{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,8]],"date-time":"2026-01-08T06:38:22Z","timestamp":1767854302755,"version":"3.49.0"},"reference-count":66,"publisher":"Springer Science and Business Media LLC","issue":"4","license":[{"start":{"date-parts":[[2023,12,7]],"date-time":"2023-12-07T00:00:00Z","timestamp":1701907200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2023,12,7]],"date-time":"2023-12-07T00:00:00Z","timestamp":1701907200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"name":"Instituto Nacional de Sa\u00fade Dr. Ricardo Jorge"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Int Microbiol"],"abstract":"<jats:title>Abstract<\/jats:title><jats:p>Invasive meningococcal disease (IMD) continues to be a public health problem due to its epidemic potential, affecting mostly children. We aimed to present a detailed description of the epidemiology of IMD in Portugal, including insights into the genetic diversity of <jats:italic>Neisseria meningitidis<\/jats:italic> strains. Epidemiological analysis included data from the Portuguese National Reference Laboratory of <jats:italic>Neisseria meningitidis<\/jats:italic> during 2003 to 2020. Since 2012, <jats:italic>N. meningitidis<\/jats:italic> isolates have also been assessed for their susceptibility to antibiotics and were characterized by whole genome sequencing. During 2003\u20132020, 1392 confirmed cases of IMD were analyzed. A decrease in the annual incidence rate was observed, ranging from 1.99 (2003) to 0.39 (2020), with an average case fatality rate of 7.1%. Serogroup B was the most frequent (69.7%), followed by serogroups C (9.7%), Y (5.7%), and W (2.6%). Genomic characterization of 329 isolates identified 20 clonal complexes (cc), with the most prevalent belonging to serogroup B cc41\/44 (26.3%) and cc213 (16.3%). Isolates belonging to cc11 were predominantly from serogroups W (77.3%) and C (76.5%), whereas cc23 was dominant from serogroup Y (65.7%). Over the past 4\u00a0years (2017\u20132020), we observed an increasing trend of cases assigned to cc213, cc32, and cc11. Regarding antimicrobial susceptibility, all isolates were susceptible to ceftriaxone and 61.8% were penicillin-nonsusceptible, whereas 1.4% and 1.0% were resistant to ciprofloxacin and rifampicin. This is the first detailed study on the epidemiology and genomics of invasive <jats:italic>N. meningitidis<\/jats:italic> infections in Portugal, providing relevant data to public health policy makers for a more effective control of this disease.<\/jats:p>","DOI":"10.1007\/s10123-023-00463-w","type":"journal-article","created":{"date-parts":[[2023,12,7]],"date-time":"2023-12-07T02:01:47Z","timestamp":1701914507000},"page":"1125-1136","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Epidemiology and genetic diversity of invasive Neisseria meningitidis strains circulating in Portugal from 2003 to 2020"],"prefix":"10.1007","volume":"27","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7827-8887","authenticated-orcid":false,"given":"C\u00e9lia","family":"Bettencourt","sequence":"first","affiliation":[]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6449-8053","authenticated-orcid":false,"given":"Alexandra","family":"Nunes","sequence":"additional","affiliation":[]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8316-5035","authenticated-orcid":false,"given":"Paulo","family":"Nogueira","sequence":"additional","affiliation":[]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2943-5975","authenticated-orcid":false,"given":"S\u00edlvia","family":"Duarte","sequence":"additional","affiliation":[]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0864-2572","authenticated-orcid":false,"given":"Catarina","family":"Silva","sequence":"additional","affiliation":[]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2697-2399","authenticated-orcid":false,"given":"Jo\u00e3o Paulo","family":"Gomes","sequence":"additional","affiliation":[]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7514-5923","authenticated-orcid":false,"given":"Maria