What is the incidence of meningococcemia in the US?

Updated: Aug 13, 2019
  • Author: Mahmud H Javid, MBBS; Chief Editor: John L Brusch, MD, FACP  more...
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Answer

From 2006-2015, 7,924 cases of meningococcal disease were reported (average annual incidence of 0.26 cases per 100,000 population), 2,290 (35.8%) of which were serogroup B, 1,827 (28.5%) were serogroup Y, 1,457 (22.8%) were serogroup C, 436 (6.8%) were serogroup W, and 392 (6.1%) were other serogroups. [25] Although endemic in North America, meningococcal infections follow a pattern of multiyear cycles. The most recent peak occurred in 1996 (1.1 cases/100,000 population). In contrast, the incidence in 2005 was 0.4 cases/100,000 population. This decline began before the use of conjugate vaccine among adolescents in 2005. [26] By 2011, the incidence had decreased to 0.3 cases/100,000 population. [27] In 2006, 1194 cases of meningococcal disease were reported in the United States; 974 cases were reported in 2007. [28, 29] From January 2014 through December 2016, 1,174 confirmed or probable meningococcal cases were reported. [30]

Serogroup B infections have occurred in college outbreaks, especially among freshmen. [31] Data have also shown that college-attending students are at a higher risk of invasive meningococcal disease than nonattenders, and all outbreaks in the 2011-2019 period involved serogroup B disease. [32] High overall vaccination coverage rather than use during outbreaks would be an effective strategy, as the serogroup B meningococcal (MenB) vaccine may not be associated with reduced carriage or acquisition rates. [33]

A systematic review of carriage rates in the Americas from 2001-2018 found the second highest rate (24%) in the United States. [34]

Outbreaks account for less than 5% of meningococcal infections in the United States. They may be restricted to a closed population or may involve a larger community. In a Los Angeles County outbreak of meningococcal disease, nearly one half of community residents with the disease had had contact with persons who had been incarcerated. [35]

The increased risk of invasive meningococcal disease among young adults who live in close quarters under stressful situations has been long recognized. The prototype of this type of outbreak is that among military recruits living in crowded barracks. Resultant disruption and basic training prompted the Department of Defense to initiate development of the original meningococcal vaccines. [36]

Between 2010 and March 2013, 22 cases of meningococcal infection, serogroup C, were documented in New York City among men who have sex with men (MSM). Sixteen of these occurred in 2013. Fifty percent involved blacks. Fifty-five percent of infected persons were also HIV-positive. Seven cases were fatal.

In 2012, the incidence of meningococcal disease among MSM aged 18-64 years in New York City was 12.6 per 1000 population, compared with 0.16 per 500,000 non-MSM population. In 2014, there were 4 additional cases. Several outbreaks were reported in Los Angeles during the same time. [37] Serogroup C disease has been associated with a significantly higher number of cases. [38]

In the HAART era, the relative risk of meningococcal disease among persons with HIV infection was 10, with the greatest likelihood among those with CD4 counts less than 200/µL. [39]

The incidence of meningococcal infection among healthcare workers and first responders is quite low. However, it is estimated that the rate of acquisition of meningococcal by microbiological laboratory workers infection in the United States is significant. The vast majority of cases were associated with absence of any respiratory protection during the time that the specimens were handled. [40]

Thirty-five percent of meningococcal disease cases are caused by serogroup C, 32% by serogroup B, and 26% by serogroup Y. [41] Since 2005, the year that the quadrivalent (serogroup A, C, W-135, and Y) conjugated meningococcal vaccine was made available, there has been a rise in outbreaks of serogroup B infection on college campuses. [42]

Patients with complement deficiencies have a higher proportion of meningococcal disease caused by serotypes Y and W-135.


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