School-based clusters of meningococcal disease in the United States. Descriptive epidemiology and a case-control analysis
K. M. Zangwill, A. Schuchat, F. X. Riedo, R. W. Pinner, D. T. Koo, M. W. Reeves and J. D. Wenger
Childhood and Respiratory Diseases Branch, Division of Bacterial and Mycotic Diseases, Centers for Disease Control and Prevention (CDC), Atlanta, GA 30333, USA.
OBJECTIVE: To evaluate the epidemiologic features and risk factors for
multiple cases of meningococcal disease in schools. DESIGN:
Population-based prospective evaluation and case-control study of clusters
of meningococcal disease that occurred in schools from January 1989 to June
1994. SETTING: Surveillance conducted through state health departments in
the United States. MAIN OUTCOME MEASURES: Descriptive epidemiology of
school-based clusters of meningococcal disease and determinants of their
occurrence. RESULTS: We identified 22 clusters of meningococcal disease in
15 states. The estimated incidence of secondary meningococcal disease among
schoolchildren aged 5 to 18 years was 2.5 per 100000 population, a relative
risk of 2.3 (95% confidence interval [CI], 1.6-3.3). The median number of
students per cluster was 2 (range, 2-4). Of 30 subsequent cases, 10 (33%)
occurred 2 or fewer days after the index case, and 22 (73%) occurred 14 or
fewer days after the index case. Among the 8 schools with 2 or more cases,
50% of the additional cases occurred 2 or more days after the second case.
Secondary schools (grades 7 through 12) accounted for 15 (75%) of 20
cluster schools compared with 9 (45%) of 20 matched control schools
(P<.05). In 16 (73%) of 22 clusters, interaction between case patients
was noted. The index patient in cluster schools was more likely than the
controls to have participated in a school-based group activity 14 or fewer
days before illness (matched odds ratio, 7.0; 95% CI, 0.9-57). CONCLUSIONS:
Three quarters of the school clusters occurred in secondary schools, with
over 70% of subsequent cases occurring within 2 weeks of the index case.
Rapid initiation of a chemoprophylaxis program after 2 cases of
meningococcal disease in a school would have potentially prevented 50% of
subsequent cases in the clusters described.
Molecular Epidemiology of Neisseria meningitidis Isolates from an Outbreak of Meningococcal Disease among Men Who Have Sex with Men, Chicago, Illinois, 2003
Schmink et al.
J. Clin. Microbiol. 2007;45:3768-3770.
ABSTRACT
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Evidence for Indirect Nosocomial Transmission of Neisseria meningitidis Resulting in Two Cases of Invasive Meningococcal Disease
Elias et al.
J. Clin. Microbiol. 2006;44:4276-4278.
ABSTRACT
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Prevention of Meningococcal Disease
Gardner
NEJM 2006;355:1466-1473.
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Prospects for Vaccine Prevention of Meningococcal Infection
Harrison
Clin. Microbiol. Rev. 2006;19:142-164.
ABSTRACT
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Clusters of meningococcal disease in school and preschool settings in England and Wales: what is the risk?
Davison et al.
Arch. Dis. Child. 2004;89:256-260.
ABSTRACT
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How Contagious Are Common Respiratory Tract Infections?
Musher
NEJM 2003;348:1256-1266.
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Antibiotic Treatment of Children With Unsuspected Meningococcal Disease
Wang et al.
Arch Pediatr Adolesc Med 2000;154:556-560.
ABSTRACT
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Update on Meningococcal Disease with Emphasis on Pathogenesis and Clinical Management
van Deuren et al.
Clin. Microbiol. Rev. 2000;13:144-166.
ABSTRACT
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Meningococcal Disease and Public Health Practice: A Complicated Road Map
Moore and Osterholm
JAMA 1998;279:472-473.
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