Infection and Drug Resistance (Dec 2021)

Invasive Meningococcal Disease Remains a Health Threat in Vietnam People’s Army

  • Van CP,
  • Nguyen TT,
  • Bui ST,
  • Nguyen TV,
  • Tran HTT,
  • Pham DT,
  • Trieu LP,
  • Nguyen MD

Journal volume & issue
Vol. Volume 14
pp. 5261 – 5269

Abstract

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Chung Pham Van,1,2,* The Trong Nguyen,2,3,* Sy Tien Bui,2,4 Trong Van Nguyen,2,4 Huyen Thi Thanh Tran,2,5 Dong Trac Pham,6 Long Phi Trieu,7 Manh Dang Nguyen1,2 1Department of Foodborne Infectious Disease, Institute of Clinical Infectious Disease, 108 Military Central Hospital, Hanoi, Vietnam; 2Vietnamese-German Center of Excellence in Medical Research, 108 Military Central Hospital, Hanoi, Vietnam; 3Department of Airborne Infectious Disease and Intensive Care Unit, Institute of Clinical Infectious Disease, 108 Military Central Hospital, Hanoi, Vietnam; 4Department of Microbiology, 108 Military Central Hospital, Hanoi, Vietnam; 5Department of Molecular Biology, 108 Military Central Hospital, Hanoi, Vietnam; 6Military Medical Department, Ministry of National Defense, Hanoi, Vietnam; 7Department of Microbiology, Military Institute of Preventive Medicine, Hanoi, Vietnam*These authors contributed equally to this workCorrespondence: The Trong NguyenDepartment of Airborne Infectious Disease and Intensive Care Unit, Institute of Clinical Infectious Disease, 108 Military Central Hospital, No. 1, Tran Hung Dao Street, Hai Ba Trung District, Hanoi, 11610, VietnamTel +84 964666899Email [email protected]: Despite strict surveillance, Neisseria meningitidis still causes life-threatening invasive meningococcal disease (IMD). The study aimed to describe the prevalence, clinical and subclinical features, and treatment outcomes of IMD among young soldiers of the Vietnam People’s Army.Methods: A prospective, population-based surveillance study was conducted in all Vietnamese military hospitals from January 2014 to June 2021. The presence of Neisseria meningitidis was confirmed by PCR or culture from blood or/and CSF. Epidemiological indices (incidence, serogroups, and distribution of cases by length of service), medical history, clinical and sub-clinical features, and treatment outcomes were documented and analyzed.Results: There were 69 IMD cases (91% serogroup B) documented, mainly in conscripts (91%). The highest annual incidence was 3.33/100,000 soldiers per year. Of these cases, 44% were meningitis (n=30), 19% septicemia (n=13), and 38% meningococcemia (n=26). The most common clinical symptoms were neck stiffness (61 cases, 88%), petechial rash (51%), and shock (20 cases, 29%). Laboratory findings showed leukocytosis in 96% of IMD cases, PCT > 0.05 (ng/mL) in 100%, elevated leukocyte count (> 1,000/mm3) in 71%, and high protein > 1 g/L in 70%. The overall mortality rate was 9%. Two cases were found to be resistant to ceftriaxone. Prognostic factors of severity included petechial rash (OR = 9.82, p < 0.001), septicemia (OR = 5.83, p < 0.001), meningococcemia (OR = 6.22, p < 0.001), low platelet count, prolonged prothrombin time; high PCT (AUC = 0.84, p < 0.001), and increased creatinine (AUC = 0.86, p < 0.001).Conclusion: IMD remains a health threat in the armed forces in Vietnam, especially among new recruits. To the best of our knowledge, this is the first study in Vietnam describing ceftriaxone resistance in Neisseria meningitidis and suggests the need to reconsider standard empiric therapy for IMD.Keywords: meningitis, Neisseria meningitidis, sepsis

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