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February 1, 1995, Vol 273, No. 5 >
ARTICLE | February 1, 1995

Serogroup C Meningococcal Outbreaks in the United States: Title and subTitle BreakAn Emerging Threat FREE

Lisa A. Jackson, MD; Anne Schuchat, MD; Michael W. Reeves, PhD; Jay D. Wenger, MD
[+] Author Affiliations

Reprint requests to Childhood and Respiratory Diseases Branch, Centers for Disease Control and Prevention, Mailstop C-09, 1600 Clifton Rd, Atlanta, GA 30333 (Dr Schuchat).


JAMA. 1995;273(5):383-389. doi:10.1001/jama.1995.03520290035026
Text Size: A A A
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Article
References

Objective.  —Multiple outbreaks of serogroup C Neisseria meningitidis have recently been reported from diverse areas of the United States. To better define the characteristics of this increasingly important problem, we reviewed data on all known serogroup C outbreaks in the United States from January 1980 through June 1993.

Data Sources.  —MEDLINE searches, Centers for Disease Control and Prevention records, state health department officials, infectious disease experts, and the meningococcal vaccine manufacturer.

Definition of an Outbreak.  —Three or more cases of serogroup C meningococcal disease within a 3-month period, either among members of a community or persons attending a single school or other institution, for which those cases represented an attack rate of at least five per 100 000 population.

Results.  —Twenty-one outbreaks of serogroup C meningococcal disease were identified; eight occurred since 1991. In 1992 and the first half of 1993, approximately 180 000 doses of vaccine were administered for outbreak control, compared with approximately 34000 doses from 1980 to 1991. Approximately 50% of community-outbreak cases were between the ages of 5 and 24 years, compared with only 19% of sporadic serogroup C cases (P<.001). Subtyping of patient isolates indicates that outbreaks are clonal; however, at least five distinct but closely related strains have caused recent outbreaks.

Conclusions.  —Serogroup C outbreaks are occurring more frequently in the United States. The effectiveness of preventive measures depends on early recognition; therefore, physicians should promptly report all cases of suspected meningococcal disease, and the causative serogroup should be established for every case.(JAMA. 1995;273:383-389)

