Abstract
Between March 2010 and November 2013 eight laboratory-confirmed cases of serogroup B, invasive meningococcal disease (IMD) were identified in an extended Irish Traveller family across three Health Service Executive (HSE) areas of Ireland. Cases were aged between 5 and 46 months, and were either a cousin or sibling of another case. All eight cases survived. Chemoprophylaxis was given to relevant nuclear family members and close contacts on each occasion, but failed to prevent further cases. Neisseria meningitidis isolates from six cases were highly related, belonging to the ST-41/44 clonal complex, and shared the porA designation 7–2,4. In November 2013, the outbreak control team recommended that directly observed ciprofloxacin chemoprophylaxis be administered simultaneously to the extended family, and that the four component meningococcal B (4CMenB) vaccine be administered to family members aged 2 months to 23 years inclusive and relevant close contacts of the eighth case. Subsequently these recommendations were implemented at three regional clinics. Additionally pharyngeal swabs (n=112) were collected to assess carriage rates of N. meningitidis in this extended family. Pharyngeal carriage of N. meningitidis was detected in 15 (13%) family members. From the epidemiological investigation and carriage study overcrowding was the most likely risk factor identified in this outbreak. To date, the combination of directly observed ciprofloxacin chemoprophylaxis and use of 4CMenB vaccine have controlled the outbreak with no further cases diagnosed.
Highlights
Under Irish law, clinicians and clinical directors of laboratories must immediately notify suspected cases of invasive meningococcal disease (IMD) to the Medical Officer of Health (MOH) at the local Department of Public Health
We describe the identification of eight cases of IMD due to N. meningitidis serogroup B in an extended Irish Traveller family over a three and a half year period across three of eight public health areas of the Health Service Executive (HSE) in Ireland
The case definition used in this outbreak was ‘A laboratory-confirmed case of IMD caused by N. meningitidis serogroup B in a person who is a member of this extended Irish Traveller family’
Summary
In 2011, Ireland had the highest incidence of meningococcal disease in the European Union at 1.99 per 100,000 population [4]. This figure represents a decrease of 86% from 14.8 per 100,000 population reported in 1999. Irish Travellers are an indigenous minority in Ireland. Their lifestyle and culture, which may include a nomadic lifestyle, distinguishes them from the general population [5]. Since 2004, when the CIDR system became operational, limited data on ethnicity is available Based on such data, it is evident that while the incidence of IMD has decreased in the Number of cases. JAN–MAR 2010 APR–JUN 2010 JUL–SEP 2010 OCT–DEC 2010 JAN–MAR 2011 APR–JUN 2011 JUL–SEP 2011 OCT–DEC 2011 JAN–MAR 2012 APR–JUN 2012 JUL–SEP 2012 OCT–DEC 2012 JAN–MAR 2013 APR–JUN 2013 JUL–SEP 2013 OCT–DEC 2013 JAN–MAR 2014 APR–JUN 2014
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