Characteristics of the mechanism of the development of the epidemic process in meningococcal infection in organized collectives

The specific features of the epidemiology of meningococcal infection in organized groups have been established after comprehensive (epidemiological, microbiological and immunological) studies, evaluated from the viewpoint of the law of the autoregulation of the epidemic process. The studies have revealed the phenomenon of the adaptive biological variability of meningococci with their prolonged reservation due to the transformation of typical bacterial forms of meningococci characterized by strict serogroup specificity and typical fermentative activity into serologically and biochemically undifferentiated forms, capable of prolonged persistence in human populations. The model demonstrating the development of the epidemic process in meningococcal infection in an organized group has been worked out.     

Characteristics of the meningococcal carrier state in organized collectives and its role in the development of generalized forms of meningococcal infection

Complex (epidemiological and bacteriological) investigations of the level and structure of meningococcal carriership among the members of organized collective bodies differing in the epidemiological situation with respect to meningococcal infection have been carried out. The absence of differences between the total level of meningococcal carriership and the morbidity rate with respect to the generalized forms of meningococcal infection has been shown. The presence of cases of meningococcal meningitis in the groups under study has been found to depend on the intensity of the circulation of certain meningococcal serogroups. The possibility of the ecological reservation of the causative agents of meningococcal infection as polyagglutinable forms has been suggested.     

The role and place of serologic research in the system of epidemiologic surveillance of meningococcal infection

The results of serological surveys, carried out with a view to the detection of capsular meningococcal polysaccharides in the passive hemagglutination (PHA) test and covering 1,289 patients with systemic meningococcal infection, 221 patients with bacteriologically confirmed meningococcal nasopharyngitis, 2,820 persons in organized groups of children and adults with different epidemiological situation (including 650 carriers) and 4,050 residents of 8 cities with different morbidity levels, were analyzed. The patients, the carriers and the members of organized groups underwent multiple surveys. As shown in this study, the confirmation of the meningococcal etiology of the systemic forms of meningococcal infection (meningitis, meningococcemia) in all cases with the exception of children under 1 year of age, as well as the determination of the groups of meningococci, could be achieved in the PHA test twice as frequently, i.e. in 60-70% of cases, as with the use of the bacteriological method. The same regularities were observed in nasopharyngitis. The conclusion was made on the possibility of using the PHA test for more exact determination of the group of meningococci, prevailing at the initial stage of diseases, this determination playing an essential role in the epidemiological surveillance. The data obtained as the result of serological surveys in organized groups may lead to conclusions on the circulation of meningococci and their group composition, thus showing the necessity of profound epidemiological study with ensuring epidemic-control measures. The selective serological study of some hundreds of donor sera is not expedient in big cities, as it provides no data on the circulation of meningococci there.(ABSTRACT TRUNCATED AT 250 WORDS)     

Immunological factors in the evolution of the epidemic process in meningococcal infection

The results obtained in 1987 in the study of the immunostructure of the population of Yaroslavl with respect to meningococcal polysaccharides, groups, A, B, C, and lipopolysaccharide are presented in comparison with earlier results obtained in 1976. The regulating role of the immunological factor in the evolution of the epidemic process of meningococcal infection has been confirmed. The level of antibodies to meningococcal polysaccharides, groups A and B, has been found to reflect the intensity of the circulation of the infective agent among the population. The comparison of the results of investigations carried out in 1976 and 1987 has revealed the essential role of the lipopolysaccharide antigen in the formation of the postinfection immunity of the population to meningococcal infection, irrespective of the group of the infective agent.     

Epidemiological significance of carriers of hyaluronidase-active meningococci

To find out the epidemiological role of the carriers of hyaluronidase-positive meningococcal strains, their spread in the foci of meningococcal infection, as well as outside these foci, was studied. For this purpose, altogether 5059 persons from 40 family foci of infection and 40 organized groups were examined. The number of carriers of hyaluronidase-active meningococci, detected among those of them who had contacts with sick persons, was 13 times greater than among the persons having no such contacts. In preschool institutions with unfavorable morbidity situation this number was 16 times greater than in those with favorable situation. In the family foci carriers of hyaluronidase-active meningococci constituted 80-88 %. The percentage of the carriers of hyaluronidase-active meningococci causing cases of the generalized form of meningococcal infection varied in different groups. According to the results obtained in this study, the threshold percentage of such carriers constituted 30 in preschool institutions, 36 in boarding schools and 50 in common school and in hostels for adults.     

