Title

Evaluation of the use of mass chemoprophylaxis during a school outbreak of enzyme type 5 serogroup B

Source

Pediatric Infectious Disease Journal. 15(11):992-8, 1996 Nov.

Unique Identifier

97087555

Authors

Jackson LA. Alexander ER. DeBolt CA. Swenson PD. Boase J. McDowell MG. Reeves MW. Wenger JD .

Institution

Department of Epidemiology, School of Public Health and Community Medicine,

University of Washington, Seattle 98195-7236, USA. lajack:u.washington.edu

Abstract

BACKGROUND: A vaccine for prevention of serogroup B meningococcal disease is not available in the United

States, and indications for the use of mass chemoprophylaxis for control of meningococcal outbreaks are not

well-defined. In response to an outbreak of six cases of enzyme type 5 serogroup B meningococcal disease among

students at a middle school, we implemented a program of mass rifampin prophylaxis and evaluated the effectiveness of this preventive measure.

METHODS: Oropharyngeal cultures were obtained from 351 of the 900 students before prophylaxis; 196 participants

were recultured 3 weeks later. Meningococcal isolates were subtyped and tested for rifampin susceptibility, and risk

factors for disease or carriage among students were evaluated.

RESULTS: No cases occurred after prophylaxis. Before prophylaxis 10% of students were meningococcal carriers and 3.4% carried the epidemic strain. After prophylaxis 2.5% were carriers and 1.0% carried the epidemic strain. Rifampin was 85% effective in eradicating carriage, and the rate of acquisition of carriage during the 3-week period was low (0.5%). Carriage persisted after prophylaxis in 4 students; 3 of these post-prophylaxis isolates were rifampin-resistant. Rifampin resistance thus developed in 12% of preprophylaxis isolates. Disease/epidemic strain carriage was associated with enrollment in the school band and certain other classes.

CONCLUSIONS: These findings suggests that mass chemoprophylaxis may be effective and should be considered for control of school serogroup B meningococcal outbreaks. This approach is less likely to be effective for control of

outbreaks affecting larger, less well-defined populations and is associated with the rapid development of antibiotic

resistance.

Title

Risk factors for Neisseria meningitidis carriage in a school during a community outbreak of meningococcal infection.

Source

Epidemiology & Infection. 117(2):259-66, 1996 Oct.

Unique Identifier

97024395

Authors

Davies AL. O'Flanagan D. Salmon RL. Coleman TJ .

Institution

PHLS Communicable Disease Surveillance Centre, Roath, Cardiff.

Abstract

As part of the management of an outbreak of meningococcal infection, 119 school contacts of an index case were

swabbed for nasopharyngeal carriage. In a cohort study, risk factors for Neisseria meningitidis carriage were

ascertained by means of a questionnaire, completed by 114 (96%) of those swabbed. Twenty five (21%) cultures were

identified as "neisseria positive'; of which there were 18 (15%) Neisseria meningitidis isolates, 2 (2%) Neisseria

lactamica isolates and 5 (4%) showed contaminants only. Two (2%) carriers were identified as harbouring the

implicated outbreak strain. Single variable analysis identified six statistically significant risk factors for meningococcal

carriage; increasing age, female sex, manual social class, personal smoking, regular attendance at a discotheque and

rhinorrhoea. Multivariate analysis, using logistic regression modelling, found that of these six variables only age, sex and

social class remained statistically significant when the other factors were controlled for. Nevertheless the role of

smoking, social events and respiratory/viral infections in nasopharyngeal carriage, and other plausible mechanisms

whereby age, sex and social class might exert their effect, could usefully be investigated further.

Title

Community immunization programme in response to an outbreak of invasive Neisseria meningitidis serogroup C infection in the Trent region of England 1995-1996.

Source

Journal of Public Health Medicine. 19(2):162-70, 1997 Jun.

Unique Identifier

97387398

Authors

Irwin DJ. Miller JM. Milner PC. Patterson T. Richards RG. Williams DA. Insley CA. Stuart JM .

Institution

North Essex Health Authority, Witham.

Abstract

Between 8 December 1995 and 16 January 1996 seven laboratory confirmed cases of septicaemia owing to infection

with Neisseria meningitidis serogroup C strains and one highly probable case of meningococcal septicaemia occurred

in three electoral wards in south Rotherham and the Retford area of north Nottinghamshire. All cases occurred among

children aged 1-17 years. One patient died. The public health response to this outbreak was the largest community

prophylactic antibiotic and immunization programme against meningococcal infection, to date, in the United Kingdom.

The target group for each Health Authority was 8900 for Rotherham Health Authorities and 8000 for North

Nottinghamshire Health. Local logistical factors led to differences in the implementation of the programme by each

Health Authority. At the completion of each programme, 8320 doses of vaccine had been administered (92.5 per cent

coverage) during the Rotherham Health Authorities programme and 7660 (95.7 per cent coverage) during the North

Nottinghamshire Health programme. The additional financial cost of the exercise amounted to approximately Pounds

125000 for each Health Authority. This paper describes the evolution of the outbreak, the decision-making process

resulting in the immunization programme in each Health Authority, the implementation of each programme, problems

identified and lessons learned.

