A cluster of meningococcal disease in western Sydney, Australia initially associated with a nightclub

Abstract

Fourteen cases of meningococcal disease (MD) occurred in August September 1996 in western Sydney, Australia. Seven of the 10 young adults affected had a direct or indirect link with a local nightclub. Ten of 11 systemic meningococcal isolates had the phenotype C:2a:P1.5 and showed close genetic relationship by pulsed-field gel electrophoresis (PFGE). Organisms of this phenotype have not previously caused outbreaks in Australia, but have been associated with outbreaks and hyperendemic serogroup C MD in Europe, Canada, and the United States. This is the largest cluster of serogroup C MD reported in urban Australia, and the first involving a nightclub. The strain differentiation results were available rapidly enough to augment epidemiological investigations on a daily basis. Public health staff could thus establish links between cases quickly, follow the spread of new cases in the community, give accurate information to health officials and the press, and utilize existing knowledge about the characteristics of this phenotype to predict likely developments during the outbreak and afterwards. The strain differentiation data was also very helpful when the role of vaccination was considered, and existing guidelines on the management of outbreaks of MD could be used effectively for the first time in western Sydney.

Changing carriage rate of Neisseria meningitidis among university students during the first week of term: cross sectional study

“…Nevertheless, we identified male sex, active smoking, visits to hall bars and nightclubs, intimate kissing, and mixed sex halls as risk factors for acquisition. Most of these factors have been previously identified in carriage and outbreak studies, 14 – 16 but few have been addressed the risk of acquiring carriage 11. The lower rate of acquisition seen in female only halls probably reflects different patterns of social behaviour.…”

Sequence Variation in the porA Gene of a Clone of Neisseria meningitidis during Epidemic Spread

“…In this study we examined a collection of 38 strains, all of which had previously been identified as belonging to a single newly generated clone of the ET-37 complex (4,8). This new variant, ET-15, was first identified in 1986 after an extensive outbreak of meningococcal disease in Canada (4) and has later been associated with outbreaks and clusters of meningococcal disease in many different countries (4,8,18,20,28,(34)(35). The ET-15 strains examined here were isolated between 1988 and 1999 in eight countries and were selected on the basis of their phenotypic traits.…”

Phenotypic and molecular characterization of serogroup C Neisseria meningitidis associated with an outbreak in Bahia, Brazil

“…8 PFGE has the advantage of being able to identify subclones of the same clone 20 and has been systematically used to identify N. meningitidis outbreaks. 7,21–23 In this study, we identified 2 PFGE patterns among strains belonging to the same clone (ST-103 complex) and observed excellent correlation between the epidemiological data and PFGE results: all the 4 strains isolated from the cases linked with the party had indistinguishable PFGE, consistent with an outbreak; in addition, PFGE was able to differentiate the outbreak strain from the case that was not linked to the party.…”

“…22,23,28 Other crowded environments, such as the Hajj pilgrimage, educational and military institutions have also been associated with outbreaks, indicating that crowding also facilitates transmission. 29,30 …”