REFERENCES

1 +
Gilmore A.  Ottawa's meningococcal outbreak provided a lesson in professional judgment and science. Can Med Assoc J . 1992;;147:729-732.
2 +
Gold R.  Meningococcal disease in Canada: 1991-1992. Can J Public Health . 1992;;83:5-8.
3 +
Guilmette P, Fourier B, Robert Y.  A cluster of Neisseria meningitidis cases in Quebec, January 1991. Can Dis Wkly Rep . 1993;;17:295-296.
4 +
Centers for Disease Control and Prevention.  Laboratory-based surveillance for meningococcal disease in selected areas—United States, 1989-1991. MMWR Morb Mortal Wkly Rep . 1993;;42(No. (SS-2) ):21-30.
5 +
Jacobson JA, Chester TJ, Fraser DW.  An epidemic of disease due to serogroup B Neisseria meningitidis in Alabama: report of an investigation and community-wide prophylaxis with a sulfonamide. J Infect Dis . 1977;;136:104-108.
6 +
Broome CV, Rugh MA, Yada AA, et al.  Epidemic group C meningococcal meningitis in Upper Volta, 1979. Bull World Health Organ . 1983;;61: 325-330.
7 +
de Morais JS, Munford RS, Risi JB, et al.  Epidemic disease due to serogroup C Neisseria meningitidis in São Paulo, Brazil. J Infect Dis . 1974;; 129:568-571.
8 +
Ronne T, Berthelsen L, Buhl LH, Lind I.  Comparative studies on pharyngeal carriage of Neisseria meningitidis during a localized outbreak of serogroup C meningococcal disease. Scand J Infect Dis . 1993;;25:331-339.
9 +
Masterton RG, Youngs ER, Wardle JC, Croft KF, Jones DM.  Control of an outbreak of group C meningococcal meningitis with a polysaccharide vaccine. J Infect . 1988;;17:177-182.
10 +
S'aez-Nieto JA, Perucha M, Casamayor H, et al.  Outbreak of infection caused by Neisseria meningitidis group C type 2 in a nursery. J Infect . 1984;;8:49-55.
11 +
Reingold AL, Broome CV, Hightower AW, et al.  Age-specific differences in duration of clinical protection after vaccination with meningococcal polysaccharide A vaccine. Lancet . 1985;;2:114-118.
12 +
Centers for Disease Control.  Meningococcal vaccines. MMWR Morb Mortal Wkly Rep . 1985;;34: 255-259.
13 +
Artenstein MS, Gold R, Zimmerly JG, Wyle FA, Schneider H, Harkins C.  Prevention of meningococcal disease by group C polysaccharide vaccine. N Engl J Med . 1970;;282:417-420.
14 +
Wahdan MH, Rizk F, El-Akkad AM, et al.  A controlled field trial of a serogroup A meningococcal polysaccharide vaccine. Bull World Health Organ . 1977;;55:645-651.
15 +
Peltola H, Makela H, Kayhty H, et al.  Clinical efficacy of meningococcus group A capsular polysaccharide vaccine in children three months to five years of age. N Engl J Med . 1977;;297:686-691.
16 +
Dean AG, Dean JA, Burton AH, Dicker RC. Epi Info, Version 5: A Word Processing, Database, and Statistics Program for Epidemiology on Microcomputers . Atlanta, Ga: Centers for Disease Control and Prevention; 1990;.
17 +
Selander RK, Caugant DA, Ochman H, Musser JM, Gilmour MN, Whittam TS.  Methods of multilocus enzyme electrophoresis for bacterial population genetics and systematics. Appl Environ Microbiol . 1986;;51:873-884.
18 +
Jacobs D.  SAS/GRAPH software and numerical taxonomy.  In: Proceedings of the 15th Annual SAS Users Group Conference (Nashville) . Cary, NC: SAS Institute; 1990;:1413-1418.
19 +
Feigin RD, Baker CJ, Herwaldt LA, Lampe RM, Mason E, Whitney SE.  Epidemic meningococcal disease in an elementary-school classroom. N Engl J Med . 1982;;307:1255-1257.
20 +
Hudson PJ, Vogt RL, Heun E, et al.  Evidence for school transmission of Neisseria meningitidis during a Vermont outbreak. Pediatr Infect Dis J . 1986;;5:213-217.
21 +
Harrison LH, Armstrong CW, Jenkins SR, et al.  A cluster of meningococcal disease on a school bus following epidemic influenza. Arch Intern Med . 1991;;151:1005-1009.
22 +
Thomas JC, Bendana NS, Waterman SH, et al.  Risk factors for carriage of meningococcus in the Los Angeles County men's jail system. Am J Epidemiol . 1991;;133:286-295.
