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The Evolving Epidemiology of the ET-5 Strain

Marion Diermayer, MD; Katrina Hedberg, MD, MPH; Frederick Hoesly, MD, MPH; Marc Fischer, MD; Bradley Perkins, MD; Michael Reeves, PhD; David Fleming, MD

JAMA. 1999;281:1493-1497.

Context  In 1993, Oregon's incidence of serogroup B meningococcal disease began to rise because of a highly clonal group of strains designated enzyme type 5 (ET-5), the first such increase observed in the United States.

Objective  To evaluate the impact that the ET-5 strain has had on the epidemiology of meningococcal disease in Oregon.

Design and Setting  Epidemiologic analysis of surveillance data on Oregon meningococcal disease cases from 1987 through 1996 and multilocus enzyme electrophoresis typing of serogroup B isolates from June 1993 through April 1995 and from April through June 1996.

Patients  A total of 836 persons with invasive meningococcal disease.

Main Outcome Measures  Disease frequency and clonality of strains.

Results  Serogroup B disease incidence rates more than doubled from the preepidemic period in 1987-1992 (1.0 case per 100,000 population) to the recent epidemic period in 1995-1996 (2.2 cases per 100,000). The age-specific incidence rate of serogroup B disease among those 15 through 19 years old increased 13-fold between the preepidemic period (0.5 case per 100,000) and 1995-1996 (6.4 cases per 100,000). However, the proportion of cases with meningococcemia and the case-fatality rate did not change. Of 99 Neisseria meningitidis isolates obtained from 1993-1995, 88 (89%) belonged to the ET-5 complex. Of these, 69 (78%) were a single clone, designated 301. Of 20 serogroup B isolates from 1996, 18 (90%) belonged to the ET-5 complex; 17 (94%) were the 301 clone.

Conclusion  Serogroup B meningococcal disease incidence continues at high levels in Oregon with increasing predominance of the ET-5 clonal strains.

Author Affiliations: Oregon Health Division, Portland (Drs Diermayer, Hedberg, Hoesly, and Fleming); the Division of Field Epidemiology, Epidemiology Program Office (Dr Diermayer), and the Meningitis and Special Pathogens Branch, Division of Bacterial and Mycotic Diseases (Drs Fischer, Perkins, and Reeves), Centers for Disease Control and Prevention, Atlanta, Ga.

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