Epidemiology of Meningococcal Disease, New York City, 1989-2000

Alexandre Sampaio Moura, Ariel Pablos-Méndez, Marcelle Layton, Don Weiss


Emerging Infectious Diseases. 2003;9(3) 

In This Article

Abstract and Introduction

Study of the epidemiologic trends in meningococcal disease is important in understanding infection dynamics and developing timely and appropriate public health interventions. We studied surveillance data from the New York City Department of Health and Mental Hygiene, which showed that during 1989-2000 a decrease occurred in both the proportion of patients with serogroup B infection (from 28% to 13% of reported cases; p<0.01) and the rate of serogroup B infection (from 0.25/100,000 to 0.08/100,000; p<0.01). We also noted an increased proportion (from 3% to 39%; p<0.01) and rate of serogroup Y infection (from 0.02/100,000 to 0.23/100,000; p<0.01). Median patient age increased (from 15 to 30 years; p<0.01). The case-fatality rate for the period was 17%. As more effective meningococcal vaccines become available, recommendations for their use in nonepidemic settings should consider current epidemiologic trends, particularly changes in age and serogroup distribution of meningococcal infections.

Meningococcal disease is a broad term used to describe the different clinical syndromes resulting from Neisseria meningitidis infection. Its two major clinical illnesses, meningitis and meningococcemia (i.e., sepsis caused by meningococcal infection), occur more often as sporadic cases, but occasional outbreaks are an important cause of illness and death worldwide.

In the United States, a substantial proportion of cases of meningitis and sepsis are caused by N. meningitidis.[1] The incidence rate of meningococcal disease in the United States is estimated to be 0.7-1.4/100,000 population, and the case-fatality rate (CFR) is approximately 10%.[2,3] Both the incidence rate and CFR have been relatively constant, with no major changes observed in the past decade.[2]

Serogroups B and C are the most common strains found in the United States; however, increased rates of infection from serogroup Y were observed in the 1990s.[2,3] Changes in the age distribution of those infected have also been noted, and the conventional concept that meningococcal disease predominately affects infants and young children should be revised because the median age of meningococcal disease case-patients has increased.[2]

We describe the epidemiology of meningococcal disease in New York City from January 1989 to December 2000 with an emphasis on the trends of serogroup incidence, age, and fatality rates. The hypotheses tested were consistent with the trends in the epidemiology of meningococcal disease in the United States, the incidence of serogroup Y infection in New York City is increasing, the median age of patients is increasing, and the CFR is comparable to national figures.