Jo\u00e3o","family":"Sim\u00f5es","sequence":"additional","affiliation":[]}],"member":"297","published-online":{"date-parts":[[2023,12,7]]},"reference":[{"issue":"1","key":"463_CR1","doi-asserted-by":"publisher","first-page":"53.e1","DOI":"10.1016\/j.anpedi.2020.10.002","volume":"94","author":"FJ \u00c1lvarezGarc\u00eda","year":"2021","unstructured":"\u00c1lvarezGarc\u00eda FJ, Cilleruelo Ortega MJ, \u00c1lvarezAlde\u00e1n J et al (2021) Calendario de vacunaciones de la Asociaci\u00f3n Espa\u00f1ola de Pediatr\u00eda: recomendaciones 2021 [Immunisation schedule of the Pediatric Spanish Association: 2021 recommendations]. An Pediatr (Engl Ed) 94(1):53.e1-53.e10. https:\/\/doi.org\/10.1016\/j.anpedi.2020.10.002","journal-title":"An Pediatr (Engl Ed)"},{"issue":"33","key":"463_CR2","doi-asserted-by":"publisher","first-page":"4772","DOI":"10.1016\/j.vaccine.2022.06.038","volume":"40","author":"C Bettencourt","year":"2022","unstructured":"Bettencourt C, Nogueira P, Gomes JP, Sim\u00f5es MJ (2022a) Vaccines against Neisseria meningitidis serogroup B strains - what does genomics reveal on the Portuguese strain\u2019s coverage. Vaccine 40(33):4772\u20134779. https:\/\/doi.org\/10.1016\/j.vaccine.2022.06.038","journal-title":"Vaccine"},{"issue":"2","key":"463_CR3","doi-asserted-by":"publisher","first-page":"289","DOI":"10.1007\/s10096-021-04371-7","volume":"41","author":"C Bettencourt","year":"2022","unstructured":"Bettencourt C, Nunes A, Gomes JP, Sim\u00f5es MJ (2022b) Genomic surveillance of Neisseria meningitidis serogroup W in Portugal from 2003 to 2019. Eur J Clin Microbiol Infect Dis 41(2):289\u2013298. https:\/\/doi.org\/10.1007\/s10096-021-04371-7","journal-title":"Eur J Clin Microbiol Infect Dis"},{"issue":"41","key":"463_CR4","doi-asserted-by":"publisher","first-page":"4477","DOI":"10.1016\/j.vaccine.2013.07.083","volume":"31","author":"R Borrow","year":"2013","unstructured":"Borrow R, Abad R, Trotter C, van der Klis FR, Vazquez JA, Borrow R, Abad R, Trotter C, van der Klis FR, Vazquez JA (2013) Effectiveness of meningococcal serogroup C vaccine programmes. Vaccine 31(41):4477\u20134486. https:\/\/doi.org\/10.1016\/j.vaccine.2013.07.083","journal-title":"Vaccine"},{"issue":"6","key":"463_CR5","doi-asserted-by":"publisher","first-page":"1725","DOI":"10.4161\/hv.28206","volume":"10","author":"M Br\u00f6ker","year":"2014","unstructured":"Br\u00f6ker M, Bukovski S, Culic D et al (2014) Meningococcal serogroup Y emergence in Europe: high importance in some European regions in 2012. Hum Vaccin Immunother 10(6):1725\u20131728. https:\/\/doi.org\/10.4161\/hv.28206","journal-title":"Hum Vaccin Immunother"},{"issue":"28","key":"463_CR6","doi-asserted-by":"publisher","first-page":"21188","DOI":"10.2807\/1560-7917.ES2015.20.28.21188","volume":"20","author":"H Campbell","year":"2015","unstructured":"Campbell H, Saliba V, Borrow R, Ramsay M, Ladhani SN (2015) Targeted vaccination of teenagers following continued rapid endemic expansion of a single meningococcal group W clone (sequence type 11 clonal complex), United Kingdom 2015. Euro Surveill 20(28):21188. https:\/\/doi.org\/10.2807\/1560-7917.ES2015.20.28.21188","journal-title":"Euro Surveill"},{"issue":"2","key":"463_CR7","doi-asserted-by":"publisher","first-page":"463","DOI":"10.1128\/jcm.01495-08","volume":"47","author":"J Castilla","year":"2009","unstructured":"Castilla J, V\u00e1zquez JA, Salcedo C et al (2009) B:2a:p1.5 meningococcal strains likely arisen from capsular switching event still spreading in Spain. J Clin Microbiol 47(2):463\u2013465. https:\/\/doi.org\/10.1128\/jcm.01495-08","journal-title":"J Clin Microbiol"},{"key":"463_CR8","unstructured":"CDC (2022) Centers for Disease Control and Prevention - meningococcal disease. https:\/\/www.cdc.gov\/meningococcal\/surveillance\/index.html. Accessed 23 May 2022"},{"key":"463_CR9","doi-asserted-by":"publisher","first-page":"237","DOI":"10.2147\/CLEP.S28410","volume":"4","author":"Q Chang","year":"2012","unstructured":"Chang Q, Tzeng YL, Stephens DS (2012) Meningococcal disease: