MENINGOCOCCAL DISEASE

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Cases = 65

Crude Rate (per 100,000 population) = 1.2

Age-adjusted race-specific rates (per 100,000 population)

White = 1.06

Nonwhite = 2.01

Sex-specific rates (per 100,000 population)

Male =1.2

Female =1.1

In 1996, sixty-three (63) cases of culture confirmed meningococcal disease were reported. In addition, two (2) probable cases, individuals with clinical symptoms and a positive antigen for Neisseria meningiditis were also reported. There were four (4) deaths. Meningococcal disease is infection of normally sterile sites by the bacteria, Neisseria meningiditis, resulting primarily in meningitis and sepsis. The disease is usually transmitted from person-to-person through the respiratory droplets from the nose and throat of infected persons. The rate of carriage in the general population is 10-15%. Nasopharyngeal carriage usually occurs without serious disease and may lead to protective immunity.

Beginning in 1994, Indiana began requesting that every meningococcal isolate be forwarded to the ISDH laboratory for serogrouping. Meningococcal disease-1 summarizes the serogroup distribution in Indiana during 1994, 1995, and 1996. The number of serotype Y isolates reported have increased in the past three (3) years and in 1996 Serotype Y became the most predominate serotype. There were no outbreaks noted in 1996.

Meningococcal disease-1

Number of Meningococcal Isolates from

Normally Sterile Sites and Percentage of Cases, Indiana 1994-1996

By Serogroup

Serogroup:

1994:

1995:

1996:

A

--

--

1 (1.5%)

B

14 (25%)

5 (9%)

14 (21.5%)

C

9 (15%)

11 (20%)

8 (12%)

Y

3 (5%)

9 (16%)

18 (28%)

W135

--

--

1 (1.5%)

Z

--

1 (2%)

1 (1.5%)

Ungroupable

1 (2%)

4 (7%)

4 (6%)

Unknown

31 (53%)

26 (46%)

18 (28%)

Total

58

56

65

The incidence of meningococcal disease began increasing in 1993 and continues to increase (Meningococcal disease-2).

Meningococcal disease-2

Meningococcal disease occurred throughout the year, seasonal distribution in 1996 is shown in Meningococcal disease-3.

Meningococcal disease-3

There was little difference in the rate of meningococcal infections by gender (male:female =1.2:1.1). The greatest age-specific rate was among infants, followed by children age one to four years. Age-specific rates are summarized in Meningococcal disease-4.

Meningococcal disease-4

The currently licensed meningococcal vaccine is not effective among children in the main risk group, those under two years of age. Routine immunization of the public is not generally recommended. However, immunization is sometimes recommended in community outbreaks where a vaccine-preventable strain (A, C, Y, or W135) is identified as the causative agent.

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