{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T07:29:20Z","timestamp":1787038160193,"version":"build-2736575974"},"reference-count":30,"publisher":"Oxford University Press (OUP)","issue":"8","license":[{"start":{"date-parts":[[2026,8,6]],"date-time":"2026-08-06T00:00:00Z","timestamp":1785974400000},"content-version":"vor","delay-in-days":5,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,8,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Invasive meningococcal disease (IMD) remains a major cause of mortality worldwide, yet its dynamics in the Brazilian Amazon are poorly understood. Following the COVID-19 pandemic, serogroup B IMD resurged in Brazil, raising concerns about changing transmission patterns in regions with limited healthcare access.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We conducted an epidemiological and genomic investigation of an ongoing IMD outbreak in Par\u00e1 State, Brazilian Amazon, between 2023 and 2025. Clinical, demographic, and outcome data were integrated with whole-genome sequencing of 69 isolates. Multivariate logistic regression identified independent predictors of mortality, and phylogenomic analyses characterized transmission dynamics and clonal expansion.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>A total of 343 IMD cases were identified, of which 321 (93.6%) were caused by serogroup B, resulting 34 deaths (case-fatality rate, 10.6%). Incidence increased up to 5-fold compared with national rates and disproportionately affected young children and adults. Mortality was independently associated with meningococcemia (adjusted odds ratio, 84.52; 95% confidence interval, 5.70\u20131253.65; P = .001); however, this finding should be interpreted with caution due to the small number of meningococcemia cases. Genomic analysis identified a predominant ST-7983\/cc60 lineage, accounting for 64 of 69 sequenced isolates (92.7%). This lineage displayed limited genetic diversity (median, 7 single nucleotide polymorphisms), consistent with sustained regional transmission across multiple municipalities.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>A highly clonal serogroup B meningococcal outbreak emerged in the Brazilian Amazon following the COVID-19 pandemic, with substantial mortality and rapid geographic spread. These findings highlight the importance of strengthened genomic surveillance and support targeted vaccination strategies to improve outbreak preparedness in underserved regions.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/ofid\/ofag501","type":"journal-article","created":{"date-parts":[[2026,8,3]],"date-time":"2026-08-03T11:23:31Z","timestamp":1785756211000},"source":"Crossref","is-referenced-by-count":0,"title":["Ongoing Outbreak of\n                    <i>Neisseria meningitidis<\/i>\n                    Serogroup B in Par\u00e1 State, Brazilian Amazon Region, Following the COVID-19 Pandemic"],"prefix":"10.1093","volume":"13","author":[{"given":"Diana da Costa","family":"Lobato","sequence":"first","affiliation":[{"name":"Graduate Program in Parasitic Biology in the Amazon, State University of Par\u00e1, and Evandro Chagas Institute (PPGBPA\/UEPA\/IEC) , Bel\u00e9m, Par\u00e1 ,","place":["Brazil"]},{"name":"Department of Epidemiology, Health Surveillance Division, State Department of Public Health (DEPI\/DVS\/SESPA) , Bel\u00e9m, Par\u00e1 ,","place":["Brazil"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"\u00c2ngela Cristina dos Reis Maia","family":"de Souza","sequence":"additional","affiliation":[{"name":"Department of Epidemiology, Health Surveillance Division, State Department of Public Health (DEPI\/DVS\/SESPA) , Bel\u00e9m, Par\u00e1 ,","place":["Brazil"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Caroline","family":"Gava","sequence":"additional","affiliation":[{"name":"General Coordination of Vaccine-Preventable Disease Surveillance, Department of the National Immunization Program, Secretariat of Health and Environmental Surveillance, Ministry of Health , Bras\u00edlia, Federal District ,","place":["Brazil"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Camilla de Miranda","family":"Ribeiro","sequence":"additional","affiliation":[{"name":"General Coordination of Vaccine-Preventable 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,","place":["Brazil"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rosa M\u00e1rcia Saraiva","family":"Gentil","sequence":"additional","affiliation":[{"name":"Center of Bacteriology, Central Public Health Laboratory of Par\u00e1 (LACEN) , Par\u00e1 ,","place":["Brazil"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Susan Beatriz Batista","family":"de Oliveira","sequence":"additional","affiliation":[{"name":"Center of Bacteriology, Central Public Health Laboratory of Par\u00e1 (LACEN) , Par\u00e1 ,","place":["Brazil"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6834-0085","authenticated-orcid":false,"given":"Carlos Henrique","family":"Camargo","sequence":"additional","affiliation":[{"name":"Center of Bacteriology, Institute Adolfo Lutz (IAL) , S\u00e3o Paulo ,","place":["Brazil"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Claudio Tavares","family":"Sacchi","sequence":"additional","affiliation":[{"name":"Strategic Laboratory, Institute Adolfo Lutz (IAL) , S\u00e3o Paulo ,","place":["Brazil"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Karoline Rodrigues","family":"Campos","sequence":"additional","affiliation":[{"name":"Strategic Laboratory, Institute Adolfo Lutz (IAL) , S\u00e3o Paulo ,","place":["Brazil"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria Eduarda de Ara\u00fajo","family":"Morais","sequence":"additional","affiliation":[{"name":"Department of Epidemiology, Health Surveillance Division, State Department of Public Health (DEPI\/DVS\/SESPA) , Bel\u00e9m, Par\u00e1 ,","place":["Brazil"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gabriela Andrade","family":"de Carvalho","sequence":"additional","affiliation":[{"name":"General Coordination of Public Health Laboratories, Secretariat of Health and Environmental Surveillance, Ministry of Health (SVSA\/CGLAB) , Bras\u00edlia, Federal District ,","place":["Brazil"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Adrianne da Silva","family":"Zifirino","sequence":"additional","affiliation":[{"name":"Graduate Program in Mathematics and Statistics, Federal University of Par\u00e1 (PPGME\/UFPA) , Bel\u00e9m, Par\u00e1 ,","place":["Brazil"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7205-576X","authenticated-orcid":false,"given":"Ana Paula Silva de","family":"Lemos","sequence":"additional","affiliation":[{"name":"Center of Bacteriology, Institute Adolfo Lutz (IAL) , S\u00e3o Paulo ,","place":["Brazil"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Danielle Melo","family":"Sardinha","sequence":"additional","affiliation":[{"name":"Graduate Program in Parasitic Biology in the Amazon, State University of Par\u00e1, and Evandro Chagas Institute (PPGBPA\/UEPA\/IEC) , Bel\u00e9m, Par\u00e1 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