Recent emergence of serogroup C meningococcal disease in Greece

The number of cases of meningococcal disease reported to the Meningitis Ref erence Laboratory in Athens rose dramatically in 1996= 1997. The aims were (1) to determine if the increase was due to introduction of new strains, (2 ) to assess the geographic and age distribution of the cases, (3) to compar e antibiotic sensitivity patterns of the current isolates with strains from the early 1990s. In 1993-1994, 15/19 (74%) of the cases for which informat ion on age was available were in children less than or equal to 5 years; in 1995-1997, 80/179 (45%) of cases were in children less than or equal to 5 years and 99 (55%) in the older age range (P < 0.02). From 593 cases in 199 3-1997, 214 (36%) isolates were available for characterisation. Serogroup B was predominant in the early 1990s, but by 1997, serogroup C accounted for 46/72 (64%) of isolates and serogroup B for 25/72 (35%). Serogroup B was p redominant in children less than or equal to 5 years (44/78, 56%) but only 19/99 (18%) of older children and adults (P= 0.0000005). Sulfonamide resist ance decreased from 10/22 (45%) in 1993-1994 to 27/192 (14%) in 1995-1997 ( P < 0.01), multilocus enzyme electrophoresis of 70 strains obtained during this period identified the epidemic ET-15 clone in 24 (34.3)%. The profiles of the Greek ET-15 isolates were identical to C:2a:P1.2(P1.5) strains resp onsible for the epidemic in the Czech Republic which began in 1993, This ge notype was not found in Greek strains isolated prior to 1993, We conclude t hat the increase in meningococcal disease is due to introduction of the epi demic serogroup C:2a:P1.2(P1.5) strain responsible for disease in the Czech Republic and Canada. (C) 1999 Federation of European Microbiological Socie ties. Published by Elsevier Science B.V. All rights reserved.