The Virginia Department of Health (VDH) is reporting an increase in meningococcal disease activity in the eastern region of Virginia. Six cases of invasive meningococcal disease serogroup Y were reported between June and August, which exceeds the expected number of cases. Whole genome sequencing confirmed that the cases are genetically linked, and thereby constitute a community outbreak of meningococcal disease. Note that this strain is not resistant to ciprofloxacin and penicillin, as has been previously detected in Maryland and northern Virginia in 2020.
To date, VDH has not identified a common risk factor among the cases, and we suspect the cases are connected by asymptomatic community transmission. Several case-patients are residents of Norfolk, with additional cases detected in other parts of Hampton Roads. The majority of case-patients are Black or African American. Most case-patients are adults between 30-40 years old. Five case-patients are unvaccinated for serogroup Y, and one is partially vaccinated. Two case-patients have died from complications associated with the disease.
Early identification and follow up are key to preventing further transmission. Public health responds to reports of suspect meningococcal disease by rapidly identifying close contacts for whom short-term antibiotics are recommended for prophylaxis.
I ask you to take the following steps:
- Maintain a high index of suspicion for meningococcal infection, especially in patients presenting with sudden onset of fever, headache, stiff neck, and photophobia. A petechial rash with pink macules might also be observed.
- Immediately notify your local health department (LHD) if meningococcal disease is suspected based on clinical findings or laboratory results of gram-negative diplococci or Neisseria meningitidis from a normally sterile site. Please coordinate with the LHD to send specimens/isolates for newly identified cases to Virginia’s state public health lab, DCLS, for serotyping.
- Continue to encourage routine administration of MenACWY vaccine in adolescents and younger children, also including children and adults at increased risk (e.g., persons with HIV).
Thank you for your attention and cooperation on this emerging situation.
Colin M. Greene, MD, MPH
Colonel, US Army, retired
State Health Commissioner