Abstract
Although most invasive meningococcal disease (IMD) cases are sporadic without identified transmission links, outbreaks can occur. We report three cases caused by meningococcus B (MenB) at a Belgian nursery school over 9 months. The first two cases of IMD occurred in spring and summer 2018 in healthy children (aged 3–5 years) attending the same classroom. Chemoprophylaxis was given to close contacts of both cases following regional guidelines. The third case, a healthy child of similar age in the same class as a sibling of one case, developed disease in late 2018. Microbiological analyses revealed MenB with identical finetype clonal complex 269 for Case 1 and 3 (unavailable for Case 2). Antimicrobial susceptibility testing revealed no antibiotic resistance. Following Case 3, after multidisciplinary discussion, chemoprophylaxis and 4CMenB (Bexsero) vaccination were offered to close contacts. In the 12-month follow-up of Case 3, no additional cases were reported by the school. IMD outbreaks are difficult to manage and generate public anxiety, particularly in the case of an ongoing cluster, despite contact tracing and management. This outbreak resulted in the addition of MenB vaccination to close contacts in Wallonian regional guidelines, highlighting the potential need and added value of vaccination in outbreak management.
Highlights
Invasive meningococcal disease (IMD) is a serious life-threatening illness and, in 2017, had a case fatality rate of 9.7% in the European Union/European Economic Area (EU/EEA) countries
We report three cases caused by meningococcus B (MenB) at a Belgian nursery school over 9 months
invasive meningococcal disease (IMD) is caused by Neisseria meningitidis, a Gram-negative bacterium present in the nasopharynx of healthy carriers, which is transmitted through droplets of respiratory or throat secretions
Summary
Invasive meningococcal disease (IMD) is a serious life-threatening illness and, in 2017, had a case fatality rate of 9.7% in the European Union/European Economic Area (EU/EEA) countries. Data from several www.eurosurveillance.org high-income countries has shown a severe long-term burden of disease with major sequelae in 10–20% of survivors [1-4]. IMD remains relatively rare in the EU/ EEA, with notification rates of 0.6 cases per 100,000 population in 2017 [1], its severity and outbreak potential make it a major public health problem. Of the 12 serogroups, A, B, C, W, Y and X cause most IMD cases worldwide [5]. Serogroup B remains the predominant serogroup in the EU/EEA, accounting for over 50% of cases overall in 2017 and for 70% of cases in children under 5 years of age [1]
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