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Interpreting the rising incidence of meningococcal disease in Belgium: the contribution of molecular typing

M. VAN LOOVEREN, D.A. CAUGANT^*, S. CHAPELLE, F. CARION and H. GOOSSENS

Department of Medical Microbiology, University Hospital Antwerp, UIA, Antwerp, Belgium, *World Health Organization Collaborating Centre for Reference and Research on Meningococci, National Institute of Public Health, Oslo, Norway and Department of Bacteriology, Scientific Institute for Public Health-Louis Pasteur, Brussels, Belgium

Corresponding author: Dr M. Van Looveren (e-mail: vloovere{at}uia.ua.ac.be).

Received 15 Jan. 2001; revised manuscript accepted 11 April 2001.

Abstract

During a period of increasing meningococcal disease incidence in Belgium, all 538 serogroup B and all 87 serogroup C strains isolated between 1996 and 1998 were investigated by PCR with the arbitrary primer D8635, which is able to identify lineage III strains. In all, 399 strains (64%) were attributed to lineage III on the basis of PCR-based typing. Since their introduction in the Belgian population in the early 1990s, lineage III strains have become increasingly variable in phenotype. Currently, they are represented by strains belonging to 38 different phenotypes, of which 25 were not found in the period 1990–1995. The 87 serogroup C strains were further investigated by pulsed-field gel electrophoresis (PFGE), and a subset of 30 strains was also investigated by multilocus sequence typing (MLST). Strains of phenotype C:2b:P1.5,2, which currently constitute the majority of the serogroup C strains, were demonstrated to belong to cluster A4. Comparison of the discriminatory ability of D8635-primed PCR, PFGE and MLST revealed that D8635-primed PCR was the least discriminatory method and PFGE the most discriminatory method. However, the MLST data were more readily interpreted than the PFGE fingerprint patterns and can be compared easily with data obtained in other studies. In conclusion, the ongoing increase of meningococcal disease in Belgium could be attributed not only to the further expansion of lineage III, but also to the introduction of C:2b:P1.5,2 strains of cluster A4 in to the Belgian population.

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