Abstract
The incidence and relative risk (RR) of meningococcal disease among college students compared with noncollege students aged 18 to 24 years during 2014-2016 were calculated by using data from the National Notifiable Diseases Surveillance System and enhanced meningococcal disease surveillance. Differences in demographic characteristics and clinical features of meningococcal disease cases were assessed. Available meningococcal isolates were characterized by using slide agglutination, polymerase chain reaction, and whole genome sequencing. From 2014 to 2016, 166 cases of meningococcal disease occurred in persons aged 18 to 24 years, with an average annual incidence of 0.17 cases per 100 000 population. Six serogroup B outbreaks were identified on college campuses, accounting for 31.7% of serogroup B cases in college students during this period. The RR of serogroup B meningococcal (MenB) disease in college students versus noncollege students was 3.54 (95% confidence interval: 2.21-5.41), and the RR of serogroups C, W, and Y combined was 0.56 (95% confidence interval: 0.27-1.14). The most common serogroup B clonal complexes identified were CC32/ET-5 and CC41/44 lineage 3. Although the incidence is low, among 18- to 24-year-olds, college students are at an increased risk for sporadic and outbreak-associated MenB disease. Providers, college students, and parents should be aware of the availability of MenB vaccines.
Highlights
Freshman college students living in residence halls have previously been identified as being at an increased risk for meningococcal disease
Previous evaluations among college students were conducted when rates of disease were higher, serogroup C was the predominant cause of disease, MenACWY and MenB vaccines had not yet become available, and the ability to characterize the molecular features of Neisseria meningitidis strains in this population had not yet been developed.2,1 0 In this evaluation, we describe the epidemiology of meningococcal disease in college students, estimate the relative risk (RR) of meningococcal disease in college students compared with noncollege students among persons aged 18 to 24 years, and characterize the disease-causing strains
In the United States, surveillance for meningococcal disease is conducted through the National Notifiable Diseases Surveillance System (NNDSS), and cases are classified by state and local public health personnel as suspected, probable, or confirmed according to the Council of State and Territorial Epidemiologists’ case definition.11,1 2 In 2014–2015, enhanced meningococcal disease surveillance activities were implemented to collect additional data and isolates on cases reported through the NNDSS
Summary
The incidence and relative risk (RR) of meningococcal disease among college students compared with noncollege students aged 18 to 24 years during 2014–2016 were calculated by using data from the National Notifiable Diseases Surveillance System and enhanced meningococcal disease surveillance. In the United States, surveillance for meningococcal disease is conducted through the National Notifiable Diseases Surveillance System (NNDSS), and cases are classified by state and local public health personnel as suspected, probable, or confirmed according to the Council of State and Territorial Epidemiologists’ case definition.11,1 2 In 2014–2015, enhanced meningococcal disease surveillance activities were implemented to collect additional data and isolates on cases reported through the NNDSS. Enhanced meningococcal disease surveillance activities are currently conducted in 45 states, representing 98% of the US population.13 All confirmed and probable cases in persons aged 18 to 24 years reported during January 1, 2014, to December 31, 2016, were included in the analysis. Patients with meningococcal disease were classified as college students or noncollege students on the basis of information collected through enhanced surveillance activities or in cases from the 5 nonparticipating states through reviews of case investigation records. All phylogenetic visualizations were generated by using the R package ggtree.22
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