Title

Source

JAMA. 277(5):389-95, 1997 Feb 5.

Unique Identifier

97163351

Authors

Zangwill KM. Schuchat A. Riedo FX. Pinner RW. Koo DT. Reeves MW. Wenger JD .

Institution

Childhood and Respiratory Diseases Branch, Division of Bacterial and Mycotic

Diseases, Centers for Disease Control and Prevention (CDC), Atlanta, GA

30333, USA.

Abstract

OBJECTIVE: To evaluate the epidemiologic features and risk factors for multiple cases of meningococcal disease in

schools.

DESIGN: Population-based prospective evaluation and case-control study of clusters of meningococcal disease that

occurred in schools from January 1989 to June 1994.

SETTING: Surveillance conducted through state health departments in the United States.

MAIN OUTCOME MEASURES: Descriptive epidemiology of school-based clusters of meningococcal disease

and determinants of their occurrence.

RESULTS: We identified 22 clusters of meningococcal disease in 15 states. The estimated incidence of secondary

meningococcal disease among schoolchildren aged 5 to 18 years was 2.5 per 100000 population, a relative risk of 2.3

(95% confidence interval [CI], 1.6-3.3). The median number of students per cluster was 2 (range, 2-4). Of 30

subsequent cases, 10 (33%) occurred 2 or fewer days after the index case, and 22 (73%) occurred 14 or fewer days

after the index case. Among the 8 schools with 2 or more cases, 50% of the additional cases occurred 2 or more days

after the second case. Secondary schools (grades 7 through 12) accounted for 15 (75%) of 20 cluster schools

compared with 9 (45%) of 20 matched control schools (P<.05). In 16 (73%) of 22 clusters, interaction between case

patients was noted. The index patient in cluster schools was more likely than the controls to have participated in a

school-based group activity 14 or fewer days before illness (matched odds ratio, 7.0; 95% CI, 0.9-57).

CONCLUSIONS: Three quarters of the school clusters occurred in secondary schools, with over 70% of subsequent

cases occurring within 2 weeks of the index case. Rapid initiation of a chemoprophylaxis program after 2 cases of

meningococcal disease in a school would have potentially prevented 50% of subsequent cases in the clusters

described.

Title

Control and prevention of serogroup C meningococcal disease: evaluation and management of suspected outbreaks: recommendations of the Advisory Committee on Immunization Practices (ACIP).

Source

MMWR - Morbidity & Mortality Weekly Report. 46(RR-5):13-21, 1997 Feb 14.

Unique Identifier

97201018

Abstract

Outbreaks of serogroup C meningococcal disease (SCMD) have been occurring more frequently in the United States

since the early 1990s, and the use of vaccine to control these outbreaks has increased. These outbreaks are

characterized by increased rates of disease among persons who may have a common organizational affiliation or who

live in the same community. By using surveillance for SCMD and calculation of attack rates, public health officials can

identify SCMD outbreaks and determine whether use of meningococcal vaccine is warranted. This report describes 10

steps for evaluation and management of suspected SCMD outbreaks. The principles described also apply to suspected

outbreaks caused by meningococcal serogroups A, Y, and W-135. The effectiveness of mass chemoprophylaxis

(administration of antibiotics to large populations) has not been demonstrated in most settings in which community and

organizational outbreaks occur. However, in outbreaks involving small populations, administration of chemoprophylaxis

to all persons within this group may be considered. The ability to validate some aspects of these recommendations is

currently limited by incomplete reporting of serogroup information in most systems for meningococcal disease

surveillance in the United States and by the relative rarity of SCMD and SCMD outbreaks.

Title

Assessment of surveillance for meningococcal disease in New York State, 1991.

Source

American Journal of Epidemiology. 144(1):78-82, 1996 Jul 1.

Unique Identifier

96259466

Authors

Ackman DM. Birkhead G. Flynn M .

Institution

Bureau of Communicable Disease Control, New York State Department of Health,

Albany 12237, USA.

Abstract

Prevention of meningococcal disease relies in part on the prompt treatment of household and other close contacts of

cases. New York State requires that all meningococcal disease cases be reported within 24 hours of diagnosis to

ensure that chemoprophylaxis is given to all exposed persons. The authors used a capture-recapture method to assess

completeness of reporting of meningococcal disease in 1991 by comparing persons reported to the Department of

Health surveillance system with patients listed in the New York State computerized hospital discharge data set who had

a discharge diagnosis of meningococcal disease. Medical records of persons identified from the discharge data set

were reviewed to verify the diagnosis of meningococcal disease, and timeliness of reporting was assessed by reviewing

surveillance case reports. In 1991, 110 cases of meningococcal disease were reported to the Department of Health

and 197 patients were identified from hospital discharge data, of which charts were reviewed for 179 (91%). Of the

charts reviewed, 116 (65%) had confirmed or probable meningococcal disease, and 57 (32%) did not have the

disease. Completeness of reporting to the notifiable disease surveillance system was estimated to be 93%, and 78%

were reported within 2 days of diagnosis. Errors of physicians and medical records departments contributed to the

misclassification of medical records. The authors conclude that notifiable disease surveillance for meningococcal

disease is relatively complete, but there is a delay in reporting some cases. Frequent errors may make invalidated

hospital discharge data unsuitable for communicable disease surveillance.

Title

How long is too long? Determining the early management of meningococcal disease in Birmingham.

Source

Public Health. 110(4):237-9, 1996 Jul.

Unique Identifier

96334249

Authors

Wood AL. O'Brien SJ .

Institution

North Birmingham Health Authority, Edgbaston.

Abstract

OBJECTIVE: To determine the length of time cases of meningococcal disease wait before receiving parenteral

antibiotic therapy in hospital.

METHOD: The hospital case notes of residents of Birmingham who were admitted to local hospitals in 1993 and

discharged with a diagnosis of meningitis or meningococcal disease were reviewed. This information was combined

with that held by the West Midlands Ambulance Service.

RESULTS: Forty out of the 82 patients (49%) who met the case definition had meningococcal infection. Twenty one

patients (26%) were admitted by ambulance, 11 of whom had meningococcal infection. The mean time from a request

for an ambulance to the patient reaching hospital was 52 min for those with meningococcal infection compared to 55

min for those without. Nineteen patients (47.5%) with meningococcal infection waited more than one hour after

admission for antibiotic treatment. Seven had an initial diagnosis of meningitis or meningococcal infection. Ten out of 27

patients with a meningococcal rash (37%), 13 out of 22 patients aged under five years (59%) and 13 out of 24

patients with microbiologically confirmed meningococcal infection (54%) waited more than one hour for treatment.

Seven patients with meningococcal infection received benzyl penicillin before admission. Six received hospital antibiotic

treatment within the hour.

CONCLUSION: The assumption that patients suspected of having meningitis or meningococcal disease are treated

promptly once in hospital is not always correct. The results of this study reinforce the need for all doctors to give benzyl

penicillin promptly to patients they suspect have meningococcal disease.

Title

Source

Journal of Pediatrics. 128(2):196-202, 1996 Feb.

Unique Identifier

96231895

Authors

King WJ. MacDonald NE. Wells G. Huang J. Allen U. Chan F. Ferris W. Diaz-Mitoma F. Ashton F .

Institution

Department of Pediatrics, Children's Hospital Eastern Ontario, University of

Ottawa, Canada.

Abstract

OBJECTIVE: To determine total and functional serogroup C antibody response after vaccination with a quadrivalent

meningococcal polysaccharide vaccine.

DESIGN: Prospective, before and after intervention study.

SUBJECTS: Study subjects were between the ages of 0.5 and 19.9 years, and were eligible for a community-wide

public health immunization campaign against Neisseria meningitidis serogroup C.

METHODS: Total and functional antibody response was measured by enzyme-linked immunosorbent assay and

bactericidal assay, respectively.

RESULTS: One month after vaccination, total capsular polysaccharide antibody significantly increased in all age

groups; a significant rise in bactericidal antibody, that correlated with total capsular polysaccharide antibody, was seen

in children 18 months of age and older. At 1 year bactericidal antibody titers were maintained but capsular

polysaccharide antibody declined substantially in children younger than 5 years.

CONCLUSION: Total capsular polysaccharide antibody concentration appears to be a useful surrogate measure of

bactericidal antibody in children 18 months and older. Children who originally received the vaccine at less than 18

months of age should be considered for revaccination if there is a new or continuing risk of disease. Because of the

differences in the total and bactericidal antibodies formed, vaccine efficacy trials are required to define which serologic

measures are associated with protection.

Title

Source

Journal of Clinical Microbiology. 33(8):2209-11, 1995 Aug.

Unique Identifier

96057621

Authors

Edmond MB. Hollis RJ. Houston AK. Wenzel RP .

Institution

Department of Internal Medicine, University of Iowa College of Medicine, Iowa

City, USA.

Abstract

Over a 2-month period, five cases of serogroup C meningococcal disease occurred in Iowa City, Iowa. Two patients

were unacquainted university students who had independently visited another university with endemic meningococcal

disease. Isolates from these patients had DNA fingerprints identical to those of the isolates responsible for infections on

the other campus. Three cases for which the patients' isolates had a different DNA fingerprint were linked to visiting a

local tavern. To disrupt the outbreak, the University of Iowa offered free meningococcal vaccine to all students. This

report demonstrates that outbreaks of meningococcal disease may be due to more than one circulating strain and

illustrates the utility of pulsed-field gel electrophoresis in defining the molecular epidemiology of meningococcal

infections.

Return to Meningitis Hot-line - Healthwatch.org