Infection preventionists should be aware of increasing cases of invasive Neisseria meningitidis, which currently are causing an 18% mortality rate and primarily infecting three risk groups: Black people, people with human immunodeficiency virus (HIV), and those in the age range of 30 to 60 years, the Centers for Disease Control and Prevention (CDC) reports in a public health alert.
That said, “recognize that invasive meningococcal disease may affect people of any age or demographic group,” the CDC noted.1 “Healthcare providers should maintain a heightened suspicion for invasive meningococcal disease and start immediate antibiotic treatment for persons with suspected meningococcal disease.”
The increase primarily is attributable to N. meningitidis serogroup Y — more specifically, sequence type (ST) 1466.
“In 2023, 422 cases were reported in the United States, the highest annual number of cases reported since 2014,” the CDC noted. “As of March 25, 2024, 143 cases have been reported to CDC for the current calendar year, an increase of 62 cases over the 81 reported as of this date in 2023.” The CDC cautions that patients with invasive meningococcal disease may present with bloodstream infection or septic arthritis rather than the typical symptoms of headache, nausea, and stiff neck.
Overall, 64% of cases of invasive meningococcal disease caused by ST-1466 in 2023 had a clinical presentation that was atypical for meningitis, including bacteremia and septic arthritis.
“Symptoms of meningococcal bloodstream infection may include fever and chills, fatigue, vomiting, cold hands and feet, severe aches and pains, rapid breathing, diarrhea, or, in later stages, a dark purple rash,” the CDC states. “While symptoms of meningococcal disease can at first be nonspecific, they worsen rapidly, and the disease can become life-threatening within hours.”
In a cohort of 94 patients with known outcomes, 17 (18%) died. “This case-fatality rate is higher than the historical case-fatality rate of 11% reported for serogroup Y cases in 2017-2021,” the CDC reported.
Blood and cerebrospinal fluid cultures are recommended to test suspect patients.
The CDC also emphasized that all people recommended for meningococcal vaccination be up to date on immunization with the MenACWY vaccine. “All 11- to 12-year-olds should receive a MenACWY vaccine,” the CDC recommends.
Since protection wanes, the CDC recommends a booster dose at age 16 years. For people with HIV and others at increased risk because of underlying medical conditions, the CDC recommends a two-dose primary MenACWY series with booster doses every three to five years, depending on age.
“Of the six N. meningitidis serogroups — A, B, C, W, X, and Y — responsible for most meningococcal disease worldwide, the four serogroups B, C, W, and Y circulate in the United States,” the CDC reported. “Vaccines against serogroups A, C, W, Y (MenACWY) and serogroup B (MenB) are available in the United States.”
Cases of invasive meningococcal disease caused by this strain occurred in both males (65%) and females (35%).
“The serogroup Y ST-1466 strain has contributed to previously reported increases in meningococcal disease in people with HIV,” the CDC stated. “Based on updated surveillance data, 24 ST-1466 cases have now been reported in people with HIV in 2022-2023. Only four were previously vaccinated with MenACWY and none were up to date on recommended doses. To date, no other ST-1466 cases have been identified in people who previously received MenACWY vaccine.”
Fortunately, all serogroup Y ST-1466 isolates tested to date have been susceptible to the first-line antibiotics recommended for treatment and prophylaxis.
“This strain is distinct from ciprofloxacin-resistant serogroup Y strains that are also circulating in the United States that are disproportionately affecting Hispanic individuals,” the CDC clarified.
Somewhat surprisingly, the CDC did not reiterate established routes of transmission or patient hospital isolation measures for N. meningitidis in the health advisory. As previously reported, the bacteria typically are spread through respiratory and throat secretions via coughing or kissing. Prolonged close contact can spread N. meningitidis within a household.2
The CDC is revising isolation precautions, and a draft under discussion calls for eliminating the “false dichotomy” of airborne and droplet categories in favor of “touch” and three levels of air transmission. With that change in limbo, the standing recommendations are standard and droplet precautions for N. meningitidis patients.
“Healthcare-associated transmission of N. meningitidis is uncommon,” the CDC states.3 “In rare instances, N. meningitidis has been transmitted from patients to healthcare personnel through contact with the respiratory secretions of patients with meningococcal disease and handling isolates of N. meningitidis. Exposures in healthcare may include mucous membrane contact with infectious secretions from close, face-to-face contact during activities such as mouth-to-mouth resuscitation, endotracheal tube placement or management, or open airway suctioning while not wearing or correctly using recommended personal protective equipment.”
Healthcare workers may be recommended for meningitis vaccination if they are immunocompromised (i.e., asplenia), are traveling to countries with epidemic meningococcal disease, or work with N. meningitidis in a laboratory.
“Brief, non-face-to-face contact, such as standing in the doorway of a patient’s room, cleaning a patient’s room, delivering a medication or food tray, starting an IV, or performing a routine physical exam, is generally not considered an exposure,” the CDC reported. Also in the category of a non-exposure is contact with a patient who is only colonized with N. meningitidis and has no signs of clinical infection.
REFERENCES
- Centers for Disease Control and Prevention. Increase in invasive serogroup Y meningococcal disease in the United States. CDC Health Alert Network. Published March 28, 2024. https://emergency.cdc.gov/han/2024/han00505.asp
- Centers for Disease Control and Prevention. Bacterial meningitis. Last reviewed July 15, 2021. https://www.cdc.gov/meningitis/bacterial.html
- Centers for Disease Control and Prevention CDC. Meningococcal disease. Last reviewed Nov. 2, 2022. https://www.cdc.gov/infectioncontrol/guidelines/healthcare-personnel/selected-infections/meningococcal-disease.html
Infection preventionists should be aware of increasing cases of invasive Neisseria meningitidis, which currently are causing an 18% mortality rate and primarily infecting three risk groups: Black people, people with human immunodeficiency virus, and those in the age range of 30 to 60 years, the Centers for Disease Control and Prevention reports in a public health alert.
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