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

• Published in: Clinical infectious diseases 2006-07, Vol.43 (1), p.49-54
• Main Authors: Brooks, Richard, Woods, Christopher W., Benjamin, Daniel K., Rosenstein, Nancy E.
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Aged; Articles and Commentaries; Bacterial diseases; Bacterial diseases of the nervous system. Bacterial myositis; Biological and medical sciences; Child; Child, Preschool; Departments; Disease outbreaks; Disease Outbreaks - statistics & numerical data; Epidemiology; Female; Human bacterial diseases; Humans; Infant; Infectious diseases; Male; Medical sciences; Meningitis; Meningococcal Infections - epidemiology; Meningococcal Infections - mortality; Meningococcal meningitis; Middle Aged; Mortality; Neisseria meningitidis; Patients; Pneumonia; Population; Population Surveillance; Preventive medicine; Public health; Retrospective Studies; Surveillance; United States - epidemiology; Vaccination; Vaccines
• ISSN: 1058-4838; 1537-6591
• DOI: 10.1086/504804

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