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Meningococcal disease--New England, 1993-1998
Abstract:
Neisseria meningitidis, a leading cause of bacterial meningitis and sepsis in children and young adults in the United States, causes both sporadic disease and outbreaks. Preventing and controlling meningococcal disease remains a public health challenge because of the multiple serogroups and the limitations of available vaccines. Vaccination with the polysaccharide meningococcal vaccine, which protects against serogroups A, C, Y, and W135 of N. meningitidis, is recommended by the Advisory Committee on Immunization Practices (ACIP) for controlling outbreaks but routine vaccination is not recommended for control of sporadic cases. During 1998, a cluster of meningococcal disease cases occurred in Rhode Island, and although the situation did not meet ACIP criteria for an outbreak, the Rhode Island Department of Health recommended vaccination of all residents aged 2-22 years. This action stimulated controversy in Rhode Island and the rest of New England (Connecticut, Maine, Massachusetts, New Hampshire, and Vermont) and prompted a review of the epidemiology of meningococcal disease in the region. This report describes meningococcal disease data reported to the region's state health departments during 1993-1998 and discusses the situation in Rhode Island.
Insights
Neisseria meningitidis causes meningitis and sepsis. While vaccines exist, controlling sporadic cases remains challenging, prompting regional vaccination debates and reviews of disease epidemiology.
Area of Science:
- Epidemiology
- Public Health
- Infectious Diseases
Background:
- Neisseria meningitidis is a significant cause of bacterial meningitis and sepsis in young people in the US.
- Controlling meningococcal disease is challenging due to multiple serogroups and vaccine limitations.
- Current vaccination guidelines recommend the polysaccharide meningococcal vaccine for outbreaks but not routine sporadic case control.
Purpose of the Study:
- To review the epidemiology of meningococcal disease in New England from 1993-1998.
- To examine the context and controversy surrounding a vaccination recommendation in Rhode Island.
- To inform public health strategies for meningococcal disease prevention and control.
Main Methods:
- Descriptive epidemiological analysis of reported meningococcal disease cases.
- Review of data from state health departments in New England (1993-1998).
- Case study analysis of the Rhode Island meningococcal disease cluster and subsequent vaccination recommendation.
Main Results:
- The report details meningococcal disease incidence across New England states during the study period.
- It analyzes a specific cluster of cases in Rhode Island that led to a controversial vaccination recommendation.
- The findings provide context for the public health decision-making process regarding meningococcal disease.
Conclusions:
- The study highlights the ongoing public health challenge posed by Neisseria meningitidis.
- It underscores the complexities of vaccine recommendations for sporadic versus outbreak-related meningococcal disease.
- The review aims to guide future strategies for managing meningococcal disease in the region.