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National Center for Immunization & Respiratory Diseases
Epidemiology of Meningococcal Disease in the
United States
Amy Rubis, MPH
Advisory Committee on Immunization Practices Meeting
February 23, 2023
Agenda
Overall epidemiology of meningococcal disease in the
United States
Recent notable epidemiology
– C
iprofloxacin- and penicillin-resistant serogroup Y
meningococcal disease cases
– Outbreaks
2
Meningococcal Disease Surveillance
Cases reported through National Notifiable Diseases
Surveillance System (NNDSS)
Additional serogroup, outcome, and clinical characteristics collected nationally through Enhanced Meningococcal Disease Surveillance (EMDS)
–
Isolates submitted for whole genome sequencing
3
Meningococcal Disease Surveillance Data, 2020–2022
2020 data are final
Delays in obtaining and finalizing surveillance data for 20
21
an
d 20
22
– Ser
ogroup missing for 17% of cases
– Clinical characteristics not yet complete for 20
22
– Al
l available isolates not yet received and tested to confirm
serogroup and antimicrobial susceptibility
4
Meningococcal Disease Incidence –
United States, 1996–2019 1.2 cases/100,000
population Incidence per 100,000 1.40
1.20
1.00 0.80 0.60
0.40
0.20
0.11 cases/100,000
population MenACWY vaccine
MenB vaccine
0.00
1996 2000 2005 2010 2015 2019
Year
Abbreviations: MenACWY vaccine = quadrivalent conjugate meningococcal vaccine against serogroups A, C, W, Y; MenB vaccine = serogroup B meningococcal vaccine
Source: 1996–2019 NNDSS Data
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Meningococcal Disease Incidence –
United States, 1996–2021* 1.2 cases/100,000
population Incidence per 100,000 1.40
1.20
1.00 0.80 0.60
0.40
0.20
0.06 cases/100,000
population MenACWY vaccine
MenB vaccine
0.00
1996 2000 2005 2010 2015 2021
Year
Abbreviations: MenACWY vaccine = quadrivalent conjugate meningococcal vaccine against serogroups A, C, W, Y; MenB vaccine = serogroup B meningococcal vaccine
Source: 1996–2021 NNDSS Data. *2021 NNDSS data are preliminary. 6
Meningococcal Disease Incidence –
United States, 1996–2022* 1.2 cases/100,000
population Incidence per 100,000 1.40
1.20
1.00 0.80 0.60
0.40
0.20
0.09 cases/100,000
population MenACWY vaccine
MenB vaccine
0.00
1996 2000 2005 2010 2015 2020 2022
Year
Abbreviations: MenACWY vaccine = quadrivalent conjugate meningococcal vaccine against serogroups A, C, W, Y; MenB vaccine = serogroup B meningococcal vaccine
Source: 1996–2022 NNDSS Data. *2021–2022 NNDSS data are preliminary. 7
Trends in Meningococcal Disease Incidence by
Serogroup – United States, 2006–2022* Incidence per 100,000 0.12
B C Y W Other
0.1
0.08
0.06
0.04
0.02
0
2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021 2022
Year
Source: NNDSS data with additional serogroup data from Active Bacterial Core surveillance (ABCs) and state health departments
*2021 and 2022 data are preliminary
8
0 0.2 0.4 0.6 0.8 1 1.2 1.4 Incidence per 100,000 B ACWY Oth/Unk Average Annual Meningococcal Disease Incidence by
Age-Group and Serogroup―United States, 2010–2019
<1 year 1 year 2-4 years 5-10 11-15 16-20 21-25 26-44 45-64 65-84 85+
years years years years years years years years
A
ge Group
Source: NNDSS data with additional serogroup data from ABCs and state health departments
9
Average Annual Meningococcal Disease Incidence by
Age-Group and Serogroup―United States, 2020–2022*
1.4
B ACWY Oth/Unk
1.2
1
0.8
0.6 0.4 0.2
0
<1 year 1 year 2-4 5-10 11-15 16-20 21-25 26-44 45-64 65-84 85+
years years years years years years years years years
Age Group
Source: NNDSS data with additional serogroup data from ABCs and state health departments
*2021 and 2022 data are preliminary
Incidence per 100,000
10
Recent Meningococcal Disease Cases
Historically resistance in N. meningitidis was rare
Ciprofloxacin- and penicillin-resistant serogroup Y cases
detected in 2020
– 27 cases from 2019–2022
– 7
8% among Hispanic or Latino persons
– Age range <1–97 years, mean 31, median 23
• Only 1 case 11–20 years of age
– No cases in vaccinated individuals
11
Resistant Serogroup Y Meningococcal Disease
Cases―United States, 2013–2022
Data are not final and
0 0.02 0.04 0.06 0.08 0.1 0.12 0.14 0.16 0.18 0.2
0 5 10 15 20 25
Incidence per 100,000 Number of cases numbers may increase
2013 2014 2015 2016 2017 2018 2019 2020 2021 2022
β-lactamase-positive only Dual-resistant Meningococcal Disease Incidence
*2021 and 2022 data are preliminary 12
Recent Meningococcal Disease Outbreaks
Largest outbreak predominantly in men who have sex with
men (MSM) reported to date
– January 2022–present*
– 4
3 serogroup C cases, 9 deaths (21% CFR)
– 12/43 non-MSM (5 women) in outbreak
– 15 (35%) cases in people living with HIV
– Age range 20–77 years, mean 35, median 31
13
*The outbreak is ongoing. Case counts may change.
Recent Meningococcal Disease Outbreaks
Unusually lethal strain of serogroup Y
– June 2022–present*
– 11 cases, 3 deaths (27% CFR)
–
10/11 cases in Black or African American persons
– Age range 30–78 years, mean 46, median 39
– Sequence type 1466, clonal complex 174
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*The outbreak is ongoing. Case counts may change.
Recent Meningococcal Disease Outbreaks
People experiencing homelessness
– 2021
• 1 out
break of 3 serogroup C cases
• Age
range 22–37 years
– 2022
• 1 ou
tbreak of 2 serogroup C cases at the same shelter
• Ag
es: 37 and 41 years
15
Conclusions
Incidence of meningococcal disease declined during 2020–
2021, but increased in 2022
New strains emerging in the US
– Pr
edominantly affecting racial and ethnic minority groups
– Unclear how this will change overall epidemiology
More complete 2021 and 2022 data are needed
More years of data needed to understand post-COVID-19
ep
idemiology
16
Thank You
For more information, contact CDC
1-800-CDC-INFO (232-4636) TTY: 1-888-232-6348 www.cdc.gov
The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention.