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Meningococcal Disease Outbreak and Mass Vaccination at University of Oregon

Posted By Katrina Hedberg, Friday, May 15, 2015
Updated: Friday, May 08, 2015
Untitled Document

In early January 2015, a University of Oregon undergraduate student who lived off campus developed fever, hemorrhagic conjunctivitis, and a non-blanching rash, but no symptoms of meningitis. Blood cultures yielded Neisseria meningitidis, serogroup B. Lane County Public Health staff identified close contacts and arranged for antimicrobial prophylaxis.

Without prompt antibiotic treatment, meningococcal disease is essentially 100 percent fatal. Those who survive may have negative long-term health effects (e.g. hearing loss, loss of limbs, etc). Household members of cases have an attack rate 500 to 1,000 times higher than the general population.1 Even with antibiotics, the fatality rate among cases reported in Oregon during 2005 to 2014 was 8.5 percent.

Meningococci come in 13 flavors, called “serogroups.” Of these, serogroups B, C, and Y each cause about one third of cases in the United States.2 Quadrivalent polysaccharide and conjugate vaccines are available US to prevent disease caused by serogroups A, C, Y and W135. Since October 2014, the FDA has licensed two new vaccines that protect against serogroup B: Bexsero® (a two-dose series) and Trumenba™ (three doses).



Meningococcal disease has declined steadily in Oregon since its 1996 peak. It has declined in the United States over the past 20 years, to recent annual incidences 0.3 to 0.5 cases per 100,000 people.
This is in spite of carriage rates of 5 to 10 percent in many communities.3

Seventeen days after the first U of O case, another student developed signs of meningococcemia, the diagnosis of which was confirmed by blood culture yielding N. meningitidis, serogroup B. Again, Lane County Public Health worked with U of O to identify close contacts and arranged prophylaxis. No epidemiologic link between the two ill students could be identified. The day after the second student fell ill, a third U of O undergrad developed malaise and possible fever; a few days later this student was admitted to hospital where serogroup B meningococcemia was confirmed. An epidemiological link was identified with one of the earlier ill students, and again close contacts were given antimicrobial prophylaxis.

Two-and-a-half weeks later, a fourth student developed severe meningococcemia and died. CDC recommends that broader community vaccination be considered when ≥3 cases of infection by a single meningococcal serogroup have occurred within a three-month period, without direct epidemiological links between the cases, and yielding an attack rate of >10 cases per 100,000 in the community at risk.4 The lack of direct links between cases implies that the infection has escaped the ring of antimicrobial prophylaxis and signals risk to the broader group: the cat has gotten out of the bag.

Vaccines were offered to students at the Student Health Service and then through local pharmacies. The U of O arranged for vaccinators and undertook a mass vaccination campaign using Trumenba™ at the campus basketball arena March 2-6. Through the Student Health Service, Lane County Public Health, pharmacies, and the mass vaccination effort on campus, approximately 8,800 students were immunized. Despite school being in session, news of the event ubiquitous on campus, mass vaccination clinics, and incentives of free t-shirts, store gift cards, and, yes, even pizza, more than 13,000 students remained unvaccinated.

Two more cases of serogroup B meningococcemia have since been confirmed. Vaccination efforts continue, and as of 28 March, 9,193 students had been immunized — 42 percent of the 22,000 target group, which is the entire undergraduate population at the University.

Collaborative Effort

The overall response to this outbreak required close collaboration between the University of Oregon, Lane County Department of Health and Human Services, the Oregon Public Health Division, CDC, as well as local pharmacies. The challenge now is to ensure that students complete their vaccination series. Thankfully, no additional cases of meningococcal disease have occurred in U of O students since early March.
References
1. Hoek MR, Christensen H, Hellenbrand W, Stefanoff P, Howitz M, Stuart JM. Effectiveness of vaccinating household contacts in addition to chemoprophylaxis after a case of meningococcal disease: a systematic review. Epidemiol Infect 2008;136:1441–7.

2. CDC. Prevention and control of meningococcal disease: recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR 2013;62(RR02):1– 22.

3. CDC. Meningococcal disease. In: Atkinson W, Wolfe S, Hamborsky J, eds. Epidemiology and Prevention of Vaccine-Preventable Diseases. 12th ed. Washington, DC: Public Health Foundation, 2011. p. 193–204.

4. CDC. Evaluation and management of suspected outbreaks of meningococcal disease. MMWR 2013;62(RR02):25–7

Katrina Hedberg, MD, MPH is state epidemiologist and state health officer at the Oregon Public Health Division. For information on CSTE’s work in this domain, see the 2014 position statement 14-ID-06 on meningococcal disease and join an Infectious Disease subcommittee, such as Vaccine-Preventable Disease.

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