The Changing Epidemiology of Meningococcal Disease in the United States, 1992–1996

Abstract

New meningococcal vaccines are undergoing clinical trials, and changes in the epidemiologic features of meningococcal disease will affect their use. Active laboratory-based, population-based US surveillance for meningococcal disease during 1992-1996 was used to project that 2400 cases of meningococcal disease occurred annually. Incidence was highest in infants; however, 32% of cases occurred in persons >/=30 years of age. Serogroup C caused 35% of cases; serogroup B, 32%; and serogroup Y, 26%. Increasing age (relative risk [RR], 1.01 per year), having an isolate obtained from blood (RR, 4.5), and serogroup C (RR, 1.6) were associated with increased case fatality. Among serogroup B isolates, the most commonly expressed serosubtype was P1.15; 68% of isolates expressed 1 of the 6 most common serosubtypes. Compared with cases occurring in previous years, recent cases are more likely to be caused by serogroup Y and to occur among older age groups. Ongoing surveillance is necessary to determine the stability of serogroup and serosubtype distribution.

Hospital-based surveillance of meningococcal meningitis in Salvador, Brazil

“…Our data support previous observations where the incidence of meningococcal meningitis was higher in young children, peaking in infants 4-5 months of age (Peltola, 1983;Rosenstein et al, 1999). However, in the USA and Europe, an elevated rate of meningococcal disease has been reported among teenagers and young adults (Cartwright et al, 2001;Rosenstein et al, 1999).…”

“…Active hospital-based surveillance was performed in metropolitan Salvador and detected a mean annual incidence of 1.71 cases of meningococcal meningitis per 100 000 population, with a CFR of 8.1%. These rates are comparable with those seen in the USA and Europe (Bilukha and Rosenstein, 2005;Rosenstein et al, 1999Rosenstein et al, ,2001. As a caveat, rates of culture-positive meningococcal meningitis are likely to underestimate the true disease burden, which is expected to be higher than that encountered in developed countries, since case ascertainment may not have been complete and use of antibiotics prior to hospitalisation may have interfered with the efficiency of culture isolation.…”

“…However, in the USA and Europe, an elevated rate of meningococcal disease has been reported among teenagers and young adults (Cartwright et al, 2001;Rosenstein et al, 1999). In this situation, increased risk was associated with exposure to diverse strains of N. meningitidis during college attendance, especially for students residing in dormitories (Cartwright et al, 2001;Rosenstein et al, 2001).…”

TLR4-dependent adjuvant activity of Neisseria meningitidis lipid A

“…Neisseria meningitidis is a leading worldwide cause of rapidly fatal sepsis and meningitis, usually in otherwise healthy individuals [1]. For example, in the African meningitis belt (e.g., subSaharan Africa) major outbreaks of meningococcal disease can occur at rates of up to 1,000/100,000 population [2].…”

Meningococcal serogroup W and varicella-zoster virus meningitis in an Irish infant

“…MenW has been known to be rare and to be associated with sporadic cases. This serogroup represented 2.6-4% of all reported N. Meningitidis in the UK, France, and the United States in the 1990s [7][8][9]. Cases of MenW in returning pilgrims and their contacts have been reported in several countries following the Hajj outbreaks of 2000 and 2001 [4,10].…”