Work

Emergence of short-lived meningococci causing focal epidemics can be associated with gene transfer from carriage-associated Neisseria

Year: 2026

Type: preprint

Abstract: ABSTRACT In March 2026, an unusually large outbreak of invasive meningococcal disease (IMD) in Kent, UK, was linked to attendance at one nightclub over a single weekend. The outbreak organism was a Neisseria meningitidis variant belonging to the longstanding hyperinvasive genotype, cc41/44. Using genome analysis of six isolates from patients, alongside >48,000 meningococcal genomes, we investigated whether the outbreak variant had acquired traits potentially contributing to the highly invasive phenotype. The six isolates were capsular group B, sequence type (ST-)485, and essentially indistinguishable, consistent with the focal nature of the outbreak. Compared with their closest available relatives, we found changes mediated by phase variation, nucleotide variation, and horizontal gene transfer (HGT) involving adhesins, iron-acquisition systems (including Transferrin and Lactoferrin binding proteins, and FetA), and Type IV pili (Tfp), factors which affect bacteria-bacteria and bacteria-host interactions. These changes occurred in a ST-485 sub-lineage that expressed capsule at high levels and a PorA porin with a truncated surface-exposed epitope, both of which are predicted to reduce immune recognition. Donors for the HGT events were predominantly carriage-associated N. meningitidis and Neisseria cinerea . We show that meningococcal variants responsible for previous focal outbreaks have not been seen subsequently. We propose that focal outbreaks of IMD are caused by meningococcal variants that may have acquired traits from non- or less invasive organisms, but subsequently these variants disappear, as their highly invasive phenotype is inconsistent with sustained transmission. Ongoing disease surveillance alongside carriage studies are therefore essential to inform public health risk and manage epidemic IMD. Significance statement Invasive meningococcal disease (IMD), comprising sepsis and/or meningitis, is a serious life-threatening infection. IMD is usually rare, but outbreaks occur, ranging from very large epidemics to small clusters, with cases occurring over days, weeks, or months. Following an unusually large, week-long, focal outbreak in Kent, UK, in 2026, affecting 21 individuals, we investigated outbreak-associated meningococcal characteristics, comparing outbreak variant genomes with their closest available relatives. We found changes in the outbreak variants, affecting bacteria-bacteria and bacteria-host cell interactions, and iron acquisition. These traits likely resulted in an unusually high invasive potential, likely at the cost of capacity for sustained transmission in asymptomatic carriage.

Source: bioRxiv (Cold Spring Harbor Laboratory)

DOI: 10.64898/2026.09.17.752363