Notice to Healthcare Providers: Recognizing and Reporting Serogroup B Meningococcal Disease Associated with Outbreaks at Princeton University and the University of California at Santa Barbara

Distributed via the CDC Health Alert Network
November 27, 2013, 10:30 ET (10:30 AM ET)
CDCHAN-00357

Summary

The purpose of this advisory is

1. to alert healthcare providers and health departments about a prolonged meningococcal disease outbreak at Princeton University and a recent outbreak at the University of California, Santa Barbara (UCSB), and the potential for cases to occur among students traveling to their home states for Thanksgiving break,
2. to advise healthcare providers about reporting suspected cases of meningococcal disease to the New Jersey Department of Health and California Department of Public Health, and
3. to provide information about PCR testing of isolates from serogroup B meningococcal disease cases at CDC.

Background

Eight cases of serogroup B meningococcal disease have been reported in Princeton University students or persons with links to Princeton University during the last eight months, including three cases reported since September. One case occurred in a high school student who stayed in a Princeton dormitory and developed illness within one day of returning home; the other seven cases occurred in Princeton University undergraduate students. Three cases of serogroup B meningococcal disease have been reported among UCSB undergraduate students during the month of November. No epidemiologic links have been identified between the Princeton University and the UCSB cases. Although both outbreaks are caused by serogroup B, additional molecular typing shows that the outbreaks are being caused by two different strains, indicating that the outbreaks are not related.

The Centers for Disease Control and Prevention (CDC), the New Jersey Department of Health (NJDOH), Princeton University officials, and local health authorities have been working closely together since the first case of meningococcal disease associated with Princeton University was reported in March 2013. CDC, the California Department of Public Health, UCSB officials, and local health authorities have also been working closely together since the first case of meningococcal disease associated with UCSB was reported in November 2013.

Clinical Recommendations

Increased awareness of meningococcal disease and prompt early case recognition among healthcare providers is critical. If a Princeton University or UCSB student or a person who has had close contact with someone from those university communities develops a fever and headache or rash, meningococcal disease should be suspected; empiric treatment should be considered; blood or cerebrospinal fluid (CSF) cultures should be collected; and suspected cases should be reported to the local health department.

If there is a high degree of clinical suspicion for meningococcal disease, but CSF or blood specimens are sterile, CDC recommends sending specimens to the Meningitis Laboratory at CDC for polymerase chain reaction (PCR) testing. The CDC considers the risk of transmission of these strains beyond the university communities to be low. However, to monitor potential transmission of these strains, CDC is requesting that health departments send all isolates, whether or not they are linked to these universities, from serogroup B meningococcal disease cases occurring during November 1, 2013, through December 31, 2013, to the Meningitis Laboratory at CDC for further molecular testing. Please contact the Meningitis and Vaccine Preventable Diseases Branch at meningnet@cdc.gov to arrange shipment of isolates.

CDC does not recommend a change in normal activity to avoid contact with the affected universities or their students. Good hygiene practices such as handwashing, and coughing or sneezing into the arm are recommended. The licensed quadrivalent meningococcal vaccines are recommended for all adolescents 11 through 18 years old and first year college students living in residence halls, but these vaccines do not protect against serogroup B, the serogroup that is causing the Princeton University and UCSB cases. A serogroup B meningococcal vaccine, which is only licensed for use in Europe and Australia, will be offered at Princeton University. FDA has allowed the use of the vaccine at Princeton University under an Investigational New Drug application.

All suspect cases of invasive meningococcal disease associated with the two universities should be reported as follows:

• Cases associated with Princeton University should be reported to Denise Garon, NJDOH, at (609)826-5964 or Denise.Garon@doh.state.nj.us .
• Cases associated with UCSB should be reported to Kathleen Harriman, CDPH, at (651)699-2970 or kathleen.harriman@cdph.ca.gov .

Guidance on recommendations for prophylactic use of antibiotics in close contacts of persons with meningococcal disease is available at http://www.cdc.gov/mmwr/preview/mmwrhtml/rr6202a2.htm?s_cid=rr6202a2_w.

For more information

Where can I get additional information?

• Your local and state health departments
• Centers for Disease Control and Prevention:
  http://www.cdc.gov/meningococcal/index.html
  http://www.cdc.gov/meningococcal/vaccine-serogroupB.html