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Comparative long-term adverse effects elicited by invasive group B and C meningococcal infections

Gottfredsson, Magnus; Reynisson, Ingi K; Ingvarsson, Ragnar F LU ; Kristjansdottir, Hafrun; Nardini, Martina V; Sigurdsson, Jon F; Schneerson, Rachel; Robbins, John B and Miller, Mark A (2011) In Clinical Infectious Diseases 53(9). p.24-117
Abstract

BACKGROUND: Given the identity between Neisseria meningitidis serogroup B (MenB) capsular polysaccharide (polysialic acid; PSA) and PSA found on neural cell adhesion molecules, it has been proposed that infection with MenB or vaccination with PSA may be associated with subsequent autoimmune or neurological disease.

METHODS: We conducted 2 studies. The first was a retrospective nationwide study of invasive meningococcal disease (IMD) in Iceland (with 541 subjects) during the period 1975-2004, and we cross referenced this cohort with databases with respect to subsequent diagnosis of autoimmune disorders. A follow-up study involving 120 survivors of IMD was performed. The study included 70 patients with a history of MenB and 50... (More)

BACKGROUND: Given the identity between Neisseria meningitidis serogroup B (MenB) capsular polysaccharide (polysialic acid; PSA) and PSA found on neural cell adhesion molecules, it has been proposed that infection with MenB or vaccination with PSA may be associated with subsequent autoimmune or neurological disease.

METHODS: We conducted 2 studies. The first was a retrospective nationwide study of invasive meningococcal disease (IMD) in Iceland (with 541 subjects) during the period 1975-2004, and we cross referenced this cohort with databases with respect to subsequent diagnosis of autoimmune disorders. A follow-up study involving 120 survivors of IMD was performed. The study included 70 patients with a history of MenB and 50 patients with N. meningitidis serogroup C (MenC) infection, who served as control subjects. Participants answered standardized questionnaires (Beck's Depression Inventory [BDI] II, Depression Anxiety Stress Scales [DASS], and Patient Health Questionnaire [PHQ]), and serum levels of immunoglobulin (Ig) G against MenB and MenC capsular polysaccharides were measured.

RESULTS: The nationwide cohort had 9166 patient-years of follow up. No evidence of increased autoimmunity was found to be associated with MenB, compared with MenC. In the follow-up study, patients were evaluated 16.6 years after the infection, representing 2022 patient-years of observation. Comparable rates of most complications were recorded, but MenC infections were associated with arthritis (P = .008) and migraine headaches (P = .01) more frequently than were MenB infections. No difference was observed with respect to scores on BDI-II, DASS, or PHQ. IgG anti-MenB and anti-MenC capsular polysaccharide levels were not related to patient complaints.

CONCLUSIONS: This study does not support the hypothesis that MenB infection may predispose to autoimmunity. MenC infections are associated with a higher prevalence of arthritis and migraine headaches. No evidence of antibody-associated pathology was detected at long-term follow-up.

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published
subject
keywords
Adolescent, Adult, Antibodies, Bacterial, Arthritis, Autoimmune Diseases, Child, Child, Preschool, Female, Follow-Up Studies, Humans, Iceland, Immunoglobulin G, Male, Meningitis, Meningococcal, Middle Aged, Migraine Disorders, Nervous System Diseases, Retrospective Studies, Surveys and Questionnaires, Young Adult, Journal Article, Research Support, N.I.H., Extramural, Research Support, Non-U.S. Gov't
in
Clinical Infectious Diseases
volume
53
issue
9
pages
24 - 117
publisher
The Infectious Diseases Society of America
external identifiers
  • scopus:80054086305
ISSN
1537-6591
DOI
10.1093/cid/cir500
language
English
LU publication?
no
id
afedfabc-24ac-4c32-a850-7551cec6aaff
date added to LUP
2018-04-26 09:55:56
date last changed
2019-05-21 04:04:37
@article{afedfabc-24ac-4c32-a850-7551cec6aaff,
  abstract     = {<p>BACKGROUND: Given the identity between Neisseria meningitidis serogroup B (MenB) capsular polysaccharide (polysialic acid; PSA) and PSA found on neural cell adhesion molecules, it has been proposed that infection with MenB or vaccination with PSA may be associated with subsequent autoimmune or neurological disease.</p><p>METHODS: We conducted 2 studies. The first was a retrospective nationwide study of invasive meningococcal disease (IMD) in Iceland (with 541 subjects) during the period 1975-2004, and we cross referenced this cohort with databases with respect to subsequent diagnosis of autoimmune disorders. A follow-up study involving 120 survivors of IMD was performed. The study included 70 patients with a history of MenB and 50 patients with N. meningitidis serogroup C (MenC) infection, who served as control subjects. Participants answered standardized questionnaires (Beck's Depression Inventory [BDI] II, Depression Anxiety Stress Scales [DASS], and Patient Health Questionnaire [PHQ]), and serum levels of immunoglobulin (Ig) G against MenB and MenC capsular polysaccharides were measured.</p><p>RESULTS: The nationwide cohort had 9166 patient-years of follow up. No evidence of increased autoimmunity was found to be associated with MenB, compared with MenC. In the follow-up study, patients were evaluated 16.6 years after the infection, representing 2022 patient-years of observation. Comparable rates of most complications were recorded, but MenC infections were associated with arthritis (P = .008) and migraine headaches (P = .01) more frequently than were MenB infections. No difference was observed with respect to scores on BDI-II, DASS, or PHQ. IgG anti-MenB and anti-MenC capsular polysaccharide levels were not related to patient complaints.</p><p>CONCLUSIONS: This study does not support the hypothesis that MenB infection may predispose to autoimmunity. MenC infections are associated with a higher prevalence of arthritis and migraine headaches. No evidence of antibody-associated pathology was detected at long-term follow-up.</p>},
  author       = {Gottfredsson, Magnus and Reynisson, Ingi K and Ingvarsson, Ragnar F and Kristjansdottir, Hafrun and Nardini, Martina V and Sigurdsson, Jon F and Schneerson, Rachel and Robbins, John B and Miller, Mark A},
  issn         = {1537-6591},
  keyword      = {Adolescent,Adult,Antibodies, Bacterial,Arthritis,Autoimmune Diseases,Child,Child, Preschool,Female,Follow-Up Studies,Humans,Iceland,Immunoglobulin G,Male,Meningitis, Meningococcal,Middle Aged,Migraine Disorders,Nervous System Diseases,Retrospective Studies,Surveys and Questionnaires,Young Adult,Journal Article,Research Support, N.I.H., Extramural,Research Support, Non-U.S. Gov't},
  language     = {eng},
  number       = {9},
  pages        = {24--117},
  publisher    = {The Infectious Diseases Society of America},
  series       = {Clinical Infectious Diseases},
  title        = {Comparative long-term adverse effects elicited by invasive group B and C meningococcal infections},
  url          = {http://dx.doi.org/10.1093/cid/cir500},
  volume       = {53},
  year         = {2011},
}