History of Meningococcal Outbreaks in the United States: Implications for Vaccination and Disease Prevention

Abstract

Invasive meningococcal disease caused by Neisseria meningitidis presents a significant public health concern. Meningococcal disease is rare but potentially fatal within 24 hours of onset of illness, and survivors may experience permanent sequelae. This review presents the epidemiology, incidence, and outbreak data for invasive meningococcal disease in the United States since 1970, and it highlights recent changes in vaccine recommendations to prevent meningococcal disease. Relevant publications were obtained by database searches for articles published between January 1970 and July 2015. The incidence of meningococcal disease has decreased in the United States since 1970, but serogroup B meningococcal disease is responsible for an increasing proportion of disease burden in young adults. Recent serogroup B outbreaks on college campuses warrant broader age-based recommendations for meningococcal group B vaccines, similar to the currently recommended quadrivalent vaccine that protects against serogroups A, C, W, and Y. After the recent approval of two serogroup B vaccines, the Advisory Committee on Immunization Practices first updated its recommendations for routine meningococcal vaccination to cover at-risk populations, including those at risk during serogroup B outbreaks, and later it issued a recommendation for those aged 16-23 years. Meningococcal disease outbreaks remain challenging to predict, making the optimal disease management strategy one of prevention through vaccination rather than containment. How the epidemiology of serogroup B disease and prevention of outbreaks will be affected by the new category B recommendation for serogroup B vaccines remains to be seen.

Eculizumab in paroxysmal nocturnal haemoglobinuria and atypical haemolytic uraemic syndrome: 10‐year pharmacovigilance analysis

“…Overall, the cumulative reporting rate of meningococcal infection in eculizumab‐treated patients tended to decline over time following the initial approval of eculizumab, then remained relatively stable over the most recent 5 years, at approximately 0·25 per 100 PY. The distribution of meningococcal infections by age (16‐ to 25‐year‐olds have a higher infection rate) is also similar to that reported in the general population (Atkinson et al , ; Centers for Disease Control and Prevention, ). These findings are also consistent with those reported in clinical studies (0·83 events per 100 PY) (Drug Safety and Risk Management Advisory Committee, ).…”

A review of the immunogenicity, safety and current recommendations for the meningococcal serogroup B vaccine, MenB‐FHbp

“…Meningococcal serogroup B is the most common disease‐causing meningococcal serogroup in the United States and is responsible for approximately 68% of meningococcal disease cases in the adolescent and young adult age group . Moreover, a number of MenB outbreaks have occurred in the United States since 1994 (Figure and Table ), with the most recent outbreaks primarily localized to college campuses …”

“…Outbreaks of meningococcal disease are unpredictable and can have devastating effects on a relatively small community . Since 1994, there have been at least 35 MenB outbreaks in the United States, resulting in more than 64 cases and in three deaths (Figure and Table ) . Based on national meningococcal surveillance data, 133 cases of MenB (including both isolated and outbreak‐related cases) occurred in 2017, resulting in 16 deaths; for every 100 cases of MenB with known outcome, there were 12 fatalities .…”

“…In the event of an outbreak, mass vaccination and prophylactic antibiotic treatment of close contacts are recommended as control measures, which involves considerable planning and resources . During these outbreaks, MenB vaccines are often made available to students through campus health services and at multiple off‐campus pharmacies.…”

“…University-based MenB outbreaks in the United States, 2011 to present [24][25][26][27]31,[94][95][96][97][98][99]. Single outbreaks are represented by circles, with circle size corresponding to the size of the student body and location corresponding to number of cases and timing of the outbreak.…”