changes in epidemiology and prevention. Clin Epidemiol 4:237\u2013245. https:\/\/doi.org\/10.2147\/CLEP.S28410","journal-title":"Clin Epidemiol"},{"issue":"9","key":"463_CR10","doi-asserted-by":"publisher","first-page":"772","DOI":"10.1038\/ng.640","volume":"42","author":"S Davila","year":"2010","unstructured":"Davila S, Wright VJ, Khor CC et al (2010) Genome-wide association study identifies variants in the CFH region associated with host susceptibility to meningococcal disease. Nat Genet 42(9):772\u2013776. https:\/\/doi.org\/10.1038\/ng.640","journal-title":"Nat Genet"},{"issue":"1","key":"463_CR11","doi-asserted-by":"publisher","first-page":"95","DOI":"10.1093\/jac\/dkw400","volume":"72","author":"AE Deghmane","year":"2017","unstructured":"Deghmane AE, Hong E, Taha MK (2017) Emergence of meningococci with reduced susceptibility to third-generation cephalosporins. J Antimicrob Chemother 72(1):95\u201398. https:\/\/doi.org\/10.1093\/jac\/dkw400","journal-title":"J Antimicrob Chemother"},{"issue":"6","key":"463_CR12","doi-asserted-by":"publisher","first-page":"992","DOI":"10.3390\/antibiotics12060992","volume":"12","author":"AE Deghmane","year":"2023","unstructured":"Deghmane AE, Hong E, Taha MK (2023) Recent evolution of susceptibility to beta-lactams in Neisseria meningitidis. Antibiotics (basel) 12(6):992. https:\/\/doi.org\/10.3390\/antibiotics12060992","journal-title":"Antibiotics (basel)"},{"key":"463_CR13","unstructured":"DGS (2002) Dire\u00e7\u00e3o Geral da Sa\u00fade - Vigil\u00e2ncia Epidemiol\u00f3gica Integrada da Doen\u00e7a Meningoc\u00f3cica. Circular Normativa 13\/DEP. https:\/\/docplayer.com.br\/23677336-Direccao-geral-da-saude-circular-normativa.html. Accessed 22 Nov 2022"},{"key":"463_CR14","unstructured":"DGS (2005) Dire\u00e7\u00e3o Geral da Sa\u00fade - Programa Nacional de Vacina\u00e7\u00e3o 2006. Circular normativa N\u00ba 08\/DT. https:\/\/www.cpjcoimbra.com\/wp-content\/uploads\/2017\/03\/Programa.pdf. Accessed 23 May 2022"},{"key":"463_CR15","unstructured":"DGS (2012) Dire\u00e7\u00e3o Geral da Sa\u00fade - Programa Nacional de Vacina\u00e7\u00e3o PNV 2012: Doen\u00e7a meningoc\u00f3cica pelo serogrupo C e estrat\u00e9gia vacinal. https:\/\/www.dgs.pt\/directrizes-da-dgs\/informacoes\/informacao-n-0042012-de-03022012-atualizacao-de-21022012-jpg.aspx. Accessed 02 Jan 2022"},{"key":"463_CR16","unstructured":"DGS (2020) Dire\u00e7\u00e3o Geral da Sa\u00fade - Programa Nacional de Vacina\u00e7\u00e3o 2020. Norma n\u00ba 018\/2020. https:\/\/www.dgs.pt\/normas-orientacoes-e-informacoes\/normas-e-circulares-normativas\/norma-n-0182020-de-27092020-pdf.aspx. Accessed 23 May 2022"},{"issue":"5","key":"463_CR17","doi-asserted-by":"publisher","first-page":"1146","DOI":"10.1080\/21645515.2018.1451810","volume":"14","author":"AW Dretler","year":"2018","unstructured":"Dretler AW, Rouphael NG, Stephens DS (2018) Progress toward the global control of Neisseria meningitidis: 21st century vaccines, current guidelines, and challenges for future vaccine development. Hum Vaccin Immunother 14(5):1146\u20131160. https:\/\/doi.org\/10.1080\/21645515.2018.1451810","journal-title":"Hum Vaccin Immunother"},{"key":"463_CR18","unstructured":"ECDC (2019) European Centre for Disease Prevention and Control - ECDC strategic framework for the integration of molecular and genomic typing into European surveillance and multi-country outbreak investigations\u20132019\u20132021. https:\/\/www.ecdc.europa.eu\/sites\/default\/files\/documents\/framework-for-genomic-surveillance.pdf. Accessed 22 Nov 2022"},{"key":"463_CR19","unstructured":"ECDC (2022a) European Centre for Disease Prevention and Control - invasive meningococcal disease. In: ECDC Annual epidemiological report for 2018. https:\/\/www.ecdc.europa.eu\/sites\/default\/files\/documents\/AER-Invasive-meningococcal-disease-2018.pdf. Accessed 20 Apr 2022"},{"key":"463_CR20","unstructured":"ECDC (2022b) European Centre for Disease Prevention and Control Surveillance - atlas of infectious diseases. https:\/\/atlas.ecdc.europa.eu\/public\/index.aspx?Dataset=27&HealthTopic=36. Accessed 