under the microscope
under the microscope
By Priya Dhagat , MS , MLS ( ASCP ) CM , CIC
Meningococcal Disease : A Nationwide Increase Requiring Prompt Attention and Treatment
People with meningococcal disease may present with symptoms of meningitis , such as fever , headache , stiff neck , nausea , vomiting , photophobia , or altered mental status ; or with symptoms of meningococcal bloodstream infection , such as fever and chills , fatigue , vomiting , severe aches and pains , rapid breathing , diarrhea , and rash .”
Cases of meningococcal disease have sharply increased in the United States since 2021 and now surpass pre-pandemic levels . A total of 422 confirmed and probable cases were reported to the Centers for Disease Control and Prevention ( CDC ) in 2023 - the highest annual number of cases reported in almost a decade . On March 28 , 2024 , the CDC issued a health advisory to alert healthcare providers about an increase in invasive meningococcal disease , attributable to Neisseria meningitidis serogroup Y . In Colorado , the Denver Department of Public Health and Environment confirmed five cases of meningococcal disease among people experiencing homelessness since January 12 , 2024 . All five individuals were hospitalized and no deaths have been reported . In Virginia , health officials have been responding to a state-wide outbreak of serogroup Y since 2022 , in which the outbreak was initially declared in the eastern region , and has now been detected in the Central , Southwest , and Northern regions of the state with a total of 36 confirmed cases and 7 deaths state-wide .
According to a recent report from the National Notifiable Disease Surveillance System , as of April 13 , 2024 there have been 170 reported cases of all serotypes ( year-to-date ) across all regions of the country . Texas , California , Arizona , and Florida have reported the highest number of cases , in addition to Virginia and Colorado . People disproportionately affected include people between the ages of 30 and 60 years , Black or African American people , and adults with HIV .
What is Meningococcal disease ?
Neisseria meningitidis is a bacterium that can cause meningococcal disease . There are six N . meningitidis serogroups that cause meningococcal disease worldwide : A , B , C , W , X , and Y . Serogroups B , C , W , and Y circulate in the United States . A specific strain from serogroup Y , called sequence type ( ST ) 1466 , caused 68 percent of cases in the United States last year .
How does Neisseria meningitidis cause infection ?
The bacteria spreads to others by exchanging respiratory and throat secretions ( saliva or spit ) during close contact . N . meningitidis colonizes the nasopharynx and then attaches to mucosal epithelial surfaces using various types of proteins . Several key virulence factors protect it from being killed , including different types of proteins , a capsule , and pili . These virulence factors contribute to the attachment and adhesion to host cells , evasion of the host immune system , and survival in the bloodstream .
Once in the bloodstream , these virulence factors allow the bacteria to cross the blood-brain-barrier , thereby causing neurologic complications like meningitis . People with meningococcal disease may present with symptoms of meningitis , such as fever , headache , stiff neck , nausea , vomiting , photophobia , or altered mental status ; or with symptoms of meningococcal bloodstream infection , such as fever and chills , fatigue , vomiting , severe aches and pains , rapid breathing , diarrhea , and rash . These non-specific initial symptoms of meningococcal disease can worsen rapidly and may quickly become life-threatening . With a case fatality rate of 10 percent to 15 percent , immediate antibiotic treatment is critical .
Treatment , Vaccination , and Infection Prevention and Control
Per the recent CDC advisory , healthcare providers should have a heightened suspicion for meningococcal disease , considering patients that may present without symptoms typical of meningitis , start immediate antibiotic treatment if meningococcal disease is suspected , and ensure that all people recommended for meningococcal vaccination are up to date for meningococcal vaccines .
Extended-spectrum cephalosporins , such as cefotaxime or ceftriaxone , can be used as empiric treatment and continued as definitive treatment after susceptibility and microbiologic testing . Penicillin G or ampicillin may also be used for definitive treatment . Vaccines against serogroups A , C , W , Y ( MenACWY ) and serogroup B ( MenB ) are available in the United States . In healthcare facilities , patients should be promptly isolated and healthcare providers should follow droplet and standard precautions until 24 hours after initial effective treatment . For more information :
● Weekly statistics from the National Notifiable Diseases Surveillance System ( NNDSS ). ( cdc . gov )
● Health Alert Network ( HAN ) - 00505 | Increase in Invasive Serogroup Y Meningococcal Disease in the United States ( cdc . gov )
● Mechanism of meningeal invasion by Neisseria meningitidis - PMC ( nih . gov )
● Virulence Factors of Meningitis-Causing Bacteria : Enabling Brain Entry across the Blood – Brain Barrier - PMC ( nih . gov )
Priya Dhagat , MS , MLS ( ASCP ) CM , CIC , is an infection preventionist and the associate director of the system-wide Special Pathogens Program within the Department of Emergency Management at New York City Health + Hospitals , overseeing special pathogen preparedness and response efforts across New York City Health + Hospitals frontline healthcare facilities . Additionally , she supports and offers subject matter expertise for infection prevention topics for the National Emerging Special Pathogens Training and Education Center ( NETEC ).
8 • www . healthcarehygienemagazine . com • may 2024