Meningococcal carriage in adolescents and young adults in Kuwait.
BACKGROUND: Neisseria meningitidis is a major cause of invasive meningococcal disease (IMD), with asymptomatic carriage playing a crucial role in transmission. Adolescents (15-17 years) and young adults (18-20 years) have the highest carriage rates, yet data from Kuwait remain limited. This study aimed to estimate the prevalence of N. meningitidis carriage among adolescents and young adults in Kuwait. METHODS: A cross-sectional study was conducted from July 2023 to May 2024, enrolling 1,398 participants aged 15-20 years. Randomly selected individuals provided oropharyngeal swabs, and demographic, behavioral, and vaccination data were collected via standardized questionnaires. Carriage prevalence was determined using selective culture-based methods. Whole genome sequencing was performed on culture-confirmed isolates. Descriptive statistics were used to summarize participant characteristics; carriage prevalence was reported as proportions, and associations were explored using Fisher's exact or chi-square tests and logistic regression where feasible. RESULTS: The overall meningococcal carriage rate was 0.21% (3/1,398). All isolates were non-groupable (NG), with one carrying the capsule null locus (CNL). Self-reported MenACWY vaccination coverage was 94.8%. No significant associations between demographic, geographic, or behavioral factors and carriage status were identified due to the small number of positive cases. CONCLUSION: This study provides a population-based estimate of meningococcal carriage among adolescents and young adults in Kuwait using a random sampling approach. The low carriage rate, alongside high vaccination coverage, suggests that existing immunization programs in Kuwait may be effective in reducing N. meningitidis transmission. However, the presence of NG strains stresses the need for continued surveillance. Further research is required to evaluate long-term vaccination impacts and potential gaps in disease protection.