Added value of PCR-testing for confirmation of invasive meningococcal disease in England

  • Ellen Heinsbroek
    Affiliations
    European Programme for Intervention Epidemiology Training (EPIET), European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden

    Immunisation, Hepatitis & Blood Safety Department, Public Health England, London, United Kingdom
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  • Shamez Ladhani
    Correspondence
    Corresponding author. Immunisation, Hepatitis & Blood Safety Department, Public Health England, 61 Colindale Avenue, London NW9 5EQ, United Kingdom. Tel.: +44 208 327 7155; fax: +44 20 8327 7404.
    Affiliations
    Immunisation, Hepatitis & Blood Safety Department, Public Health England, London, United Kingdom
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  • Steve Gray
    Affiliations
    Meningococcal Reference Unit, Public Health England, Manchester Medical Microbiology Partnership, Manchester Royal Infirmary, Manchester, United Kingdom
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  • Malcolm Guiver
    Affiliations
    Meningococcal Reference Unit, Public Health England, Manchester Medical Microbiology Partnership, Manchester Royal Infirmary, Manchester, United Kingdom
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  • Ed Kaczmarski
    Affiliations
    Meningococcal Reference Unit, Public Health England, Manchester Medical Microbiology Partnership, Manchester Royal Infirmary, Manchester, United Kingdom
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  • Ray Borrow
    Affiliations
    Meningococcal Reference Unit, Public Health England, Manchester Medical Microbiology Partnership, Manchester Royal Infirmary, Manchester, United Kingdom
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  • Mary Ramsay
    Affiliations
    Immunisation, Hepatitis & Blood Safety Department, Public Health England, London, United Kingdom
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      Summary

      Objectives

      In England, national guidance recommends that all patients with suspected invasive meningococcal disease (IMD) should be investigated by blood culture and polymerase chain reaction (PCR) testing. The Meningococcal Reference Unit (MRU) provides a national service for meningococcal species confirmation and PCR-testing of clinical samples. We performed a population-level assessment of the added value of PCR-testing for IMD to augment traditional culture confirmation.

      Methods

      We analysed all PCR-samples and invasive meningococcal isolates received by MRU in 2009 and 2010. We assumed that all patients with PCR-samples submitted to MRU also had blood cultures performed and that positive blood cultures were referred to MRU. We confirmed this assertion by case ascertainment.

      Results

      In total, 25,379 specimens from 22,039 patients were submitted for PCR-testing and 1492 (6.8%) tested PCR-positive. MRU received 825 invasive meningococcal isolates; 393 confirmed by PCR and culture, 405 without a PCR-specimen submitted and 27 with a PCR-negative result. Thus, of 1924 reported IMD cases, 1099 (57.1%) were confirmed by PCR only, 432 (22.5%) by culture only and 393 (20.4%) by both tests.

      Conclusion

      More than half of all confirmed IMD cases were confirmed by PCR only, indicating this service ensures high case ascertainment for national surveillance.

      Keywords

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