In the UK, the MenACWY vaccine was introduced in August 2015 in 14-18 year olds and university freshers and is intended to induce herd protection.
The morning ended with an encouraging presentation from Dr Marie Pierre-Preziosi, head of the Meningitis Vaccine Project, who described the huge success of the monovalent group A meningococcal vaccine (MenAfriVac). Since introduction of the vaccine, over 220 million persons have been vaccinated in 16 countries of the African Meningitis Belt, leading to a dramatic reduction in carriage and invasive disease. However, despite this promising news, the following presentation reported the current high incidence of MenC in Nigeria and Niger with 5000 and 8000 cases reported, respectively, between February and June 2015. This is the highest incidence of MenC ever reported in Africa. The outbreak has been attributed to a unique strain (ST10217) belonging to an unassigned clonal complex.
With the recent introduction of the MenB vaccine (Bexsero) to the UK routine childhood immunisation schedule in September 2015, many delegates were interested to learn about Public Health England’s plans for enhanced surveillance and evaluation of the vaccine, during the final plenary session. Evidence for the impact of Bexsero abroad has been mixed; there have been no vaccine failures in Quebec since Bexsero was used to immunise all 2 month to 20 year olds from the end of 2014, however, vaccine induced immunogenicity against an outbreak strain at Princeton University was found to be fairly low.
In addition to the plenary sessions, 58 academic posters were displayed throughout the conference and covered a range of topics including: Epidemiology & Surveillance, Clinical diagnosis, treatment & sequelae, Vaccinology, Pathogenesis and Public Health.
The prize for the best poster was awarded to Hayley Lavender’s work on how genetic variation of host FH related proteins is likely to contribute to the risk of developing meningococcal disease.
Abstracts and presentation slides from the plenary sessions can be accessed at www.meningitis.org/conference2015
ACNR V15:Issue 6 2016. Online 8/2/16