The adhesive properties of meningococci from serogroups A, B and C

The adhesive properties of 261 meningococcal strains have been studied by the methods of the hemagglutination test, the test of adhesion on buccal epithelial cells and electron microscopy. The study has revealed that adhesive properties can be observed in the strains of all groups under study (A, B and C) isolated from patients and carriers, including those isolated from the nasopharynx, blood and liquor, adhesive properties occurring in newly isolated strains with greater frequency than in museum ones. The simultaneous use of all three above-mentioned methods increases the possibility of the detection of meningococcal strains with adhesive activity.     

Reactogenicity of a group A and C meningococcal polysaccharide bivalent vaccine

A total of 1 968 persons aged 18-20 years belonging to organized groups were immunized with different doses of polysaccharide meningococcal divaccine, groups A and C, by means of syringes and jet injectors under the conditions of a controlled epidemiological trial. Systemic reactions to the injection of the preparation were found to be absent. Local reactions manifested by inflammation, swelling and tenderness at the site of injection were faintly pronounced and disappeared in 48 hours, which is indicative of low reactogenicity of the preparation under study.     

Antigenic affinity of meningococci and human A- and B-group erythrocytes

The use of the modified method of isohemagglutinin adsorption by microbial antigens in experiments with the causative agent of meningococcal infection has led, for the first time, to the detection of meningococcal antigens affined to the antigens of human erythrocytes, groups A and B. The antigenic affinity of group A erythrocytes and meningococci has proved to be more pronounced in meningococcal strains isolated from the spinal fluid of patients than in cultures obtained from the nasopharynx of healthy persons. The detection of the affinity of these antigens makes it possible to explain the mechanism of differences in the susceptibility of persons with different blood groups to meningococcal infection by "antigenic mimicry".     

Sensitizing properties of bacterial fractions of different chemical compositions

The sensitizing activity of meningococcal cells and their fractions has been studied. Only protein-containing preparations have been shown to be capable of inducing delayed hypersensitivity, while polysaccharide fractions do not induce it.     

Specific activity of colored variants of N. meningitidis colonies

The character of fluorescence of the colonies formed by serogroup A meningococci (229 strains) in oblique light and their activity in the agglutination test with group specific S and RD antisera to the meningococcal dissociant of the same serogroup were studied. Orange and orange-green colonies were found to have pronounced group-specific activity, and faint gray colonies changed the character of their agglutination with the group-specific antiserum up to the loss of agglutinability; and simultaneously their capacity for agglutination with the antiserum to the dissociant was revealed. The study of the character of fluorescence and the group-specific activity of meningococcal colonies belonging to other serogroups provided similar results.     

Evaluation of the level of antibodies to purified meningococcal antigens

Group B meningococcal antigens, such as polysaccharide, lipopolysaccharide, protein preparation, as well as sonicates obtained from meningococcal cells, groups A, B and C, have been isolated. On the basis of these preparations the parameters of an enzyme immunoassay system for the detection of antibodies to individual meningococcal antigens have been established, and the specificity of the system and the possibility of using it for the evaluation of the level of antibodies to meningococci in human sera have been studied.     

Comparative study of the sensitivity and specificity of dried and liquid meningococcal erythrocyte diagnostic agents A, C and Y in a controlled trial

The comparative study of the sensitivity and specificity of dried and liquid meningococcal erythrocyte diagnosticums A, C and Y has been carried out in the indirect hemagglutination test with the sera of persons immunized with different doses of dried chemical meningococcal (group A) polysaccharide vaccine and persons receiving placebo under the conditions of a controlled epidemiological trial. The possibility of using, on principle, both liquid (A, C) and dried (A, C, Y) preparations in clinico-epidemiological studies has been established. The continuation of the research work aimed at the improvement of meningococcal diagnosticums and, in particular, at the development of polyvalent preparations seems to be justified.     

Relationship of eicosanoids to cellular and humoral immunity factors in meningococcal infection

The dynamics of the content of thromboxane B2, 6-keto-prostaglandin F1 alpha, T- and B-lymphocytes and titers of antibodies to group polysaccharides of meningococci, groups A, B and C, have been studied in 44 patients with generalized forms of meningococcal infection. As shown in this study, in patients with the clinical course of moderate severity a decrease in the number of T-lymphocytes in the first days of infection correlates with a decrease in the concentration of thromboxane B2. In some cases the concentration of thromboxane B2 and 6-keto-prostaglandin F1 alpha has been found to correlate with the titers of antibodies to group polysaccharide of group A meningococci. The severe course of meningococcal infection is characterized by the absence of correlation between eicosanoids and the immunity factors under study.     

