Journal Article

Increased Case-Fatality Rate Associated with Outbreaks of <i>Neisseria meningitidis</i> Infection, Compared with Sporadic Meningococcal Disease, in the United States, 1994–2002

Richard Brooks, Christopher W. Woods, Daniel K. Benjamin and Nancy E. Rosenstein

in Clinical Infectious Diseases

Published on behalf of Infectious Diseases Society of America

Volume 43, issue 1, pages 49-54
Published in print July 2006 | ISSN: 1058-4838
Published online July 2006 | e-ISSN: 1537-6591 | DOI: http://dx.doi.org/10.1086/504804
Increased Case-Fatality Rate Associated with Outbreaks of Neisseria meningitidis Infection, Compared with Sporadic Meningococcal Disease, in the United States, 1994–2002

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Background. Outbreaks of meningococcal disease are infrequent but important public health events. We characterize outbreak-associated cases in the United States and compare them with sporadic disease.

Methods. Outbreaks of meningococcal disease that occurred during the period of 1 July 1994 through 30 June 2002 were identified through state health departments, Centers for Disease Control and Prevention records, and a review of newspapers and the medical literature. Cases associated with outbreaks were compared with sporadic cases identified through population-based surveillance.

Results. We identified 69 outbreaks of Neisseria meningitidis infection (median, 9.5 outbreaks per year; range, 3–14 outbreaks per year), which involved 229 patients from 30 states. Forty-three (62%) of the outbreaks involved N. meningitidis serogroup C, 17 (25%) involved serogroup B, and 9 (13%) involved serogroup Y. Twenty-five outbreaks (36%) occurred in communities, and 44 (64%) were organization based, including 12 that occurred in colleges and universities, 19 that occurred in primary and secondary schools, and 8 that occurred in nursing homes. Vaccination campaigns (with the A/C/Y/W-135 meningococcal polysaccharide vaccine) were conducted for 31 outbreaks (28 involving serogroup C and 3 involving serogroup Y). After controlling for age, serogroup, and clinical presentation, outbreak-associated cases were associated with a higher case-fatality rate than were sporadic cases (21% vs. 11%; odds ratio, 3.3; 95% confidence interval, 2.0–5.5).

Conclusions. Outbreaks remain an important but infrequent public health issue, representing <2% of all cases of meningococcal disease. However, given the increased case-fatality rate found among outbreak-related cases of N. meningitidis infection, additional investigation of factors that favor the transmission and virulence of outbreak-related strains is warranted.

Journal Article.  3783 words.  Illustrated.

Subjects: Infectious Diseases ; Immunology ; Public Health and Epidemiology ; Microbiology

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