Abstract
A cluster of three fatal cases of invasive meningococcal disease due to Neisseria meningitidis serogroup Bin a town in Suffolk, United Kingdom, during December 2009 to January 2010 was reported to the local Health Protection Unit. This paper describes the investigation undertaken to identify any potential epidemiological links among the cases, to determine if this was an outbreak and to consider whether to implement community-wide interventions and control measures. Case epidemiological information in addition to serogroup and genosubtyping (porA gene sequencing) data of the infecting organism was gathered on all cases in this reported cluster. Genosubtyping was also retrospectively requested for all serogroup B cases confirmed in Suffolk during 2009. Extensive investigation failed to establish an epidemiological link among the cluster of fatal cases of serogroup B invasive meningococcal disease in Suffolk. By demonstrating a number of distinct strains, the genosubtyping of isolates proved to be useful in the public health management of this incident by serving to exclude a community outbreak and preventing unnecessary mass chemoprophylaxis.
Highlights
Invasive meningococcal disease is caused by Neisseria meningitidis, which is a normal inhabitant of the human nasopharynx
The identification of a community outbreak is a challenge, especially when considering community interventions where the population boundary will of necessity be arbitrary
The options for community interventions are limited in outbreaks of serogroup B invasive meningococcal disease [8]
Summary
Invasive meningococcal disease is caused by Neisseria meningitidis, which is a normal inhabitant of the human nasopharynx. Meningococci are classified into serogroups based on capsular polysaccharide antigens: there are at least 13 serogroups, of which serogroups A, B, C, W135 and Y account for the majority of the invasive meningococcal disease worldwide [1]. Serogroups B, C and Y were the most common in the United Kingdom (UK). Following the introduction of the meningococcal serogroup C conjugate vaccine into the UK routine immunisation programme in November 1999, the number of cases of invasive meningococcal disease caused by serogroup C fell by over 90% [2]. Serogroup B strains account for around 90% of laboratory-confirmed cases submitted to the Health Protection Agency
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