Epidemiology of invasive meningococcal disease, Japan, 2013 to 2023

Abstract

Background: The National Surveillance for Invasive Meningococcal Disease (IMD) initiative started in Japan in April 2013. Multiple international mass gathering events have since been held in Japan, and the COVID-19 pandemic has occurred. Aim: We summarised 10 years of national surveillance data for IMD in Japan to describe epidemiological characteristics of IMD and evaluate the influence of mass gatherings and the COVID-19 pandemic on IMD. Methods: Upon diagnosis of IMD, patient information and specimens were collected and reported to local health centres. We analysed the epidemiology of IMD cases reported between 1 April 2013 and 31 March 2023. Results: Among 274 cases reported (median age: 55 years; 55% male), no outbreaks related to mass gathering events were identified. The annual reported incidence of IMD was 0.001-0.039 cases per 100,000 individuals between 2014 and 2022, with a notable decrease after 2020. The overall case fatality rate was 12% (33/274). The most frequent serogroups were Y and B (46 and 17%). Multilocus sequence typing revealed a predominance of clonal complex (cc) 23, followed by cc2057, while cc11 was detected in eight cases. Conclusion: The reported incidence of IMD in Japan is low compared with high-endemic countries and decreased further during the COVID-19 pandemic. This unique epidemiology of IMD in Japan lacks a clear explanation. However, distribution of meningococcal strains, such as predominance of serogroup Y, could be a contributing factor. Maintaining high-quality surveillance, including of serogroups and sequence types, is crucial to manage and prevent future IMD cases in Japan effectively.