Increased Case‐Fatality Rate Associated with Outbreaks of Neisseria meningitidis Infection, Compared with Sporadic Meningococcal Disease, in the United States, 1994–2002
Abstract
BACKGROUND: Outbreaks of meningococcal disease are infrequent but important public health events. We characterize outbreak-associated cases in the United States and compare them with sporadic disease. METHODS: Outbreaks of meningococcal disease that occurred during the period of 1 July 1994 through 30 June 2002 were identified through state health departments, Centers for Disease Control and Prevention records, and a review of newspapers and the medical literature. Cases associated with outbreaks were compared with sporadic cases identified through population-based surveillance. RESULTS: We identified 69 outbreaks of Neisseria meningitidis infection (median, 9.5 outbreaks per year; range, 3-14 outbreaks per year), which involved 229 patients from 30 states. Forty-three (62%) of the outbreaks involved N. meningitidis serogroup C, 17 (25%) involved serogroup B, and 9 (13%) involved serogroup Y. Twenty-five outbreaks (36%) occurred in communities, and 44 (64%) were organization based, including 12 that occurred in colleges and universities, 19 that occurred in primary and secondary schools, and 8 that occurred in nursing homes. Vaccination campaigns (with the A/C/Y/W-135 meningococcal polysaccharide vaccine) were conducted for 31 outbreaks (28 involving serogroup C and 3 involving serogroup Y). After controlling for age, serogroup, and clinical presentation, outbreak-associated cases were associated with a higher case-fatality rate than were sporadic cases (21% vs. 11%; odds ratio, 3.3; 95% confidence interval, 2.0-5.5). CONCLUSIONS: Outbreaks remain an important but infrequent public health issue, representing <2% of all cases of meningococcal disease. However, given the increased case-fatality rate found among outbreak-related cases of N. meningitidis infection, additional investigation of factors that favor the transmission and virulence of outbreak-related strains is warranted.
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For all serogroups, outbreaks of meningococcal meningitis are associated with higher case-fatality ratios than sporadic cases.
“For all serogroups, outbreaks of meningococcal meningitis are associated with higher case-fatality ratios than sporadic cases.21”
From Community-acquired acute bacterial meningitis in adults: a clinical update (2019) · cites this paper as [21]
Results (Table 3; page not provided) show higher observed case-fatality rates for outbreak-associated than sporadic cases in serogroups C, B, and Y. But the differences for B and Y are statistically uncertain, there were no outbreak-associated W-135 cases, and the meningitis-specific comparison (13% vs. 10%) is also uncertain. The claim overstates the evidence by saying this holds for all serogroups of meningococcal meningitis. (LLM, conf=0.87)
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Cites
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- Authors
- Brooks, R., Woods, C. W., Benjamin, Jr., & Rosenstein, N. E.
- Affiliations
- Duke University (US)
- Centers for Disease Control and Prevention (US)
- Corresponding author
- Woods, Christopher W.
- Venue
- Clinical Infectious Diseases
- Publisher
- Oxford University Press (OUP)
- Published
- 2006-07
- Volume
- 43
- Issue
- 1
- Pages
- 49-54
- ISSN
- 1058-4838 (ISSN-L)
- 1537-6591
- OpenAlex
- W2148145446
- Cited by
- 124
- References
- 15
- Citations by year
- 2025: 2 · 2023: 2 · 2022: 3 · 2021: 4 · 2020: 9 · 2019: 5 · 2018: 10 · 2017: 5 · 2016: 10 · 2015: 13 · 2014: 8 · 2013: 10 · 2012: 5
- FWCI
- 6.55
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Clinical Infectious Diseases (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Sanofi
- Centers for Disease Control and Prevention
- Topics
- Life Sciences › Immunology and Microbiology › Microbiology › Bacterial Infections and Vaccines
- Life Sciences › Immunology and Microbiology › Microbiology › Microbial infections and disease research
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Neonatal and Maternal Infections
- Keywords
- Neisseria meningitidis, meningococcal disease outbreak, case fatality rate, serogroup C, serogroup B, serogroup Y, community outbreak, nursing home outbreak, meningococcal polysaccharide vaccine, vaccination campaigns, United States
- MeSH terms
- Adolescent, Adult, Aged, Child, Child, Preschool, Disease Outbreaks, Female, Humans, Infant, Male, Meningococcal Infections, Middle Aged, Mortality, Neisseria meningitidis, Population Surveillance, Retrospective Studies, United States
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