Epidemiological characteristics of meningococcal infection in a number of territories of the RSFSR (1969-1984)

In this work the dynamics and morbidity level in respect of meningococcal infection at 11 territories of the RSFSR at the period of 1969-1984 are analyzed. The study covered altogether 16 cities and 211 districts. The role of big cities as the sources of infection spreading into rural areas and further "fixation" of this infection mainly in regions with a population of 60,000 and more had been established. The data on meningococcal morbidity and carriership among different age groups are presented. The study has shown a pronounced increase in the incidence rate of meningococcal infection among children aged up to 2 years, as well as an increase in the proportion of these children among patients with meningococcal infection in recent years.     

New approach to the diagnosis of meningococcal infection: latex-erythrocyte agglutination

A principal possibility and advantages of the diagnosis of meningococcal infection by means of agglutination of sensibilized latex particles with erythrocytes have been demonstrated. Polysterene carboxylated latex has been sensibilized by rabbit JgG to meningococcus of serogroup A. Dynamics of absorption of meningococcal polysaccharide on erythrocytes in vivo has been studied in mice.     

Coagglutination test and its application to the rapid diagnosis of meningococcal meningitis

Modified technique of slide coagglutination test for detecting meningococcal group-specific antigens in the spinal fluid of patients with meningococcal meningitis has been developed. Precipitating meningococcal sera, groups A, C, X, Y, Z, were conjugated with formalin-treated staphylococcal cells, strain Cowan-I. To prevent nonspecific reactions, 5-minute boiling of the spinal fluid specimens is suggested. 111 specimens of spinal fluid were taken from 75 patients at different periods of the disease. All patients were administered antibiotics, and therefore the etiology of the disease was bacteriologically confirmed only in 31% of patients. Coagglutination test was positive in 56.7% of patients, the frequency of positive results reaching 71% during the first 4 days of the disease. The specimens of spinal fluid taken from the control group of patients yielded not more than 2% of the positive results. Coagglutination test is recommended as a rapid test for diagnosing meningococcal meningitis.     

DNA repair profiles of disease-associated isolates of Neisseria meningitidis

Neisseria meningitidis, or the meningococcus, is the source of significant morbidity and mortality in humans worldwide. Even though mutability has been linked to the occurrence of outbreaks of epidemic disease, meningococcal DNA repair pathways are poorly delineated. For the first time, a collection of meningococcal disease-associated isolates has been demonstrated to express constitutively the DNA glycosylases MutY and Fpg in vivo. DNA sequence analysis showed considerable variability in the deduced amino acid sequences of MutS and Fpg, while MutY and RecA were highly conserved. Interestingly, multi-locus sequence typing demonstrated a putative link between the pattern of amino acid substitutions and levels of spontaneous mutagenicity in meningococcal strains. These results provide a basis for further studies aimed at resolving the genotype/phenotype relationships of meningococcal genome variability and mutator activity.     

Adhesion in meningococcus

The adhesive activity of 113 meningococcal strains with different invasive properties and 10 Neisseria nonpathogenic strains have been studied. Adhesive properties have been revealed in 80-82% of these strains. Meningococcal strains isolated from the nasopharynx of carriers possess high hemagglutinating activity. The percentage of cells with pili in these strain was also higher than that in meningococcal strains isolated from the liquor of patients. This shows the presence of direct correlation between the number of pili in the cells (according to the data of electron microscopy) and their activity in the hemagglutination test, which makes it possible to use this test for the determination of the adhesive capacity of meningococci, associated with the presence of pili.     

The reactogenicity and antigenic activity of a meningococcal group B vaccine made from a natural complex of the specific polysaccharide and outer membrane proteins

Group B meningococcal vaccine consisting of the natural complex of specific polysaccharide and outer membrane protein (OMP) has been shown to be moderately reactogenic, safe with respect to the effect of undermining tolerance to human brain tissue antigens and to produce no allergization of humans. The vaccine under study possesses antigenic activity: (a) immunization with this vaccine ensures the fourfold rise of the level of antibodies to the group-specific polysaccharide of group B meningococcus in about 80% of persons with the initially low level of antibodies, this percentage being retained during the whole period of observation, i. e. 85 days; (b) the vaccine enhances the level of antibodies to meningococcal OMP, determined in the enzyme immunoassay and the passive hemagglutination test; (c) these data are indicative of the expediency of immunizing the risk groups of persons with the initially low level of antibodies.