Case Manifestations and Public Health Response for Outbreak of Meningococcal W Disease, Central Australia, 2017

Abstract

I nvasive meningococcal disease (IMD) remains a major cause of death and permanent disability worldwide (1). IMD is caused by Neisseria meningitidis, a gram-negative diplococcus bacterium, which frequently colonizes the human nasopharynx and might spread from person-to-person by respiratory droplets or direct contact with respiratory secretions. However, only a small proportion of persons will show development of invasive infection, typically with serogroups A, B, C, W or Y (2). IMD is most common in the dry winter and spring, in overcrowded households, and in persons who have preceding upper respiratory tract infections, splenectomy, and in the presence of terminal complement deficiencies (3,4).

The epidemiology and outcomes of central nervous system infections in Far North Queensland, tropical Australia; 2000-2019

“…This may reflect a higher threshold for performing lumbar punctures in the remote locations in which Indigenous Australians represent a greater proportion of the population. Indigenous infants, in particular, were over-represented in this study, with disproportionately high rates of meningococcal infection, highlighting the ongoing need for optimal vaccine coverage and effective, practical strategies to improve the socioeconomic disadvantage affecting many Indigenous Australians [ 14 , 24 , 39 , 50 , 51 ]. Although the meningococcal vaccine can only be provided after 6 weeks of age, immunising household contacts of infants may prevent invasive meningococcal disease in this age group [ 52 ].…”

A Narrative Review of the W, X, Y, E, and NG of Meningococcal Disease: Emerging Capsular Groups, Pathotypes, and Global Control

“…In 2017, an unprecedented outbreak of MenW infection occurred among the Indigenous pediatric population of Central Australia. Among these cases were atypical manifestations, including meningococcal pneumonia, septic arthritis, and conjunctivitis [ 22 ]. The Canadian MenW:cc11 isolates have been shown to be distinct from the traditional MenW:cc22.…”

Meningococcal Disease Outbreaks: A Moving Target and a Case for Routine Preventative Vaccination

“…Accelerated introduction of the National MenC Programme for years 10, 11 and 12 at the school and expanded to years 7, 8 and 9 [ 78 ] Sydney 2008 B 2–13 y 3 10.7 0 No vaccine available [ 133 ] Central Australia Indigenous communities 2017 W ≤ 4 y 24 10.9 0 MenACWY-CV for 1–19 y (indigenous then also non-indigenous). 6 additional cases, all unimmunised [ 80 ] Tasmania 2018 W – 3 – – State-wide campaign with MenACWY-CV expanded to 6 w–21 y [ 134 ] New Zealand New Zealand 1991–1996 B < 5 y 473 in 1996 14.0 (142 in < 1 y, 549.6 in Maori < 1 y) ~ 5 Development of MeNZB (Chiron) with implementation from 2004 [ 60 , 135 ] Northland 2011 C – – – – MenC-CV for 1 to < 20 y 1 case in unvaccinated infant [ 14 ] Northland 2018–2019 …”

“…No patient died and the number of cases of MenW IMD decreased rapidly after the onset of the vaccination campaign. The remoteness of the Central Australian indigenous population and frequent movements between communities were challenges specific to this outbreak that necessitated a different approach compared to outbreaks in urban centres, including the use of a fever protocol and presumptive antibiotic treatment for febrile illnesses [ 80 ].…”

“…The logistics involved with accessing the target population differed in high- versus low-income countries, with apathy, particularly among students and young adults, or reluctance to identify close contacts (recreational drug users) negatively impacting uptake in high/upper-middle-income countries [ 49 , 69 , 77 ]. Accessing the target population posed specific challenges when they were located in remote settings such as central Australian indigenous communities [ 80 ], remote communities in African countries requiring the use of mobile laboratories [ 87 ] and in slum areas of large cities where house-by-house vaccination was undertaken [ 91 ].…”