The Stonehouse survey: nasopharyngeal carriage of meningococci and <i>Neisseria lactamica</i>

TLDR

The study collected 6,234 nasopharyngeal swabs from Stonehouse residents in November 1986 to investigate a meningococcal outbreak. Meningococcal carriage was 10.9 %, peaking at 24.5 % in 15‑19 year‑olds and declining thereafter, with a male‑to‑female ratio of 3:2; the outbreak’s sulphonamide‑resistant Group B strains were present in 1.4 % of subjects, showed a similar age pattern but a sharper decline, and varied by school and locality, supporting the idea that they are less transmissible yet more virulent; meanwhile, Neisseria lactamica carriage was most common in children under five and six times higher than meningococcal carriage, with females outnumbering males in older age groups.

Abstract

SUMMARY A total of 6234 nasopharyngeal swabs was collected during a survey of the population of Stonehouse, Gloucestershire in November 1986 as part of an investigation into an outbreak of meningococcal disease. The overall meningococcal carriage rate was 10·9%. The carriage rate rose with age from 2·1% in the 0- to 4-year-olds to a peak of 24·5% in the 15- to 19-year-olds, and thereafter declined steadily with age. Male carriers outnumbered female carriers of meningococci by 3:2. Group B (or non-groupable) type 15 sulphonamide-resistant strains which had caused the outbreak were isolated from 1·4% of subjects. The age distribution of carriers of these strains was similar to that of other meningococci apart from an additional peak in the 5–9-year age group and a more rapid decline in carriage with increasing age. Variations in the carriage rates of the outbreak strain were seen in children attending different schools and in the residents of different areas of the town. The low carriage rate of these strains in a community during a prolonged outbreak supports the hypothesis that these organisms are less transmissible but more virulent than other strains of pathogenic meningococci. Carriage of Neisseria lactamica , which is thought to be important in the development of meningococcal immunity, was most frequent in children under the age of 5 years and was six times commoner in this age group than carriage of Neisseria meningitidis . In older children and adults female carriers of N. lactamica increasingly outnumbered males in contrast to the male preponderance observed with meningococcal carriage.