under the microscope
under the microscope
By Rodney E . Rohde , PhD , MS , SM ( ASCP ) CM , SVCM , MBCM , FACSc
Invasive Serogroup Y Meningococcal Diseases
The bacterium Neisseria meningitidis is a rare but severe illness which causes meningococcal disease with a case-fatality rate of 10 percent to 15 percent even with appropriate antibiotic treatment . It most often presents as meningitis , often resulting in symptoms such as fever , headache , stiff neck , nausea , vomiting , photophobia , or altered mental status ; or as meningococcal bloodstream infection , with symptoms that may include fever and chills , fatigue , vomiting , cold hands and feet , severe aches and pains , rapid breathing , diarrhea , or , in later stages , a dark purple rash . While initial symptoms of meningococcal disease can at first be non-specific , they worsen rapidly , and the disease can become life-threatening within hours . Meningitis infections may also be caused by other microorganisms such as viruses , parasites , and fungi .
While initial symptoms of meningococcal disease can at first be nonspecific , they worsen rapidly , and the disease can become life-threatening within hours .”
CDC Health Alert Network Issues Health Advisory
The Centers for Disease Control and Prevention ( CDC ) issued a Health Alert Network ( HAN ) Health Advisory [ CDCHAN-00505 ] to alert healthcare providers to an increase in invasive meningococcal disease , mainly attributable to Neisseria meningitidis serogroup Y . From 2014-22 , cases reported in the United States had been typical of normal epidemiology . However , in 2023 , the U . S experienced 422 cases which was the highest annual number since 2014 . Since March 25 , 2024 , 143 cases have been reported for the year which is a 76.5 % increase [ 81 to 143 ] in cases as compared to this date in 2023 . Interestingly , sequence type [ ST ] 1466 has been responsible for the majority [ 101 of 148 , of 68 %] serogroup Y [ specific meningococcal strain ] cases across the U . S . in 2023 .
Background and Current Epidemiology
Several different bacteria can cause meningitis . Streptococcus pneumoniae , Haemophilus influenzae , and N . meningitidis are the most frequent ones . N . meningitidis , causing meningococcal meningitis , is the one with the potential to produce large epidemics . Meningococcal disease , caused by the bacterium Neisseria meningitidis , is a rare but severe illness with a case-fatality rate of 10 percent to 15 percent even with appropriate antibiotic treatment . Immediate diagnosis and antibiotic treatment for meningococcal disease is critical . Survivors may experience long-term effects such as deafness or amputations of the extremities .
Of the six N . meningitidis serogroups — A , B , C , W , X , and Y — responsible for most meningococcal disease worldwide , the four serogroups B , C , W , and Y circulate in the U . S . Vaccines against serogroups A , C , W , Y ( MenACWY ) and serogroup B ( MenB ) are available in the U . S . MenACWY vaccines are routinely recommended for adolescents and for people with other risk factors or underlying medical conditions , including HIV .
Analysis of current reported cases in the U . S . caused by ST 1466 are disproportionately occurring in people ages 30 to 60 years ( 65 percent ), Black or African American people ( 63 percent ), and people with HIV ( 15 percent ). Additionally , many invasive meningococcal disease cases caused by ST-1466 in 2023 had a clinical presentation other than meningitis : 64 percent presented with bacteremia , and at least 4 percent presented with septic arthritis . Of 94 patients with known outcomes , 17 ( 18 percent ) died ; this case-fatality rate is higher than the historical case-fatality rate of 11 percent reported for serogroup Y cases in 2017 through 2021 .
Information and Recommendations The CDC Health Advisory asks that public health departments , healthcare providers , and the public help raise awareness about the current increase in invasive serogroup Y meningococcal diseases . Healthcare providers should 1 ) have a heightened suspicion for meningococcal disease , particularly among populations disproportionately affected by the current increase , 2 ) be aware that patients may present without symptoms typical of meningitis , and 3 ) ensure that all people recommended for meningococcal vaccination , including people with HIV , are up to date for meningococcal vaccines . Specific recommendations include :
●Continue submitting all meningococcal isolates to CDC for whole-genome sequencing and antimicrobial susceptibility testing .
●Contact CDC at meningnet @ cdc . gov with any questions or concerns about increasing meningococcal disease cases in their jurisdiction or outbreak investigation or control measures .
●Maintain a heightened suspicion for invasive meningococcal disease and start immediate antibiotic treatment for persons with suspected meningococcal disease . Blood and cerebrospinal fluid ( CSF ) cultures are indicated for patients with suspected meningococcal disease .
●Be aware that patients with invasive meningococcal disease may present with bloodstream infection or septic arthritis and without symptoms typical of meningitis ( e . g ., headache , stiff neck ).
●Ensure that all people recommended for meningococcal vaccination are up to date for meningococcal vaccines .
• All 11-12-year-olds should receive a MenACWY vaccine . Since protection wanes , CDC recommends a booster dose at age 16 years .
• For people at increased risk due to medical conditions ( e . g ., with HIV ), recommended vaccination includes a two-dose primary MenACWY series with booster doses every three to five years , depending on age .
●Seek medical attention immediately if you or your child develops symptoms of meningococcal disease .
●Talk to your healthcare provider about meningococcal vaccines that may be recommended for you and your household or family members , including any recommended booster doses .
For complete information on this infection , see the CDC Health Advisory Report issued March 28 , 2024 .
Rodney E . Rohde , PhD , MS , SM ( ASCP ) CM , SVCM , MBCM , FACSc , is the Regents ’ Professor , Texas State University System ; University Distinguished Chair & Professor , Clinical Laboratory Science ( CLS ); TEDx Speaker & Global Fellow – Global Citizenship Alliance ; Texas State Honorary Professor of International Studies ; associate director , Translational Health Research Initiative ; Past President , Texas Association for CLS .
august 2024 • www . healthcarehygienemagazine . com •
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