Evolution of Sequence Type 4821 Clonal Complex Hyperinvasive and Quinolone-Resistant Meningococci

Abstract Expansion of quinolone-resistant Neisseria meningitidis clone ChinaCC4821-R1-C/B from sequence type (ST) 4821 clonal complex (CC4821) caused a serogroup shift A to C invasive meningococcal disease (IMD) in China. To determine the relationship among globally distributed CC4821 meningococci, we analyzed whole-genome data 173 meningococci isolated 4 continents during 1972–2019. These clustered into sublineages (1–4); sublineage 1 primarily comprised IMD isolates (41/50, 82%). Most outside China (40/49, 81.6%) formed distinct sublineage, Europe–USA cluster, with typical strain designation B:P1.17-6,23:F3-36:ST-3200(CC4821), harboring mutations penicillin-binding protein 2. show that has expanded other countries. The increasing distribution worldwide B raises concern potential cause pandemic would be challenging control, despite indirect evidence Trumenba vaccine might afford some protection.