Healthcare providers are facing a significant challenge in the form of an increase in invasive serogroup Y meningococcal disease, according to a recent CDC health advisory. The culprit behind the majority of cases this year is the sequence type (ST) 1466 strain of Neisseria meningitidis serogroup Y. What is particularly alarming is that many of these cases are not presenting with typical symptoms of meningitis, such as headache and stiff neck. Instead, 64% of cases are presenting with bacteremia and at least 4% with septic arthritis.
The ST 1466 strain is having a disproportionate impact on certain populations, including individuals aged 30 to 60 years, Black or African American individuals, and those with HIV. This strain also boasts a high case fatality rate of 18%, compared to the 11% rate seen in earlier years. In 2023 alone, the U.S. reported 422 cases of invasive serogroup Y meningococcal disease, with a significant increase to 143 cases already reported in 2024.
Clinicians are urged to be vigilant in identifying potential cases of meningococcal disease, especially among populations at higher risk due to the current surge. It is crucial for healthcare providers to recognize that patients may exhibit atypical symptoms that do not necessarily point to meningitis. Obtaining blood and cerebrospinal fluid cultures in suspected cases is vital for accurate diagnosis and appropriate treatment.
It is essential for clinicians to ensure that individuals for whom the meningococcal vaccine is recommended are up to date with their vaccinations. The CDC recommends that children aged 11 to 12 years receive the MenACWY vaccine and a booster at the age of 16. Those at increased risk, such as individuals with HIV, should undergo a two-dose primary MenACWY series, with booster doses every 3 to 5 years, depending on their age. Additionally, immediate notification of suspected or confirmed cases of invasive meningococcal disease to health departments is critical for timely intervention and control measures.
State and local health departments play a crucial role in providing guidance on treatment and contact prophylaxis based on local resistance patterns. Efforts should be made to raise awareness among clinicians about the heightened risk of invasive meningococcal disease among Black or African-American individuals and those in the 30 to 60-year age group. All meningococcal isolates should be submitted to the CDC for testing for antimicrobial resistance and whole-genome sequencing to aid in better understanding and response to the evolving situation.
The surge in invasive serogroup Y meningococcal disease necessitates heightened awareness and proactive measures by healthcare providers. By staying informed, implementing recommended vaccination strategies, and collaborating with public health authorities, clinicians can contribute to the early detection and control of this emerging threat.
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