Surveillance of serogroup B Neisseria meningitidis cases at United States colleges using the ProMED Mail platform

Abstract

Background: Neisseria meningitidis causes invasive meningococcal disease (IMD), an uncommon but life-threatening infection with rapid disease progression and 10–15% case fatality rate, 1 in 5 survivors can experience permanent disability. US college students have a 3.5-fold increased risk of serogroup B meningococcal disease (MenB) compared with non-college adolescents and since 2011, all college outbreaks were caused by MenB. As a mandatory reportable disease in the US, formal surveillance systems are designed to capture cases through local and state health departments, however this may result in delayed notification. Informal surveillance approaches like ProMED Mail can be an alternative to consider for real-time reporting, expedite awareness and enhance public health response to potential outbreaks. Methods and materials: ProMED's online platform with expert moderators was utilized in the US. Media reports were mined daily for MenB cases and outbreaks using automated web crawling with manual curation (through a collaboration with HealthMap) and analyzed in real time. Case numbers and rates, location, population characteristics and public health responses including antimicrobial prophylaxis and vaccination were compiled. Web and social media presence of the largest colleges in high population states was determined by internet search. Results: From March 2018 to August 2019, 40 individual reports of MenB involving US college campus sites were gathered. College press releases picked up by the media were often the first alerts detected about suspected or confirmed cases on college campuses – among the 4 largest colleges from 30 states, over 97% had dedicated Student Health Center/Services websites, and 45% had a Student Health Center/Services Facebook or Twitter account. 100% of reviewed campuses had a college news website, Facebook page, as well as Twitter account. Conclusion: Informal surveillance sources can be useful to identify MenB case reports on U.S. college campuses outside the formal public health systems. Early detection of outbreaks, along with improved student-body communication strategies through social media can better inform college health and public health professionals and potentially contain outbreaks, while optimizing the use of group B meningococcal vaccines. Future directions to study may include analyzing the occurrences of MenB cases in different states and regions by demographic features of colleges.