Health Advisory: Increase in Invasive Meningococcal Disease due to Serogroup Y N. meningitidis

April 11, 2024

Action Requested 

• Be aware that CDC has issued an advisory regarding an increase in invasive meningococcal disease due to serogroup Y Neisseria meningitidis. At this time, the Washington State Department of Health reports that Washington is not seeing an increase in meningococcal disease, this is true in Snohomish County as well.
  • A specific meningococcal strain, sequence type (ST) 1466, is responsible for most (101 of 148, 68%) serogroup Y cases with available sequence type data that were reported across the United States in 2023.
• 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.
• Recognize that invasive meningococcal disease may affect people of any age or demographic group.
  • Current increases in disease are disproportionately affecting people ages 30–60 years, Black or African American people, and people with HIV.
• 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 2-dose primary MenACWY series with booster doses every 3–5 years, depending on age.
• Report any suspected or confirmed cases of invasive meningococcal disease in Snohomish County to the Snohomish County Health Department.
  • Call 425-339-3503 to reach the Communicable Disease program by phone.
  • Please complete and fax the Communicable Disease Report Form (PDF) and any accompanying lab reports to 425-339-8706. 
• Consult with the Health Department for any questions about meningococcal disease treatment or contact prophylaxis, including any changes based on local meningococcal resistance patterns.

For more information, see the full CDC health alert.

Background

CDC reports an increase in invasive meningococcal disease, mainly attributable to Neisseria meningitidis serogroup Y. In 2023, 422 cases were reported in the United States, the highest annual number of cases reported since 2014. As of March 25, 2024, 143 cases have been reported to CDC for the current calendar year, an increase of 62 cases over the 81 reported as of this date in 2023. Washington State is not seeing an increase in meningococcal disease at this time. The preliminary case count for 2023 is four confirmed cases, and three confirmed cases have been reported to-date in 2024. 

Cases caused by this strain are disproportionately occurring in people ages 30–60 years (65%), Black or African American people (63%), and people with HIV (15%). In addition, most cases of invasive meningococcal disease caused by ST-1466 in 2023 had a clinical presentation other than meningitis: 64% presented with bacteremia, and at least 4% presented with septic arthritis. Of 94 patients with known outcomes, 17 (18%) died; this case-fatality rate is higher than the historical case-fatality rate of 11% reported for serogroup Y cases in 2017–2021.

Resources

• Health Alert Network (HAN) - 00505 | Increase in Invasive Serogroup Y Meningococcal Disease in the United States (CDC)
• Meningococcal Disease Reporting and Investigation Guideline (PDF)
• DOH-LHJ Training Recording - Invasive Meningococcal Disease - 101023 (YouTube)
• Epidemiology and Prevention of Vaccine-Preventable Diseases (“The Pink Book”) – Chapter 14: Meningococcal Disease (CDC)
• Manual for the Surveillance of Vaccine-Preventable Diseases – Chapter 8: Meningococcal Disease (CDC)

MESSAGE CATEGORIES

• Health Alert: High-importance information about a public health incident. Warrants immediate action.
• Health Advisory: Important information about a potential or ongoing public health incident. May not require immediate action.
• Health Update: Updates about an ongoing public health incident. Immediate action not required.