23 May 2022"},{"issue":"4","key":"463_CR21","doi-asserted-by":"publisher","first-page":"e01409","DOI":"10.1128\/JCM.01409-17","volume":"56","author":"L Eriksson","year":"2018","unstructured":"Eriksson L, Hedberg ST, Jacobsson S, Fredlund H, M\u00f6lling P, Stenmark B (2018) Whole-genome sequencing of emerging invasive Neisseria meningitidis serogroup W in Sweden. J Clin Microbiol 56(4):e01409-e1417. https:\/\/doi.org\/10.1128\/JCM.01409-17","journal-title":"J Clin Microbiol"},{"key":"463_CR22","unstructured":"EUCAST (2020) European Committee on Antimicrobial Susceptibility Testing Breakpoint tables for interpretation of MICs and zone diameters, version 9.0. http:\/\/www.eucast.org\/clinical_breakpoints\/. Accessed 22 Jan 2020"},{"issue":"4","key":"463_CR23","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0250103","volume":"16","author":"P Gon\u00e7alves","year":"2015","unstructured":"Gon\u00e7alves P, S\u00e1ez-L\u00f3pez E, Carneiro S, Sim\u00f5es MJ (2015) Seroprevalence of meningococcal serogroup C bactericidal antibodies in the Portuguese population, a decade after vaccine introduction in the National Immunisation Programme. PLoS One 16(4):e0250103. https:\/\/doi.org\/10.1371\/journal.pone.0250103","journal-title":"PLoS One"},{"issue":"6","key":"463_CR24","doi-asserted-by":"publisher","first-page":"750","DOI":"10.1099\/jmm.0.000743","volume":"67","author":"MC Gorla","year":"2018","unstructured":"Gorla MC, Pinhata JMW, Dias UJ, de Moraes C, Lemos AP (2018) Surveillance of antimicrobial resistance in Neisseria meningitidis strains isolated from invasive cases in Brazil from 2009 to 2016. J Med Microbiol 67(6):750\u2013756. https:\/\/doi.org\/10.1099\/jmm.0.000743","journal-title":"J Med Microbiol"},{"issue":"4","key":"463_CR25","doi-asserted-by":"publisher","first-page":"566","DOI":"10.3201\/eid1904.111799","volume":"19","author":"OB Harrison","year":"2013","unstructured":"Harrison OB, Claus H, Jiang Y et al (2013) Description and nomenclature of Neisseria meningitidis capsule locus. Emerg Infect Dis 19(4):566\u2013573. https:\/\/doi.org\/10.3201\/eid1904.111799","journal-title":"Emerg Infect Dis"},{"key":"463_CR26","doi-asserted-by":"crossref","unstructured":"Ishola DA Jr, Borrow R, Findlow H, Findlow J, Trotter C, Ramsay ME (2012) Prevalence of serum bactericidal antibody to serogroup C Neisseria meningitidis in England a decade after vaccine introduction. Clin Vaccine Immunol 19(8):1126\u20131130. https:\/\/journals.asm.org\/doi\/10.1128\/cvi.05655-11","DOI":"10.1128\/CVI.05655-11"},{"key":"463_CR27","doi-asserted-by":"publisher","first-page":"595","DOI":"10.1186\/1471-2105-11-595","volume":"11","author":"KA Jolley","year":"2010","unstructured":"Jolley KA, Maiden MC (2010) BIGSdb: scalable analysis of bacterial genome variation at the population level. BMC Bioinformatics 11:595. https:\/\/doi.org\/10.1186\/1471-2105-11-595","journal-title":"BMC Bioinformatics"},{"key":"463_CR28","doi-asserted-by":"publisher","unstructured":"Jolley KA, Bray JE, Maiden MCJ (2018) Open-access bacterial population genomics: BIGSdb software, the PubMLST.org website and their applications. Wellcome Open Res 3:124. https:\/\/doi.org\/10.12688\/wellcomeopenres.14826.1","DOI":"10.12688\/wellcomeopenres.14826.1"},{"issue":"5","key":"463_CR29","doi-asserted-by":"publisher","first-page":"588","DOI":"10.1093\/aje\/kwn383","volume":"169","author":"LM Kinlin","year":"2009","unstructured":"Kinlin LM, Spain CV, Ng V, Johnson CC, White AN, Fisman DN (2009) Environmental exposures and invasive meningococcal disease: an evaluation of effects on varying time scales. Am J Epidemiol 169(5):588\u2013595. https:\/\/doi.org\/10.1093\/aje\/kwn383","journal-title":"Am J Epidemiol"},{"issue":"10","key":"463_CR30","doi-asserted-by":"publisher","first-page":"e473","DOI":"10.1016\/S2468-2667(17)30157-3","volume":"2","author":"MJ Knol","year":"2017","unstructured":"Knol MJ, Hahn\u00e9 SJM, Lucidarme J et al (2017) Temporal associations between national outbreaks of meningococcal