23 +
Houck P.  Outbreak of meningococcal disease. Public Health Rep . In press.
24 +
Morrow HW, Slaten DD, Reingold AL, Werner SB, Fenstersheib MD.  Risk factors associated with a school-related outbreak of serogroup C meningococcal disease. Pediatr Infect Dis J . 1990;;9:394-398.
25 +
Oakes P.  Meningococcal outbreak. Miss Morb Rep . 1991;;9:1.
26 +
Imrey PB, Jackson LA, Ludwinski PH, England AC, Fox BC, Isdale LB. Epidemic invasive meningococcal disease among university students: possible transmission in campus bars. Presented at the third annual meeting of the Society for Hospital Epidemiology of America; April 18,1993; Chicago, Ill.
27 +
Edmond MB, Hollis RJ, Houston AK, Wenzel RP.  Epidemiologic analysis of an outbreak of meningococcal disease.  In: Program and abstracts of the 33rd Interscience Conference on Antimicrobial Agents and Chemotherapy ; October 17-21, 1993;; New Orleans, La. Abstract 1390.
28 +
Jafari H, Schuchat A, McClure R, et al.  A clonal outbreak of N meningitidis serogroup C disease in western Georgia: risk factors for disease.  In: Program and abstracts of the 33rd Interscience Conference on Antimicrobial Agents and Chemotherapy ; October 17-21, 1993;; New Orleans, La. Abstract 1389.
29 +
Zeitz P, Jafari H, Kioski C, et al.  A cluster of N meningitidis serogroup C disease in Phoenix: risk factors for disease.  In: Program and abstracts of the 33rd Interscience Conference on Antimicrobial Agents and Chemotherapy ; October 17-21, 1993;; New Orleans, La. Abstract 1388.
30 +
Wenger JD, Jackson LA, Raj P, Tonelli MJ.  Issues in the control of outbreaks of group C meningococcal disease in the United States. Infect Dis Clin Pract . 1994;;3:136-140.
31 +
Tappero JW, Ward B, Reporter R, et al.  Meningococcal disease in Los Angeles County (LAC) and the LAC jail system.  In: Program and abstracts of the 34th Interscience Conference on Antimicrobial Agents and Chemotherapy ; October 4-6, 1994;; Orlando, Fla. Abstract J14.
32 +
Pinner RW, Gellin BG, Bibb WF, et al.  Meningococcal disease in the United States—1986. J Infect Dis . 1991;;164:368-374.
33 +
Ashton FE, Ryan JA, Borczyk A, Caugant DA, Mancino L, Huang D.  Emergence of a virulent clone of Neisseria meningitidis serotype 2a that is associated with meningococcal group C disease in Canada. J Clin Microbiol . 1991;;29:2489-2492.
34 +
Peltola H, Kataja JM, Makela PH.  Shift in the age-distribution of meningococcal disease as a predictor of an epidemic? Lancet . 1982;;2:595-597.
35 +
Sacchi CT, Pessoa LL, Ramos SR, et al.  Ongoing group B Neisseria meningitidis in Sao Paulo, Brazil, due to increased prevalence of a single clone of the ET-5 complex. J Clin Microbiol . 1992;;30: 1734-1738.
36 +
Moore PS, Reeves MW, Schwartz B, Gellin BG, Broome CV.  Intercontinental spread of an epidemic group A Neisseria meningitidis strain. Lancet . 1989;; 2:260-263.
37 +
Scholten RJPM, Poolman JT, Valkenburg HA, Bijlmer HA, Dankert J, Caugant DA.  Phenotypic and genotypic changes in a new clone complex of Neisseria meningitidis causing disease in the Netherlands, 1958-1990. J Infect Dis . 1994;;169:673-676.
38 +
Krasinski K, Nelson JD, Butler S, Luby JP, Kusmiesz H.  Possible association of Mycoplasma and viral respiratory infections with bacterial meningitis. Am J Epidemiol . 1987;;125:499-508.
39 +
Cartwright KA, Jones DM, Smith AJ, Stuart JM, Kaczmarski EB, Palmer SR.  Influenza A and meningococcal disease. Lancet . 1991;;338:554-557.
40 +
Young LS, LaForce FM, Head JJ, Feeley JC, Bennett JV.  A simultaneous outbreak of meningococcal and influenza infections. N Engl J Med . 1972;; 287:5-9.
41 +
Moore PS, Hierholzer J, DeWitt W, et al.  Respiratory viruses and mycoplasma as cofactors for epidemic group A meningococcal meningitis. JAMA . 1990;;264:1271-1275.

