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BackgroundVarious pathogens, including bacteria, fungi, parasites, and viruses can lead to meningitis. Among viruses causing meningitis, Toscana virus (TOSV), a phlebovirus, is transmitted through sandfly bites. TOSV infection may be suspected if patients with enterovirus- and herpesvirus-negative aseptic (non-bacterial) meningitis recall recent insect bites. Other epidemiological factors (season, rural area) may be considered. The broad range of possible meningitis aetiologies poses considerable diagnosis challenges. Untargeted metagenomic next-generation sequencing (mNGS) can potentially identify pathogens, which are not considered or detected in routine diagnostic panels. AimIn this retrospective, single-centre observational study, we investigated mNGS usefulness to understand the cause of meningitis when conventional approaches fail. MethodsCerebrospinal fluid (CSF) samples from patients hospitalised in southern Spain in 2015–2019 with aseptic meningitis and no aetiology found by conventional testing, were subjected to mNGS. Patients’ demographic characteristics had been recorded and physicians had asked them about recent insect bites. Obtained viral genome sequences were phylogenetically analysed. ResultsAmong 23 idiopathic cases, TOSV was identified in eight (all male; median age:  39 years, range: 15–78 years). Five cases lived in an urban setting, three occurred in autumn and only one recalled insect bites. Phylogenetic analysis of TOSV segment sequences supported one intra-genotype reassortment event. ConclusionsOur study highlights the usefulness of mNGS for identifying viral pathogens directly in CSF. In southern Spain, TOSV should be considered regardless of recalling of insect bites or other epidemiological criteria. Detection of a disease-associated reassortant TOSV emphasises the importance of monitoring the spread and evolution of phleboviruses in Mediterranean countries. …

BackgroundRodent-borne viruses such as orthohantaviruses and arenaviruses cause considerable disease burden with regional and temporal differences in incidence and clinical awareness. Therefore, it is important to regularly evaluate laboratory diagnostic capabilities, e.g. by external quality assessments (EQA). AimWe wished to evaluate the performance and diagnostic capability of European expert laboratories to detect orthohantaviruses and lymphocytic choriomeningitis virus (LCMV) and human antibody response towards orthohantaviruses. MethodsWe conducted an EQA in 2021; molecular panels consisted of 12 samples, including different orthohantaviruses (Seoul, Dobrava-Belgrade (DOBV), Puumala (PUUV) and Hantaan orthohantavirus), LCMV and negative controls. Serological panels consisted of six human serum samples reactive to PUUV, DOBV or negative to orthohantaviruses. The EQA was sent to 25 laboratories in 20 countries. ResultsThe accuracy of molecular detection of orthohantaviruses varied (50‒67%, average 62%) among 16 participating laboratories, while LCMV samples were successfully detected in all 11 participating laboratories (91-100%, average 96%). The accuracy of serological diagnosis of acute and past orthohantavirus infections was on average 95% among 20 participating laboratories and 82% in 19 laboratories, respectively. A variety of methods was used, with predominance of in-house assays for molecular tests, and commercial assays for serological ones. ConclusionSerology, the most common tool to diagnose acute orthohantavirus infections, had a high accuracy in this EQA. The molecular detection of orthohantaviruses needs improvement while LCMV detection (performed in fewer laboratories) had 95% accuracy. Further EQAs are recommended to be performed periodically to monitor improvements and challenges in the diagnostics of rodent–borne diseases. …

This issue of the ECDC Communicable Disease Threats Report (CDTR) covers the period 23-29 July 2023 and includes updates on cholera, MERS-CoV, Chikungunya, dengue, COVID-19, West Nile virus, avian influenza, echovirus, botulism, and bacterial meningitis.

This issue of the ECDC Communicable Disease Threats Report (CDTR) covers the period 23-29 July 2023 and includes updates on cholera, MERS-CoV, Chikungunya, dengue, COVID-19, West Nile virus, avian influenza, echovirus, botulism, and bacterial meningitis.

This issue of the ECDC Communicable Disease Threats Report (CDTR) covers the period 25 June - 1 July 2023. It includes updates on avian influenza, COVID-19, West Nile virus, poliomyelitis, cholera, fungal meningitis, Oz virus, and information on mass gatherings (the Hajj).

This issue of the ECDC Communicable Disease Threats Report (CDTR) covers the period 25 June - 1 July 2023. It includes updates on avian influenza, COVID-19, West Nile virus, poliomyelitis, cholera, fungal meningitis, Oz virus, and information on mass gatherings (the Hajj).