serogroup W and C disease in the Netherlands and England: an observational cohort study. Lancet Public Health 2(10):e473\u2013e482. https:\/\/doi.org\/10.1016\/S2468-2667(17)30157-3","journal-title":"Lancet Public Health"},{"issue":"16","key":"463_CR31","doi-asserted-by":"publisher","first-page":"18","DOI":"10.2807\/1560-7917.ES.2018.23.16.18-00158","volume":"23","author":"MJ Knol","year":"2018","unstructured":"Knol MJ, Ruijs WL, Antonise-Kamp L, de Melker HE, van der Ende A (2018) Implementation of MenACWY vaccination because of ongoing increase in serogroup W invasive meningococcal disease, the Netherlands. Euro Surveill 23(16):18\u201300158. https:\/\/doi.org\/10.2807\/1560-7917.ES.2018.23.16.18-00158","journal-title":"Euro Surveill"},{"key":"463_CR32","unstructured":"Kwong JC, Gon\u00e7alves da Silva A, Stinear TP, Howden BP, Seemann T (2010) Meningotype: in silico typing for Neisseria meningitidis. GitHub. https:\/\/github.com\/MDU-PHL\/meningotype"},{"issue":"4","key":"463_CR33","doi-asserted-by":"publisher","first-page":"578","DOI":"10.1093\/cid\/ciu881","volume":"60","author":"SN Ladhani","year":"2015","unstructured":"Ladhani SN, Beebeejaun K, Lucidarme J et al (2015) Increase in endemic Neisseria meningitidis capsular group W sequence type 11 complex associated with severe invasive disease in England and Wales. Clin Infect Dis 60(4):578\u2013585. https:\/\/doi.org\/10.1093\/cid\/ciu881","journal-title":"Clin Infect Dis"},{"key":"463_CR34","doi-asserted-by":"publisher","unstructured":"Lahra MM, George CR, Hogan TR (2022) Australian meningococcal surveillance programme annual report, 2021. Commun Dis Intell (2018) 46. https:\/\/doi.org\/10.33321\/cdi.2022.46.46. https:\/\/doi.org\/10.33321\/cdi.2022.46.46","DOI":"10.33321\/cdi.2022.46.46 10.33321\/cdi.2022.46.46"},{"issue":"1","key":"463_CR35","doi-asserted-by":"publisher","first-page":"191","DOI":"10.1016\/j.micinf.2005.06.012","volume":"8","author":"M Lancellotti","year":"2006","unstructured":"Lancellotti M, Guiyoule A, Ruckly C, Hong E, Alonso JM, Taha MK (2006) Conserved virulence of C to B capsule switched Neisseria meningitidis clinical isolates belonging to ET-37\/ST-11 clonal complex. Microbes Infect 8(1):191\u2013196. https:\/\/doi.org\/10.1016\/j.micinf.2005.06.012","journal-title":"Microbes Infect"},{"issue":"7","key":"463_CR36","doi-asserted-by":"publisher","first-page":"618","DOI":"10.1097\/INF.0b013e3181d3ce32","volume":"29","author":"C Levy","year":"2012","unstructured":"Levy C, Taha MK, Weil Olivier C et al (2012) Association of meningococcal phenotypes and genotypes with clinical characteristics and mortality of meningitis in children. Pediatr Infect Dis J 29(7):618\u2013623. https:\/\/doi.org\/10.1097\/INF.0b013e3181d3ce32","journal-title":"Pediatr Infect Dis J"},{"key":"463_CR37","doi-asserted-by":"publisher","unstructured":"Llarena A-K, Ribeiro\u2010Gon\u00e7alves BF, Nuno Silva D et al (2018) INNUENDO: a cross\u2010sectoral platform for the integration of genomics in the surveillance of food\u2010borne pathogens. EFSA Support Publ EN-1498.142 pp. https:\/\/doi.org\/10.2903\/sp.efsa.2018.EN-1498","DOI":"10.2903\/sp.efsa.2018.EN-1498"},{"issue":"2","key":"463_CR38","doi-asserted-by":"publisher","first-page":"98","DOI":"10.1080\/1120009X.2020.1723967","volume":"32","author":"L Lodi","year":"2020","unstructured":"Lodi L, Rubino C, Ricci S et al (2020) Neisseria meningitidis with H552Y substitution on rpoB gene shows attenuated behavior in vivo: report of a rifampicin-resistant case following chemoprophylaxis. J Chemother 32(2):98\u2013102. https:\/\/doi.org\/10.1080\/1120009X.2020.1723967","journal-title":"J Chemother"},{"issue":"5","key":"463_CR39","doi-asserted-by":"publisher","first-page":"544","DOI":"10.1016\/j.jinf.2015.07.007","volume":"71","author":"J Lucidarme","year":"2015","unstructured":"Lucidarme J, Hill DM, Bratcher HB et al (2015) Genomic resolution of an aggressive, widespread, diverse and expanding meningococcal serogroup B, C and W lineage. J Infect 71(5):544\u2013552. https:\/\/doi.org\/10.1016\/j.jinf.2015.07.007","journal-title":"J