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Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature

Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal

1 +
Gilmore A.  Ottawa's meningococcal outbreak provided a lesson in professional judgment and science. Can Med Assoc J . 1992;;147:729-732.
2 +
Gold R.  Meningococcal disease in Canada: 1991-1992. Can J Public Health . 1992;;83:5-8.
3 +
Guilmette P, Fourier B, Robert Y.  A cluster of Neisseria meningitidis cases in Quebec, January 1991. Can Dis Wkly Rep . 1993;;17:295-296.
4 +
Centers for Disease Control and Prevention.  Laboratory-based surveillance for meningococcal disease in selected areas—United States, 1989-1991. MMWR Morb Mortal Wkly Rep . 1993;;42(No. (SS-2) ):21-30.
5 +
Jacobson JA, Chester TJ, Fraser DW.  An epidemic of disease due to serogroup B Neisseria meningitidis in Alabama: report of an investigation and community-wide prophylaxis with a sulfonamide. J Infect Dis . 1977;;136:104-108.
6 +
Broome CV, Rugh MA, Yada AA, et al.  Epidemic group C meningococcal meningitis in Upper Volta, 1979. Bull World Health Organ . 1983;;61: 325-330.
7 +
de Morais JS, Munford RS, Risi JB, et al.  Epidemic disease due to serogroup C Neisseria meningitidis in São Paulo, Brazil. J Infect Dis . 1974;; 129:568-571.
8 +
Ronne T, Berthelsen L, Buhl LH, Lind I.  Comparative studies on pharyngeal carriage of Neisseria meningitidis during a localized outbreak of serogroup C meningococcal disease. Scand J Infect Dis . 1993;;25:331-339.
9 +
Masterton RG, Youngs ER, Wardle JC, Croft KF, Jones DM.  Control of an outbreak of group C meningococcal meningitis with a polysaccharide vaccine. J Infect . 1988;;17:177-182.
10 +
S'aez-Nieto JA, Perucha M, Casamayor H, et al.  Outbreak of infection caused by Neisseria meningitidis group C type 2 in a nursery. J Infect . 1984;;8:49-55.
11 +
Reingold AL, Broome CV, Hightower AW, et al.  Age-specific differences in duration of clinical protection after vaccination with meningococcal polysaccharide A vaccine. Lancet . 1985;;2:114-118.
12 +
Centers for Disease Control.  Meningococcal vaccines. MMWR Morb Mortal Wkly Rep . 1985;;34: 255-259.
13 +
Artenstein MS, Gold R, Zimmerly JG, Wyle FA, Schneider H, Harkins C.  Prevention of meningococcal disease by group C polysaccharide vaccine. N Engl J Med . 1970;;282:417-420.
14 +
Wahdan MH, Rizk F, El-Akkad AM, et al.  A controlled field trial of a serogroup A meningococcal polysaccharide vaccine. Bull World Health Organ . 1977;;55:645-651.
15 +
Peltola H, Makela H, Kayhty H, et al.  Clinical efficacy of meningococcus group A capsular polysaccharide vaccine in children three months to five years of age. N Engl J Med . 1977;;297:686-691.
16 +
Dean AG, Dean JA, Burton AH, Dicker RC. Epi Info, Version 5: A Word Processing, Database, and Statistics Program for Epidemiology on Microcomputers . Atlanta, Ga: Centers for Disease Control and Prevention; 1990;.
17 +
Selander RK, Caugant DA, Ochman H, Musser JM, Gilmour MN, Whittam TS.  Methods of multilocus enzyme electrophoresis for bacterial population genetics and systematics. Appl Environ Microbiol . 1986;;51:873-884.
18 +
Jacobs D.  SAS/GRAPH software and numerical taxonomy.  In: Proceedings of the 15th Annual SAS Users Group Conference (Nashville) . Cary, NC: SAS Institute; 1990;:1413-1418.
19 +
Feigin RD, Baker CJ, Herwaldt LA, Lampe RM, Mason E, Whitney SE.  Epidemic meningococcal disease in an elementary-school classroom. N Engl J Med . 1982;;307:1255-1257.
20 +
Hudson PJ, Vogt RL, Heun E, et al.  Evidence for school transmission of Neisseria meningitidis during a Vermont outbreak. Pediatr Infect Dis J . 1986;;5:213-217.
21 +
Harrison LH, Armstrong CW, Jenkins SR, et al.  A cluster of meningococcal disease on a school bus following epidemic influenza. Arch Intern Med . 1991;;151:1005-1009.
22 +
