1. Chapter 28 Meningococcal Disease

2. Epidemiology – U.S. Each year 1,400-3,000 cases of meningococcal disease (MD) in the US. 0.5-1.1 per 100,000 population 97% of cases sporadic (background endemic disease), 3% outbreaks Seasonal – peak in December/January Highest rate of disease among infants <1 yr of age (9.2/100,000 from 1992-2001)

3. US distribution

5. Meningococcal Disease Worldwide Incidence likely exceeds 100,000 cases/yr Majority are epidemics within the meningitis belt Worldwide, endemic disease 1-5/100,000 Sub-Saharan Africa, approaches 20/100,000

6. Serotypes of MD Almost all MD in US due to serogroups B, C, Y Africa and Asia, mostly groups A, C In infants, >50% of cases are serogroup B (>70% in 2005) In patients > 11 yrs of age, 75% are caused by C, Y or W-135

8. Risk Factors Military recruits College students, especially freshmen in dorms Travel to endemic area, sub-Saharan Africa, Saudi Arabia during the Hajj Terminal complement component deficiency Asplenia Recent URI Active/passive smoking Microbiology techs

9. MD and the Military WWI: 150 cases/100,000 troops per year with 39% mortality Military recruits given sulfadiazine to prevent disease 1969-1971 studies of serogroup C vaccine on US Army soldiers proved effective. Addition of bivalent and tetravalent vaccines decreased rate of disease further

10. MD and the Military Cannot attribute decline in disease entirely to vaccine Other measures taken to decrease transmission such as: –Head-to-toe sleeping –Reduced crowding in barracks –Cohorting –Aggressive treatment and ppx with antibiotics

11. MD and College Students 1998-1999 # cases Population in Rate/ millions 100,000 Ages 18-23 304 22.11.4 College Students 19.614.90.6 Freshmen 442.91.9 Freshmen in dorms 300.6 5.1 Bilukha O. MMWR 2005;54(RR07):1

12. Meningococcal Vaccines Menomune/MPSV4 (Meningococcal polysaccharide vaccine) –Safe for ages > 2 –Serogroups A, C, Y, W135 Menactra/MCV4 (meningococcal conjugated vaccine) –Ages 11-55 –Conjugated with diphtheria toxin variant –Serogroups A, C, Y, W135

13. Who should get MCV4? Routine immunization at 11-12 yo visit Catch-up dose for high-school/college entry Terminal complement deficiency or asplenia in patients between ages 11-55 Ages 11-55 and traveling to endemic areas Military recruits Microbiologists/techs exposed Revaccination for any patient at risk who received MPSV4 more than 3 yrs ago HIV > 11yo

14. Additional Resources Rosenstein NE, et al. The Changing Epidemiology of Meningococcal Disease in the United States, 19921996. The Journal of Infectious Diseases 1999; 180:1894- 1901. Steffen R, Dupont H. Manual of travel medicine and health. 1999: 267 73. Brundage JF. Meningococcal Disease among United States Military Service Members in Relation to Routine Uses of Vaccines with Different Serogroup- Specific Components, 19641998. Clinical Infectious Diseases 2002; 35:1376-1381 Bilukha O, Rosenstein N. Prevention and Control of Meningococcal Disease. MMWR 2005; 54 (RR07): 1-21. Raghunathan PL, Bernhardt SA, Rosenstein NE. Opportunities for Control of Meningococcal Disease in the United States. Annual Review of Medicine 2004;55: 333-353. Tondella ML, Popovic T, Rosenstein NE. Distribution of Neisseria meningitidis Serogroup B Serosubtypes and Serotypes Circulating in the United States. The Journal of Clinical Microbiology 2000; 38(9): 3323-3328. Active Bacterial Core Surveillance (ABCs) Report. Emerging Infections Program Network, Neisseria meningitidis, 2003. Retrieved March 18, 2007 from http://0- www.cdc.gov.mill1.sjlibrary.org/ncidod/dbmd/abcs/survreports/mening03.pdfhttp://0- www.cdc.gov.mill1.sjlibrary.org/ncidod/dbmd/abcs/survreports/mening03.pdf