Infect"},{"issue":"2","key":"463_CR40","doi-asserted-by":"publisher","first-page":"95","DOI":"10.1016\/j.jinf.2017.05.015","volume":"75","author":"J Lucidarme","year":"2017","unstructured":"Lucidarme J, Lekshmi A, Parikh SR et al (2017) Frequent capsule switching in \u2018ultra-virulent\u2019 meningococci - are we ready for a serogroup B ST-11 complex outbreak? J Infect 75(2):95\u2013103. https:\/\/doi.org\/10.1016\/j.jinf.2017.05.015","journal-title":"J Infect"},{"issue":"1","key":"463_CR41","doi-asserted-by":"publisher","first-page":"43","DOI":"10.1186\/s13073-023-01196-1","volume":"15","author":"V Mix\u00e3o","year":"2023","unstructured":"Mix\u00e3o V, Pinto M, Sobral D, Di Pasquale A, Gomes JP, Borges V (2023) ReporTree: a surveillance-oriented tool to strengthen the linkage between pathogen genetic clusters and epidemiological data. Genome Med 15(1):43. https:\/\/doi.org\/10.1186\/s13073-023-01196-1","journal-title":"Genome Med"},{"issue":"10","key":"463_CR42","doi-asserted-by":"publisher","first-page":"1447","DOI":"10.1016\/j.ebiom.2015.09.007","volume":"2","author":"MM Mustapha","year":"2015","unstructured":"Mustapha MM, Marsh JW, Krauland MG et al (2015) Genomic epidemiology of hypervirulent serogroup W, ST-11 Neisseria meningitidis. EBioMedicine 2(10):1447\u20131455. https:\/\/doi.org\/10.1016\/j.ebiom.2015.09.007","journal-title":"EBioMedicine"},{"issue":"4","key":"463_CR43","doi-asserted-by":"publisher","first-page":"569","DOI":"10.1007\/s40121-019-00262-9","volume":"8","author":"AR Muttalif","year":"2019","unstructured":"Muttalif AR, Presa JV, Haridy H, Gamil A, Serra LC, Can\u00e9 A (2019) Incidence and prevention of invasive meningococcal disease in global mass gathering events. Infect Dis Ther 8(4):569\u2013579. https:\/\/doi.org\/10.1007\/s40121-019-00262-9","journal-title":"Infect Dis Ther"},{"key":"463_CR44","doi-asserted-by":"publisher","unstructured":"Nadel S (2016) Treatment of meningococcal disease. J Adolesc Health 59(2 Suppl):S21\u2013S28. https:\/\/doi.org\/10.1016\/j.jadohealth.2016.04.013","DOI":"10.1016\/j.jadohealth.2016.04.013"},{"issue":"6","key":"463_CR45","doi-asserted-by":"publisher","first-page":"e370","DOI":"10.1016\/S2214-109X(16)30064-X","volume":"4","author":"J Paireau","year":"2016","unstructured":"Paireau J, Chen A, Broutin H, Grenfell B, Basta NE (2016) Seasonal dynamics of bacterial meningitis: a time-series analysis. Lancet Glob Health 4(6):e370\u2013e377. https:\/\/doi.org\/10.1016\/S2214-109X(16)30064-X","journal-title":"Lancet Glob Health"},{"key":"463_CR46","doi-asserted-by":"publisher","unstructured":"Pelton SI (2016) The global evolution of meningococcal epidemiology following the introduction of meningococcal vaccines. J Adolesc Health 59(2Suppl):S3\u2013S11. https:\/\/doi.org\/10.1016\/j.jadohealth.2016.04.012","DOI":"10.1016\/j.jadohealth.2016.04.012"},{"key":"463_CR47","unstructured":"PORDATA (2021) Estat\u00edsticas sobre Portugal e Europa. https:\/\/www.pordata.pt\/. Accessed 22 Jan 2022"},{"issue":"11","key":"463_CR48","doi-asserted-by":"publisher","first-page":"1871","DOI":"10.1093\/infdis\/jiac046","volume":"225","author":"CC Potts","year":"2022","unstructured":"Potts CC, Rodriguez-Rivera LD, Retchless AC et al (2022) Antimicrobial susceptibility survey of invasive Neisseria meningitidis, United States 2012\u20132016. J Infect Dis 225(11):1871\u20131875. https:\/\/doi.org\/10.1093\/infdis\/jiac046","journal-title":"J Infect Dis"},{"key":"463_CR49","unstructured":"Prata F, Cabral M, Ventura L, Ferreira PR, Brito MJ (2013) Meningites bacterianas. Recomenda\u00e7\u00f5es da Sociedade de Infecciologia Pedi\u00e1trica e da Sociedade de Cuidados Intensivos Pedi\u00e1tricos da Sociedade Portuguesa de Pediatria. https:\/\/www.spp.pt\/UserFiles\/file\/Protocolos_SPP\/Meningites_Agudas_Bacterianas_Protocolo.pdf. Accessed 02 Jan 2022"},{"key":"463_CR50","doi-asserted-by":"publisher","first-page":"1378","DOI":"10.1056\/NEJM200105033441807","volume":"344","author":"NE Rosenstein","year":"2001","unstructured":"Rosenstein