Thomas JC, Bendana NS, Waterman SH, et al.  Risk factors for carriage of meningococcus in the Los Angeles County men's jail system. Am J Epidemiol . 1991;;133:286-295.
23 +
Houck P.  Outbreak of meningococcal disease. Public Health Rep . In press.
24 +
Morrow HW, Slaten DD, Reingold AL, Werner SB, Fenstersheib MD.  Risk factors associated with a school-related outbreak of serogroup C meningococcal disease. Pediatr Infect Dis J . 1990;;9:394-398.
25 +
Oakes P.  Meningococcal outbreak. Miss Morb Rep . 1991;;9:1.
26 +
Imrey PB, Jackson LA, Ludwinski PH, England AC, Fox BC, Isdale LB. Epidemic invasive meningococcal disease among university students: possible transmission in campus bars. Presented at the third annual meeting of the Society for Hospital Epidemiology of America; April 18,1993; Chicago, Ill.
27 +
Edmond MB, Hollis RJ, Houston AK, Wenzel RP.  Epidemiologic analysis of an outbreak of meningococcal disease.  In: Program and abstracts of the 33rd Interscience Conference on Antimicrobial Agents and Chemotherapy ; October 17-21, 1993;; New Orleans, La. Abstract 1390.
28 +
Jafari H, Schuchat A, McClure R, et al.  A clonal outbreak of N meningitidis serogroup C disease in western Georgia: risk factors for disease.  In: Program and abstracts of the 33rd Interscience Conference on Antimicrobial Agents and Chemotherapy ; October 17-21, 1993;; New Orleans, La. Abstract 1389.
29 +
Zeitz P, Jafari H, Kioski C, et al.  A cluster of N meningitidis serogroup C disease in Phoenix: risk factors for disease.  In: Program and abstracts of the 33rd Interscience Conference on Antimicrobial Agents and Chemotherapy ; October 17-21, 1993;; New Orleans, La. Abstract 1388.
30 +
Wenger JD, Jackson LA, Raj P, Tonelli MJ.  Issues in the control of outbreaks of group C meningococcal disease in the United States. Infect Dis Clin Pract . 1994;;3:136-140.
31 +
Tappero JW, Ward B, Reporter R, et al.  Meningococcal disease in Los Angeles County (LAC) and the LAC jail system.  In: Program and abstracts of the 34th Interscience Conference on Antimicrobial Agents and Chemotherapy ; October 4-6, 1994;; Orlando, Fla. Abstract J14.
32 +
Pinner RW, Gellin BG, Bibb WF, et al.  Meningococcal disease in the United States—1986. J Infect Dis . 1991;;164:368-374.
33 +
Ashton FE, Ryan JA, Borczyk A, Caugant DA, Mancino L, Huang D.  Emergence of a virulent clone of Neisseria meningitidis serotype 2a that is associated with meningococcal group C disease in Canada. J Clin Microbiol . 1991;;29:2489-2492.
34 +
Peltola H, Kataja JM, Makela PH.  Shift in the age-distribution of meningococcal disease as a predictor of an epidemic? Lancet . 1982;;2:595-597.
35 +
Sacchi CT, Pessoa LL, Ramos SR, et al.  Ongoing group B Neisseria meningitidis in Sao Paulo, Brazil, due to increased prevalence of a single clone of the ET-5 complex. J Clin Microbiol . 1992;;30: 1734-1738.
36 +
Moore PS, Reeves MW, Schwartz B, Gellin BG, Broome CV.  Intercontinental spread of an epidemic group A Neisseria meningitidis strain. Lancet . 1989;; 2:260-263.
37 +
Scholten RJPM, Poolman JT, Valkenburg HA, Bijlmer HA, Dankert J, Caugant DA.  Phenotypic and genotypic changes in a new clone complex of Neisseria meningitidis causing disease in the Netherlands, 1958-1990. J Infect Dis . 1994;;169:673-676.
38 +
Krasinski K, Nelson JD, Butler S, Luby JP, Kusmiesz H.  Possible association of Mycoplasma and viral respiratory infections with bacterial meningitis. Am J Epidemiol . 1987;;125:499-508.
39 +
Cartwright KA, Jones DM, Smith AJ, Stuart JM, Kaczmarski EB, Palmer SR.  Influenza A and meningococcal disease. Lancet . 1991;;338:554-557.
40 +
Young LS, LaForce FM, Head JJ, Feeley JC, Bennett JV.  A simultaneous outbreak of meningococcal and influenza infections. N Engl J Med . 1972;; 287:5-9.
41 +
Moore PS, Hierholzer J, DeWitt W, et al.  Respiratory viruses and mycoplasma as cofactors for epidemic group A meningococcal meningitis. JAMA . 1990;;264:1271-1275.

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