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

Chung Pham Van; The Trong Nguyen; Sy Tien Bui; Trong Van Nguyen; Huyen Thi Thanh Tran; Dong Trac Pham; Long Phi Trieu; Manh Dang Nguyen

doi:10.2147/IDR.S339110

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

Infect Drug Resist. 2021 Dec 8:14:5261-5269. doi: 10.2147/IDR.S339110. eCollection 2021.

Authors

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 Pham⁶, Long Phi Trieu⁷, Manh Dang Nguyen^{1

2}

Affiliations

¹ Department of Foodborne Infectious Disease, Institute of Clinical Infectious Disease, 108 Military Central Hospital, Hanoi, Vietnam.
² Vietnamese-German Center of Excellence in Medical Research, 108 Military Central Hospital, Hanoi, Vietnam.
³ Department of Airborne Infectious Disease and Intensive Care Unit, Institute of Clinical Infectious Disease, 108 Military Central Hospital, Hanoi, Vietnam.
⁴ Department of Microbiology, 108 Military Central Hospital, Hanoi, Vietnam.
⁵ Department of Molecular Biology, 108 Military Central Hospital, Hanoi, Vietnam.
⁶ Military Medical Department, Ministry of National Defense, Hanoi, Vietnam.
⁷ Department of Microbiology, Military Institute of Preventive Medicine, Hanoi, Vietnam.

^# Contributed equally.

Abstract

Objective: 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: Neisseria meningitidis; meningitis; sepsis.