NE, Perkins BA, Stephens DS, Popovic T, Hughes JM (2001) Meningococcal disease. N Engl J Med 344:1378\u20131388. https:\/\/doi.org\/10.1056\/NEJM200105033441807","journal-title":"N Engl J Med"},{"issue":"5","key":"463_CR51","doi-asserted-by":"publisher","first-page":"1753","DOI":"10.1128\/aac.49.5.1753-1760.2005","volume":"49","author":"TR Shultz","year":"2005","unstructured":"Shultz TR, White PA, Tapsall JW (2005) In vitro assessment of the further potential for development of fluoroquinolone resistance in Neisseria meningitidis. Antimicrob Agents Chemother 49(5):1753\u20131760. https:\/\/doi.org\/10.1128\/aac.49.5.1753-1760.2005","journal-title":"Antimicrob Agents Chemother"},{"key":"463_CR52","unstructured":"Sim\u00f5es MJ (2012) Sistema Din\u00e2mico da Doen\u00e7a Meningoc\u00f3cica em Portugal: caracteriza\u00e7\u00e3o e modelo de transmiss\u00e3o. Dissertation, Universidade de Lisboa, Faculdade de Farm\u00e1cia. https:\/\/repositorio.ul.pt\/handle\/10451\/7453"},{"key":"463_CR53","unstructured":"Sim\u00f5es MJ, Martins JV (2020) Doen\u00e7a invasiva meningoc\u00f3cica em Portugal. Vigil\u00e2ncia epidemiol\u00f3gica integrada, 2007\u20132016: relat\u00f3rio anual da Rede de Laborat\u00f3rios VigLab Doen\u00e7a Meningoc\u00f3cica. Instituto Nacional de Sa\u00fade Doutor Ricardo Jorge, IP. http:\/\/repositorio.insa.pt\/handle\/10400.18\/7024"},{"issue":"6","key":"463_CR54","doi-asserted-by":"publisher","first-page":"1195","DOI":"10.1017\/S0950268806006248","volume":"134","author":"I Smith","year":"2006","unstructured":"Smith I, Caugant DA, H\u00f8iby EA, Wentzel-Larsen T, Halstensen A (2006) High case-fatality rates of meningococcal disease in Western Norway caused by serogroup C strains belonging to both sequence type (ST)-32 and ST-11 complexes, 1985\u20132002. Epidemiol Infect 134(6):1195\u20131202. https:\/\/doi.org\/10.1017\/S0950268806006248","journal-title":"Epidemiol Infect"},{"key":"463_CR55","unstructured":"SPP (2018) Sociedade Portuguesa de Pediatria e a Comiss\u00e3o de Vacinas da Sociedade de Infeciologia Pedi\u00e1trica - recomenda\u00e7\u00f5es sobre vacinas extra Programa Nacional de Vacina\u00e7\u00e3o. http:\/\/criancaefamilia.spp.pt\/media\/127910\/Vacinas-extra-PNV-RecomendaCOes-SIP-SPP-2018.pdf. Accessed 23 May 2022"},{"issue":"1","key":"463_CR56","doi-asserted-by":"publisher","first-page":"111.e1","DOI":"10.1016\/j.cmi.2018.07.014","volume":"25","author":"P Stefanelli","year":"2019","unstructured":"Stefanelli P, Fazio C, Vacca P et al (2019) An outbreak of severe invasive meningococcal disease due to a capsular switched Neisseria meningitidis hypervirulent strain B:cc11. Clin Microbiol Infect 25(1):111.e1-111.e4. https:\/\/doi.org\/10.1016\/j.cmi.2018.07.014","journal-title":"Clin Microbiol Infect"},{"key":"463_CR57","doi-asserted-by":"crossref","unstructured":"Stephens DS, Apicella MA (2015) Neisseria meningitidis. In: Mandell, Douglas, and Bennett\u2019s principles and practice of infectious diseases (8th edition). Elsevier Saunders Philadelphia, pp 2425\u20132445","DOI":"10.1016\/B978-1-4557-4801-3.00213-7"},{"issue":"1","key":"463_CR58","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pmed.0020006","volume":"2","author":"B Sultan","year":"2005","unstructured":"Sultan B, Labadi K, Gu\u00e9gan JF, Janicot S (2005) Climate drives the meningitis epidemics onset in west Africa. PLoS Med 2(1):e6. https:\/\/doi.org\/10.1371\/journal.pmed.0020006","journal-title":"PLoS Med"},{"issue":"8","key":"463_CR59","doi-asserted-by":"publisher","first-page":"2784","DOI":"10.1128\/AAC.00412-07","volume":"51","author":"MK Taha","year":"2007","unstructured":"Taha MK, V\u00e1zquez JA, Hong E et al (2007) Target gene sequencing to characterize the penicillin G susceptibility of Neisseria meningitidis. Antimicrob Agents Chemother 51(8):2784\u20132792. https:\/\/doi.org\/10.1128\/AAC.00412-07","journal-title":"Antimicrob Agents Chemother"},{"issue":"6","key":"463_CR60","doi-asserted-by":"publisher","first-page":"687","DOI":"10.1016\/s1286-4579(00)00356-7","volume":"2","author":"YL