CDC Issues Alert on Recognizing, Reporting Meningitis Associated with University Outbreaks

Eight cases of serogroup B meningococcal disease have been reported in Princeton University students or persons with links to Princeton University during the last eight months, including three cases reported since September. One case occurred in a high school student who stayed in a Princeton dormitory and developed illness within one day of returning home; the other seven cases occurred in Princeton University undergraduate students. Three cases of serogroup B meningococcal disease have been reported among UCSB undergraduate students during the month of November. According to the Centers for Disease Control and Prevention (CDC), no epidemiologic links have been identified between the Princeton University and the UCSB cases. Although both outbreaks are caused by serogroup B, additional molecular typing shows that the outbreaks are being caused by two different strains, indicating that the outbreaks are not related.

The CDC, the New Jersey Department of Health (NJDOH), Princeton University officials, and local health authorities have been working closely together since the first case of meningococcal disease associated with Princeton University was reported in March 2013. CDC, the California Department of Public Health, UCSB officials, and local health authorities have also been working closely together since the first case of meningococcal disease associated with UCSB was reported in November 2013.
 
Increased awareness of meningococcal disease and prompt early case recognition among healthcare providers is critical. If a Princeton University or UCSB student or a person who has had close contact with someone from those university communities develops a fever and headache or rash, meningococcal disease should be suspected; empiric treatment should be considered; blood or cerebrospinal fluid (CSF) cultures should be collected; and suspected cases should be reported to the local health department.

If there is a high degree of clinical suspicion for meningococcal disease, but CSF or blood specimens are sterile, CDC recommends sending specimens to the Meningitis Laboratory at CDC for polymerase chain reaction (PCR) testing. The CDC considers the risk of transmission of these strains beyond the university communities to be low. However, to monitor potential transmission of these strains, the CDC is requesting that health departments send all isolates, whether or not they are linked to these universities, from serogroup B meningococcal disease cases occurring from Nov. 1, 2013, through Dec. 31, 2013, to the Meningitis Laboratory at CDC for further molecular testing. Contact the Meningitis and Vaccine Preventable Diseases Branch at meningnet@cdc.gov to arrange shipment of isolates.

The CDC does not recommend a change in normal activity to avoid contact with the affected universities or their students. Good hygiene practices such as handwashing, and coughing or sneezing into the arm are recommended. The licensed quadrivalent meningococcal vaccines are recommended for all adolescents 11 through 18 years old and first year college students living in residence halls, but these vaccines do not protect against serogroup B, the serogroup that is causing the Princeton University and UCSB cases. A serogroup B meningococcal vaccine, which is only licensed for use in Europe and Australia, will be offered at Princeton University. FDA has allowed the use of the vaccine at Princeton University under an Investigational New Drug application.

All suspect cases of invasive meningococcal disease associated with the two universities should be reported as follows:
- Cases associated with Princeton University should be reported to Denise Garon, NJDOH, at (609)826-5964 or Denise.Garon@doh.state.nj.us.
- Cases associated with UCSB should be reported to Kathleen Harriman, CDPH, at (651)699-2970 or kathleen.harriman@cdph.ca.gov.
 
Guidance on recommendations for prophylactic use of antibiotics in close contacts of persons with meningococcal disease is available at http://www.cdc.gov/mmwr/preview/mmwrhtml/rr6202a2.htm?s_cid=rr6202a2_w.

Source:  Centers for Disease Control and Prevention (CDC)