{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,25]],"date-time":"2026-09-25T01:45:33Z","timestamp":1790300733968,"version":"4.1.0"},"reference-count":53,"publisher":"National Academy of Sciences","issue":"21","license":[{"start":{"date-parts":[[2018,5,7]],"date-time":"2018-05-07T00:00:00Z","timestamp":1525651200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["www.pnas.org"],"crossmark-restriction":true},"short-container-title":["Proc. Natl. Acad. Sci. U.S.A."],"published-print":{"date-parts":[[2018,5,22]]},"abstract":"<jats:title>Significance<\/jats:title>\n                  <jats:p>\n                    Historically,\n                    <jats:italic>Neisseria meningitidis<\/jats:italic>\n                    serogroup A strains have caused large epidemics of meningitis across sub-Saharan Africa. Following mass vaccination from 2010, serogroup A outbreaks have been mostly eliminated. Starting in 2013 however, yearly epidemics of a previously unknown serogroup C strain have led to tens of thousands of cases in Nigeria and Niger. We show how this new strain evolved from a benign ancestor through the acquisition of virulence genes encoding the serogroup C capsule and a phage linked to invasiveness, illustrating that minor genetic changes in a microbe can have major public health consequences. Our reconstruction of the spatiotemporal outbreak dynamics in the Niger\u2013Nigeria border region suggests direct epidemiological consequences of contrasting outbreak responses in the two countries.\n                  <\/jats:p>","DOI":"10.1073\/pnas.1802298115","type":"journal-article","created":{"date-parts":[[2018,5,7]],"date-time":"2018-05-07T15:25:44Z","timestamp":1525706744000},"page":"5510-5515","update-policy":"https:\/\/doi.org\/10.1073\/pnas.cm10313","source":"Crossref","is-referenced-by-count":53,"title":["Acquisition of virulence genes by a carrier strain gave rise to the ongoing epidemics of meningococcal disease in West Africa"],"prefix":"10.1073","volume":"115","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7566-4133","authenticated-orcid":false,"given":"Ola Br\u00f8nstad","family":"Brynildsrud","sequence":"first","affiliation":[{"name":"Division for Infection Control and Environmental Health, Norwegian Institute of Public Health, 0456 Oslo, Norway;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6721-3375","authenticated-orcid":false,"given":"Vegard","family":"Eldholm","sequence":"additional","affiliation":[{"name":"Division for Infection Control and Environmental Health, Norwegian Institute of Public Health, 0456 Oslo, Norway;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jon","family":"Bohlin","sequence":"additional","affiliation":[{"name":"Division for Infection Control and Environmental Health, Norwegian Institute of Public Health, 0456 Oslo, Norway;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kennedy","family":"Uadiale","sequence":"additional","affiliation":[{"name":"Nigeria Emergency Response Unit, M\u00e9decins sans Fronti\u00e8res, Sokoto, Nigeria;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stephen","family":"Obaro","sequence":"additional","affiliation":[{"name":"Division of Pediatric Infectious Diseases, University of Nebraska Medical Center, Omaha, NE 68198;"},{"name":"International Foundation Against Infectious Disease in Nigeria, Abuja, Nigeria;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2765-9844","authenticated-orcid":false,"given":"Dominique A.","family":"Caugant","sequence":"additional","affiliation":[{"name":"Division for Infection Control and Environmental Health, Norwegian Institute of Public Health, 0456 Oslo, Norway;"},{"name":"WHO Collaborating Centre for Reference and Research on Meningococci, Norwegian Institute of Public Health, 0456 Oslo, Norway;"},{"name":"Department of Community Medicine, Faculty of Medicine, University of Oslo, 0372 Oslo, Norway"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"341","published-online":{"date-parts":[[2018,5,7]]},"reference":[{"key":"e_1_3_4_1_2","doi-asserted-by":"crossref","first-page":"21","DOI":"10.1007\/978-1-61779-346-2_2","article-title":"Classification and pathogenesis of meningococcal infections","volume":"799","author":"Brandtzaeg P","year":"2012","unstructured":"P Brandtzaeg, M van Deuren, Classification and pathogenesis of meningococcal infections. Methods Mol Biol 799, 21\u201335 (2012).","journal-title":"Methods Mol Biol"},{"key":"e_1_3_4_2_2","doi-asserted-by":"crossref","first-page":"821","DOI":"10.1099\/jmm.0.45529-0","article-title":"Neisseria meningitidis: An overview of the carriage state","volume":"53","author":"Yazdankhah SP","year":"2004","unstructured":"SP Yazdankhah, DA Caugant, Neisseria meningitidis: An overview of the carriage state. J Med Microbiol 53, 821\u2013832 (2004).","journal-title":"J Med Microbiol"},{"key":"e_1_3_4_3_2","doi-asserted-by":"crossref","first-page":"3","DOI":"10.1111\/j.1574-6976.2006.00051.x","article-title":"Conquering the meningococcus","volume":"31","author":"Stephens DS","year":"2007","unstructured":"DS Stephens, Conquering the meningococcus. FEMS Microbiol Rev 31, 3\u201314 (2007).","journal-title":"FEMS Microbiol Rev"},{"key":"e_1_3_4_4_2","doi-asserted-by":"crossref","first-page":"566","DOI":"10.3201\/eid1904.111799","article-title":"Description and nomenclature of Neisseria meningitidis capsule locus","volume":"19","author":"Harrison OB","year":"2013","unstructured":"OB Harrison, , Description and nomenclature of Neisseria meningitidis capsule locus. Emerg Infect Dis 19, 566\u2013573 (2013).","journal-title":"Emerg Infect Dis"},{"key":"e_1_3_4_5_2","doi-asserted-by":"crossref","first-page":"68","DOI":"10.1016\/j.mib.2014.11.006","article-title":"Neisseria meningitidis: Pathogenesis and immunity","volume":"23","author":"Pizza M","year":"2015","unstructured":"M Pizza, R Rappuoli, Neisseria meningitidis: Pathogenesis and immunity. Curr Opin Microbiol 23, 68\u201372 (2015).","journal-title":"Curr Opin Microbiol"},{"key":"e_1_3_4_6_2","doi-asserted-by":"crossref","first-page":"341","DOI":"10.1016\/S0035-9203(99)90106-2","article-title":"Manson lecture. Meningococcal meningitis in Africa","volume":"93","author":"Greenwood B","year":"1999","unstructured":"B Greenwood, Manson lecture. Meningococcal meningitis in Africa. Trans R Soc Trop Med Hyg 93, 341\u2013353 (1999).","journal-title":"Trans R Soc Trop Med Hyg"},{"key":"e_1_3_4_7_2","doi-asserted-by":"crossref","first-page":"657","DOI":"10.1086\/511646","article-title":"Meningococcal meningitis: Unprecedented incidence of serogroup X-related cases in 2006 in Niger","volume":"44","author":"Boisier P","year":"2007","unstructured":"P Boisier, , Meningococcal meningitis: Unprecedented incidence of serogroup X-related cases in 2006 in Niger. 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