BackgroundPneumococcal conjugated vaccine (PCV)7 and PCV13 programmes started in Israel from July 2009 and November 2010 respectively, with a 2+1 schedule (one dose at 2 months old, one at 4 months old, and a booster dose at 12 months old). Thereafter, invasive pneumococcal disease (IPD) rates substantially declined in children. Uptake of all three doses in  90%. For still incompletely vaccinated infants (≤ 12 months old), how well the PCV 2+1 programme shields from IPD is not fully resolved. AimTo assess the adequacy of protection conferred by the 2+1 schedule PCV vaccination programme, particularly among incompletely-vaccinated infants. MethodsThis was a population-based, prospective, nationwide active IPD surveillance study in Israel, 2004–2019, in children

This issue of the ECDC Communicable Disease Threats Report (CDTR) covers the period 28 May - 3 June 2023 and includes updates on COVID-19, West Nile virus, Legionnaires\' disease, avian influenza, Marburg virus disease, cholera, and fungal meningitis.

This issue of the ECDC Communicable Disease Threats Report (CDTR) covers the period 28 May - 3 June 2023 and includes updates on COVID-19, West Nile virus, Legionnaires\' disease, avian influenza, Marburg virus disease, cholera, and fungal meningitis.

Meningitis -- United StatesAuthorities in the U.S. and Mexico have asked the World Health Organization to declare a public health emergency of international concern over a deadly fungal outbreak, a Centers for Disease Control and Prevention official said Friday [26 May 2023]. The request comes after recruiters lured hundreds of patients from multiple countries and 24 U.S. states to 2 facilities in Mexico for cosmetic operations that may have exposed them to the fungus. The CDC is currently monitoring the condition…

Leptospirosis -- United StatesA cluster of brain infections in Oklahoma may have been caused by bacteria from rat urine contaminating the state\'s lakes, an expert suggests. Several people have fallen ill after swimming in rivers and lakes near Bartlesville city, in the east of the state, officials say. They are believed to be suffering from meningitis, or an inflammation of the lining of the brain or spinal cord caused by an infection.Testing has already ruled out the brain-eating amoeba _Naegleria fowleri_, which can…

Meningitis -- United StatesHistory appears to be repeating itself. Authorities in Mexico and the United States believe a contaminated anesthetic drug is behind a meningitis outbreak at 2 private clinics in Matamoros, Mexico, located close to the country\'s border with the United States. Both clinics, which specialize in cosmetic surgery, were closed on 13 May 2023.Mexico\'s Ministry of Health has reported 23 cases: 9 involving American patients and a further 14 infections among Mexican patients. One death has been…

Meningitis -- CDC is collaborating with the Mexican Ministry of Health and U.S. state and local health departments to respond to an outbreak of suspected fungal meningitis among patients who had surgical procedures under epidural anesthesia in Matamoros, Tamaulipas, Mexico. Officials have identified two clinics associated with the outbreak, River Side Surgical Center and Clinica K-3. These clinics were closed on [13 May 2023].The Mexican Ministry of Health sent CDC a list of 221 U.S. patients who might…

This issue of the ECDC Communicable Disease Threats Report (CDTR) covers the period 21-27 May 2023 May 2023 and includes updates on COVID-19, influenza, Marburg virus disease, poliomyelitis, extensively drug-resistant Pseudomonas aeruginosa, and suspected fungal meningitis.

This issue of the ECDC Communicable Disease Threats Report (CDTR) covers the period 21-27 May 2023 May 2023 and includes updates on COVID-19, influenza, Marburg virus disease, poliomyelitis, extensively drug-resistant Pseudomonas aeruginosa, and suspected fungal meningitis.

Fungal Meningitis -- [A 37 year-old woman] died yesterday [9 May 2023] due to respiratory complications caused by fungal meningitis that kept her hospitalized for nearly half a year, reported the sub-delegate of the Institute of Security and Social Services for State Workers (ISSSTE), Marcela Pelayo Nieto. With this death, there are 39 victims of this condition.[This woman] gave birth to her baby by caesarean section at the Santé private hospital, one of the 4 hospitals involved in the currently closed cases…

Pneumonia -- IraqFollowing a surge in meningitis cases in Halabjah City and Sulaymaniyah governorate since mid-April 2023, an expert team from the World Health Organization (WHO) and the Ministry of Health was deployed to the affected areas to perform a joint epidemiological investigation of the reported cases and develop a swift response plan to curb the transmission of the disease.Preliminary laboratory results from 24 collected samples showed a mixture of bacterial (_Streptococcus pneumoniae_) and viral…

