The Virginia Department of Health (VDH) is declaring a statewide outbreak of meningococcal disease caused by the bacterium Neisseria meningitidis serogroup Y. The sequence type associated with this outbreak was first identified in eastern Virginia in September 2022 and has since been detected in central and southwest Virginia. This letter provides an update to the most recent notice to clinicians that was issued in March 2023.
Meningococcal disease is a rare, but very serious illness. From June 2022 to August 2023, there have been 27 cases of meningococcal disease caused by Neisseria meningitidis serogroup Y reported in Virginia, with most cases (20) occurring in the eastern region. All isolates available for sequencing (22 out of 27) were found to be highly genetically related. This strain is susceptible to ciprofloxacin and penicillin, unlike other serogroup Y strains previously detected in Maryland and northern Virginia, and is known to be circulating more widely across the United States.
Five case-patients associated with this outbreak have died from complications of meningococcal disease, indicating that this strain might have a higher case fatality rate (19% CFR) than is commonly observed in serogroup Y cases (source). The majority of case-patients (18) developed septicemia, and not meningitis, with common symptoms including fever, nausea, vomiting, and muscle aches.
VDH has not yet identified a common risk factor among the cases. The majority of cases have occurred in Black or African American adults between 30-60 years of age. Twenty-six case-patients were unvaccinated for serogroup Y.
Early identification and prompt public health follow up remain key to preventing further transmission. VDH responds to reports of suspected meningococcal disease by rapidly identifying close contacts for whom short-term antibiotics are recommended for post-exposure prophylaxis. VDH is dedicated to increasing access to meningococcal conjugate vaccine (MenACWY), which provides protection against serogroup Y. In areas that have reported an outbreak-associated case, MenACWY vaccine is being made available through the local health departments for people at increased risk of meningococcal disease due to certain medical conditions and residents of localized areas with increased transmission. Additionally, VDH is offering vaccine to outbreak-associated close contacts in an effort to vaccinate individuals who may be part of an unknown social network at increased risk for meningococcal disease serogroup Y.
Please consider the following actions:
- Maintain a high index of suspicion for meningococcal disease while this outbreak continues. The majority of case-patients have presented with symptoms of septicemia; several case-patients presented with meningitis, citing neck stiffness and photophobia. A petechial rash with pink macules might also be observed. This rash may appear purple, dark brown, or black on darker skin tones.
- 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 your LHD to send specimens/isolates for newly identified cases to Virginia’s state public health lab, the Department of General Services Division of Consolidated Laboratory Services (DCLS), for serotyping.
- Ensure that all patients who are at increased risk for meningococcal disease are up to date on MenACWY vaccine. People at increased risk include: people with HIV, those whose spleen is damaged or removed, people with sickle cell disease, anyone with a rare immune condition called “complement deficiency” or people taking “complement inhibitors.” A MenACWY booster is recommended every five years for people with increased risk due to medical conditions.
- Continue to encourage routine administration of MenACWY vaccine in adolescents. As a reminder, a dose of MenACWY vaccine is required for students enrolled prior to 7th and 12th grade.
Thank you for your attention and cooperation.
Karen Shelton, MD
State Health Commissioner