Temporal associations between national outbreaks of meningococcal serogroup W and C disease in the Netherlands and England: an observational cohort study

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Temporal associations between national outbreaks of meningococcal serogroup W and C disease in the Netherlands and England: an observational cohort study Dr Mirjam J Knol, PhD, Susan J M Hahné, PhD, Jay Lucidarme, PhD, Helen Campbell, MSc, Hester E de Melker, PhD, Stephen J Gray, PhD, Prof Ray Borrow, FRCPath, Shamez N Ladhani, MRCPCH, Mary E Ramsay, FFPHM, Arie van der Ende, PhD The Lancet Public Health Volume 2, Issue 10, Pages e473-e482 (October 2017) DOI: 10.1016/S2468-2667(17)30157-3 Copyright © 2017 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY NC-ND 4.0 license Terms and Conditions

Figure 1 Incidence of invasive meningococcal disease in the Netherlands and England Incidence of meningococcal serogroup W and serogroup C disease by epidemiological year (July to June). Arrows show the start of implementation of quadrivalent conjugate meningococcal vaccine (MenACWY) in the UK in 2015, and meningococcal serogroup C vaccination in the UK in 1999 and the Netherlands in 2002. The Lancet Public Health 2017 2, e473-e482DOI: (10.1016/S2468-2667(17)30157-3) Copyright © 2017 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY NC-ND 4.0 license Terms and Conditions

Figure 2 Genomic analysis of the MenW:cc11 South American strain sublineage Neighbour-net phylogenetic network of all available genomes of MenW:cc11 South American strain sublineage isolates from England and the Netherlands, 2009–10 to 2015–16. Colours represent the epidemiological year the sample was acquired. The insert shows the position of individual strains within the South American strain sublineage. cc11=sequence type-11 clonal complex. The Lancet Public Health 2017 2, e473-e482DOI: (10.1016/S2468-2667(17)30157-3) Copyright © 2017 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY NC-ND 4.0 license Terms and Conditions

Figure 3 Incidence of invasive meningococcal serogroup W disease caused by the South American MenW:cc11 strain sublineage Incidence is for the original UK strain and the 2013 strain by epidemiological year in England and the Netherlands, 2009–10 to 2015–16. The arrow shows the start of implementation of quadrivalent conjugate meningococcal vaccine (MenACWY) vaccination in the UK in 2015. cc11=sequence type-11 clonal complex. The Lancet Public Health 2017 2, e473-e482DOI: (10.1016/S2468-2667(17)30157-3) Copyright © 2017 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY NC-ND 4.0 license Terms and Conditions

Figure 4 Cases of invasive meningococcal serogroup W disease caused by the South American MenW:cc11 strain sublineage Cases are by age group and epidemiological year in England (A) and the Netherlands (B), 2009–10 to 2015–16. The arrow shows the start of implementation of quadrivalent conjugate meningococcal vaccine (MenACWY) vaccination in the UK in 2015. cc11=sequence type-11 clonal complex. The Lancet Public Health 2017 2, e473-e482DOI: (10.1016/S2468-2667(17)30157-3) Copyright © 2017 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY NC-ND 4.0 license Terms and Conditions

Figure 5 Cases of invasive meningococcal serogroup C disease Cases are by age group and epidemiological year in England (A) and the Netherlands (B), 1992–93 to 2003–04. The arrows show the start of implementation of meningococcal serogroup C vaccination in the UK in 1999 (A) and the Netherlands in 2002 (B). The Lancet Public Health 2017 2, e473-e482DOI: (10.1016/S2468-2667(17)30157-3) Copyright © 2017 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY NC-ND 4.0 license Terms and Conditions