The Centers for Disease Control and Prevention (CDC) has issued a health advisory warning clinicians to be vigilant for invasive serogroup Y meningococcal disease, especially in at-risk populations. The advisory comes as the CDC reports the highest annual number of cases since 2014. Specifically, a strain of Neisseria meningitidis serogroup Y, known as Sequence Type (ST) 1466, has been responsible for the majority of cases in 2024.
One of the concerning aspects of the current outbreak is that a significant percentage of patients infected with the ST 1466 strain have not presented with typical symptoms of meningitis, such as headache and stiff neck. Instead, 64% of cases have presented with bacteremia, while at least 4% have presented with septic arthritis. It is important to note that the ST 1466 strain is disproportionately affecting individuals between the ages of 30 to 60 years, Black or African American individuals, and those living with HIV.
Of particular concern is the high case fatality rate associated with the ST 1466 strain, which stands at 18%. This is significantly higher than the 11% case fatality rate reported for serogroup Y in previous years. In 2023, a total of 422 cases of invasive serogroup Y meningococcal disease were reported in the U.S. By March 25, 2024, 143 cases had already been reported, indicating a dramatic increase compared to the same period in the previous year.
Recommendations for Clinicians
The CDC strongly recommends that clinicians maintain a heightened level of suspicion for meningococcal disease, particularly among populations that are disproportionately affected by the current outbreak. Clinicians should be aware that patients infected with the ST 1466 strain may not exhibit typical symptoms of meningitis. Blood and cerebrospinal fluid cultures should be obtained in individuals suspected of having meningococcal disease.
It is crucial for clinicians to ensure that individuals who are recommended to receive the meningococcal vaccine are up to date with their vaccination schedule. The CDC advises that all children between the ages of 11 to 12 years receive the MenACWY vaccine, with a booster dose administered at age 16. Individuals at higher risk for the disease, such as those with HIV, should receive a two-dose primary MenACWY series, with booster doses every 3 to 5 years, depending on age.
Furthermore, clinicians are urged to promptly notify their local health departments if invasive meningococcal disease is suspected or confirmed. State and local health departments can provide guidance on treatment and contact prophylaxis based on local resistance patterns. Additionally, public health departments are encouraged to raise awareness among clinicians about the risk of invasive meningococcal disease among Black or African American individuals and those between the ages of 30 to 60 years.
Health departments are advised to submit all meningococcal isolates to the CDC for testing of antimicrobial resistance and whole-genome sequencing. This collaboration between clinicians and public health authorities is essential in controlling and preventing the spread of invasive serogroup Y meningococcal disease in the community.
Leave a Reply