TY - JOUR AU - Azzari, Chiara AU - Nieddu, Francesco AU - Moriondo, Maria AU - Indolfi, Giuseppe AU - Canessa, Clementina AU - Ricci, Silvia AU - Bianchi, Leila AU - Serranti, Daniele AU - Poggi, Giovanni Maria AU - Resti, Massimo T1 - Underestimation of Invasive Meningococcal Disease in Italy T2 - Emerging Infectious Disease journal PY - 2016 VL - 22 IS - 3 SP - 469 SN - 1080-6059 AB - Knowing the incidence of invasive meningococcal disease (IMD) is essential for planning appropriate vaccination policies. However, IMD may be underestimated because of misdiagnosis or insufficiently sensitive laboratory methods. Using a national molecular surveillance register, we assessed the number of cases misdiagnosed and diagnoses obtained postmortem with real-time PCR (rPCR), and we compared sensitivity of rPCR versus culture-based testing. A total of 222 IMD cases were identified: 11 (42%) of 26 fatal cases had been misdiagnosed or undiagnosed and were reclassified as IMD after rPCR showed meningococcal DNA in all available specimens taken postmortem. Of the samples tested with both rPCR and culture, 58% were diagnosed by using rPCR alone. The underestimation factor associated with the use of culture alone was 3.28. In countries such as Italy, where rPCR is in limited use, IMD incidence may be largely underestimated; thus, assessments of benefits of meningococcal vaccination may be prone to error. KW - Neisseria meningitidis KW - invasive meningococcal disease KW - underestimation KW - PCR KW - underreporting KW - misdiagnosis KW - bacteria KW - bacterial meningitis KW - Italy DO - 10.3201/eid2203.150928 UR - https://wwwnc.cdc.gov/eid/article/22/3/15-0928_article ER - End of Reference