Tzeng","year":"2000","unstructured":"Tzeng YL, Stephens DS (2000) Epidemiology and pathogenesis of Neisseria meningitidis. Microbes Infect 2(6):687\u2013700. https:\/\/doi.org\/10.1016\/s1286-4579(00)00356-7","journal-title":"Microbes Infect"},{"key":"463_CR61","doi-asserted-by":"crossref","unstructured":"Vacca P, Fazio C, Neri A, Ambrosio L, Palmieri A, Stefanelli P (2018) Neisseria meningitidis Antimicrobial Resistance in Italy, 2006 to 2016. Antimicrob Agents Chemother 62(9):e00207\u201318. Published 2018 Aug 27. https:\/\/journals.asm.org\/doi\/10.1128\/aac.00207-18","DOI":"10.1128\/AAC.00207-18"},{"issue":"5","key":"463_CR62","doi-asserted-by":"publisher","first-page":"1203","DOI":"10.1080\/21645515.2018.1451287","volume":"14","author":"S Vuocolo","year":"2018","unstructured":"Vuocolo S, Balmer P, Gruber WC et al (2018) Vaccination strategies for the prevention of meningococcal disease. Hum Vaccin Immunother 14(5):1203\u20131215. https:\/\/doi.org\/10.1080\/21645515.2018.1451287","journal-title":"Hum Vaccin Immunother"},{"issue":"5","key":"463_CR63","doi-asserted-by":"publisher","first-page":"23","DOI":"10.2807\/1560-7917.ES.2016.21.5.30125","volume":"21","author":"S Vygen","year":"2016","unstructured":"Vygen S, Hellenbrand W, Stefanoff P, Hanquet G, Heuberger S, Stuart J (2016) European public health policies for managing contacts of invasive meningococcal disease cases better harmonised in 2013 than in 2007. Euro Surveill 21(5):23\u201331. https:\/\/doi.org\/10.2807\/1560-7917.ES.2016.21.5.30125","journal-title":"Euro Surveill"},{"key":"463_CR64","unstructured":"WHO (2011) World Health Organization & Centers for Disease Control and Prevention (U.S.) - laboratory methods for the diagnosis of meningitis caused by Neisseria meningitidis, Streptococcus pneumoniae, and Haemophilus influenzae: WHO manual, 2nd ed. https:\/\/apps.who.int\/iris\/handle\/10665\/70765. Accessed 22 Nov 2022"},{"key":"463_CR65","unstructured":"WHO (2022) World Health Organization - meningococcal meningitis. https:\/\/www.who.int\/news-room\/fact-sheets\/detail\/meningitis. Accessed 11 Apr 2022"},{"issue":"11","key":"463_CR66","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0260677","volume":"16","author":"L Willerton","year":"2021","unstructured":"Willerton L, Lucidarme J, Walker A et al (2021) Antibiotic resistance among invasive Neisseria meningitidis isolates in England, Wales, and Northern Ireland (2010\/11 to 2018\/19). PLoS ONE 16(11):e0260677. https:\/\/doi.org\/10.1371\/journal.pone.0260677","journal-title":"PLoS ONE"}],"container-title":["International Microbiology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s10123-023-00463-w.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s10123-023-00463-w\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s10123-023-00463-w.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,8,5]],"date-time":"2024-08-05T12:21:01Z","timestamp":1722860461000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s10123-023-00463-w"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,12,7]]},"references-count":66,"journal-issue":{"issue":"4","published-online":{"date-parts":[[2024,8]]}},"alternative-id":["463"],"URL":"https:\/\/doi.org\/10.1007\/s10123-023-00463-w","relation":{},"ISSN":["1618-1905"],"issn-type":[{"value":"1618-1905","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,12,7]]},"assertion":[{"value":"25 August 2023","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"20 November 2023","order":2,"name":"revised","label":"Revised","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"27 November 2023","order":3,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"7 December 2023","order":4,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"All patient data associated with each <i>Neisseria meningitidis<\/i> isolate were fully anonymized.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval"}},{"value":"The authors declare no competing interests.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}]}}