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

Emerg Infect Dis. 2021 Apr;27(4):1110-1122. doi: 10.3201/eid2704.203612.


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

Keywords: China; Neisseria meningitidis; ST4821 clonal complex; antimicrobial resistance; bacteria; genome; meningitis/encephalitis; phylogenetic analysis; quinolone resistance; recombination.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • China
  • Europe
  • Humans
  • Meningococcal Infections*
  • Meningococcal Vaccines*
  • Neisseria meningitidis*
  • Quinolones*
  • Serogroup


  • Meningococcal Vaccines
  • Quinolones