The CDC has issued a health advisory(www.bt.cdc.gov) in response to reports of eight cases of serogroup B meningococcal disease in students at Princeton University in Princeton, N.J.(www.state.nj.us), as well as three additional cases in students at the University of California, Santa Barbara(studenthealth.sa.ucsb.edu) (UC-Santa Barbara). Although both outbreaks are caused by serogroup B Neisseria meningitidis, additional molecular typing shows that the outbreaks are being caused by two different strains, indicating that they are not related.
The agency is urging health care professionals to maintain a high level of suspicion for the disease in patients who are students at, or who have had close contact with anyone from, those university communities and who present with fever and headache or rash.
If physicians suspect meningococcal disease based on a patient's history and symptoms, empiric therapy should be considered, blood or cerebrospinal fluid (CSF) specimens should be collected, and suspected cases should be reported to the local health department, according to CDC officials. In the event that clinical suspicion is high, but blood or CSF specimens are sterile, the agency recommends sending specimens to its meningitis laboratory for polymerase chain reaction testing.
- The CDC has issued a health advisory following reports of serogroup B meningococcal disease in students at Princeton University and the University of California, Santa Barbara.
- The agency asks physicians to maintain a high level of suspicion for the disease in patients from those university communities who present with fever and headache or rash.
- At this time, the CDC does not recommend any changes in normal activity to avoid contact with the affected university campuses or their students, although the agency is emphasizing the importance of observing good hygiene practices.
Although administration of the quadrivalent meningococcal conjugate vaccine is recommended for all eligible adolescents at age 11-12, with a booster dose at age 16, the vaccine covers only the A, C, Y and W-135 serogroups. No vaccine that covers serogroup B is currently available in the United States, but CDC officials have recommended that certain individuals in the Princeton University community receive a serogroup B vaccine(www.cdc.gov) used in the European Union and Australia. The FDA will allow administration of that vaccine in accordance with an Investigational New Drug application.
Pediatrician Amanda Cohn, M.D., a meningococcal expert with the CDC, specifically addressed the decision to use the unlicensed vaccine in a press briefing(www.cdc.gov) the agency conducted on Nov. 25.
"In general, CDC defines an outbreak of meningococcal disease as three or more cases in three months that can't be (directly) connected to each other," Cohn explained. "And these outbreaks occur in a certain population, like schools or organizations. Most outbreaks of this disease are self-limited, and no more than three or four cases occur. However, when cases continue to occur over a several-month period, like what is happening at Princeton University, intervention is required to reduce the length of the outbreak."
That is the chief difference between the New Jersey and California outbreaks, according to Cohn: Princeton University's first case was reported in March of this year, whereas the UC-Santa Barbara cases were all diagnosed in November.
"The CDC and the Food and Drug Administration have determined that the unique pattern of disease in this Princeton outbreak, the high rate of cases that have occurred and over the long period of time they've occurred, warrants access to this serogroup B vaccine for that high-risk population," said Cohn.
Admittedly, using an unlicensed vaccine represents a "highly unusual" move, Cohn added. "I'm not sure if it's completely unprecedented, but I think it speaks to the really very high attack rates that we saw at Princeton University, and how strongly we felt along with our partners in New Jersey and at Princeton that we needed to do something to prevent additional cases."
At this time, the CDC does not recommend any changes in normal activity to avoid contact with the affected university campuses or their students, although the agency is emphasizing that observing good hygiene practices, such as thorough hand-washing and coughing or sneezing into the arm, is important.
The agency continues to track the outbreaks and asks that all suspected cases of invasive meningococcal disease associated with the two universities be reported as follows:
- cases associated with Princeton University should be reported to Denise Garon at the New Jersey Department of Health by calling (609) 826-5964 or via e-mail to Denise.Garon@doh.state.nj.us; and
- cases associated with UC-Santa Barbara should be reported to Kathleen Harriman at the California Department of Public Health by calling (651) 699-2970 or via e-mail to firstname.lastname@example.org.
Recommendations for prophylactic use of antibiotics in close contacts of people with meningococcal disease are available from the CDC's Mortality and Morbidity Weekly Report(www.cdc.gov).