BackgroundMeningococcus (Neisseria meningitidis) is the causative bacteria of invasive meningococcal disease (IMD), a major cause of meningitis and sepsis. In 2015–16, an outbreak caused by serogroup C meningococci (MenC), belonging to the hyperinvasive strain ST-11(cc-11), resulted in 62 IMD cases in the region of Tuscany, Italy. AimWe aimed to estimate the key outbreak parameters and assess the impact of interventions used in the outbreak response. MethodsWe developed a susceptible-carrier-susceptible individual-based model of MenC transmission, accounting for transmission in households, schools, discos/clubs and the general community, which was informed by detailed data on the 2015–16 outbreak (derived from epidemiological investigations) and on the implemented control measures. ResultsThe outbreak reproduction number (Re) was 1.35 (95% prediction interval: 1.13–1.47) and the IMD probability was 4.6 for every 1,000 new MenC carriage episodes (95% confidence interval: 1.8–12.2). The interventions, i.e. chemoprophylaxis and vaccination of close contacts of IMD cases as well as age-targeted vaccination, were effective in reducing Re and ending the outbreak. Case-based interventions (including ring vaccination) alone would have been insufficient to achieve outbreak control. The definition of age groups to prioritise vaccination had a critical impact on the effectiveness and efficiency of control measures. ConclusionsOur findings suggest that there are no effective alternatives to widespread reactive vaccination during outbreaks of highly transmissible MenC strains. Age-targeted campaigns can increase the effectiveness of vaccination campaigns. These results can be instrumental to define effective guidelines for the control of future meningococcal outbreaks caused by hypervirulent strains. …

Hospital-Related Infection -- United StatesA bacterial outbreak at Virginia Mason Medical Center in Seattle has sickened 31 patients since October [2022]. Seven of them have since died, but it\'s unknown what caused those deaths -- the infection or the diagnoses that brought them to the hospital in the first place._Klebsiella pneumoniae_ is a bacterium usually found in health care settings, and often resistant to antibiotics. It can cause pneumonia, meningitis, and wound or bloodstream infections.Virginia Mason is working with…

Meningitis - Neisseria -- AustraliaA man in his 20s from Adelaide has been hospitalised with invasive meningococcal disease, as cases almost double from this time last year [2022]. The strain has been identified as sero[group] B, and the man is in a stable condition.Authorities said multiple people had been in contact with the man, with 3 of those directed to take clearance antibiotics.A total of 7 cases of invasive meningococcal disease have been reported so far this year in South Australia compared with 4 at the same…

Meningitis - Neisseria -- FranceAfter more than 2 years of low incidence during the COVID-19 pandemic, an upsurge in invasive meningococcal infections (IMIs) has been observed in the [2022 - 2023] season, Santé publique France reports.A peak in incidence was observed in December [2022], particularly during week [52/2022]. This peak was early compared to the seasonal peak observed during the pre-pandemic seasons (peak between January and March depending on the season). During the first quarter of [2023], the number of…

Meningitis -- IraqThe ministry\'s spokesman, Saif Al-Badr, told the Iraqi News Agency, on [Fri 28 Apr 2023], that \'meningitis is present in Iraq and cases are recorded individually in all regions, but what happened in Sulaymaniyah and some of its neighboring areas is a relative increase in the number of cases, and immediately the Minister of Health, Salih Al-Hasnawi, sent a high-level team from the Department of Public Health, consisting of specialists from the National Center for Communicable Disease Control…

Meningitis -- NigeriaBetween 1 Oct 2022 and 16 Apr 2023, Nigeria reported a total of 1686 suspected cases of meningitis, including 124 deaths, for a case fatality ratio (CFR) of 7%.Meningitis is a serious infection of the meninges, the membranes covering the brain and spinal cord. It is a devastating disease and a major public health challenge. _Neisseria meningitidis_ (meningococcus), _Streptococcus pneumoniae_ (pneumococcus), _Haemophilus influenzae_ [serotype b or Hib] and _Streptococcus agalactiae_ (group…

Meningitis -- NigeriaNo fewer than 10 persons have been confirmed dead out of 177 suspected cases of cerebrospinal meningitis reported in Degubi community in Nangere Local Government Area of Yobe State [Nigeria].Confirming the outbreak, the state Commissioner for Health, Dr Muhammad Lawan Gana, who led a state government\'s delegation to visit the victims in the town, said the state government was working tirelessly to provide rapid response to the outbreak.He said the state government had taken adequate…

Meningitis -- IraqThe director of Sulaymaniyah Children\'s Hospital, Basdar Abdullah, revealed, on Saturday [22 Apr 2023], an increase in meningitis cases in the province, stressing at the same time that treating the disease early reduces its risks.Abdullah said in a statement received by Shafaq News agency, \'The number of meningitis cases increased unexpectedly more than a month ago, but if it is treated, it may not be dangerous to spread.\'The General Directorate of Health in Halabja Governorate had…

Meningitis - Neisseria -- Niger- The technical committee established in the Zinder region continues to coordinate the response to the outbreak.- Active case finding at the community level and in health facilities for early detection of new cases continues.- Household sensitization through community relays and volunteers continues in affected districts.- Case management activities have been intensified, including procurement of ceftriaxone, case isolation, deployment of health workers for case management, distribution…