Document text
Epidemiology of Meningococcal Disease in the
United States
Amy Rubis, MPH
Advisory Committee on Immunization Practices Meeting
June 28, 2024National Center for Immunization and Respiratory Diseases
2▪Overall epidemiology of meningococcal disease in the United
States
▪Recent notable epidemiology
–Serogroup Y meningococcal disease cases
–OutbreaksAgenda
3▪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 sequencingMeningococcal Disease Surveillance
4▪2023 data are still preliminary
–Serogroup missing for 14% of cases
–Clinical characteristics not yet complete
–All available isolates not yet received and tested to confirm
serogroup and antimicrobial susceptibility Meningococcal Disease Surveillance Data, 2023
50.000.200.400.600.801.001.201.40
1996 2000 2005 2010 2015 2020 2023Incidence per 100,000
YearMeningococcal Disease Incidence –
United States, 1996 –2023*
Abbreviations: MenACWY vaccine = quadrivalent (serogroups A, C, W, and Y) meningococcal conjugate vaccine; MenB vaccine = serogroup B meningococcal vaccine
Source: 1996 –2023 NNDSS Data. *2023 NNDSS data are preliminary.0.13 cases/100,000 populationMenACWY vaccine1.2 cases/100,000
population
MenB vaccine
600.020.040.060.080.10.12
2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021 2022 2023Incidence per 100,000
YearB C Y W Other
Source: NNDSS data with additional serogroup data from Active Bacterial Core surveillance (ABCs) and state health departments
*2023 data are preliminaryTrends in Meningococcal Disease Incidence by
Serogroup – United States, 2006 –2023*
700.020.040.060.080.10.12
2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021 2022 2023Incidence per 100,000
YearB C Y W Other
Source: NNDSS data with additional serogroup data from Active Bacterial Core surveillance (ABCs) and state health departments
*2023 data are preliminaryTrends in Meningococcal Disease Incidence by
Serogroup – United States, 2006 –2023*
8Serogroup Y Sequence Type 1466
9Much of the increase is attributable to NmY ST -1466
▪In many jurisdictions, the increases are primarily due to NmY
sequence type (ST) 1466 (clonal complex CC174)
–Susceptible to all treatment and prophylaxis antibiotics
▪31 cases of this strain detected in 2022; 122 so far in 2023
–2023 numbers are preliminary and incomplete
10Characteristics of ST -1466 Cases
▪Of those with information available:
–64% (94/148) among Black or African American persons
–18% (27/153) in people with HIV
–Majority had clinical presentations other than meningitis
•62% (76/122) presented with bacteremia
–4 cases in individuals who received MenACWY vaccine
•Among 55% with known vaccine history
•All were people with HIV
•3 received vaccine >7 years before onset
•1 received a single dose 3 years before onset
11Age distribution among NmY ST -1466 cases
0%5%10%15%20%25%30%35%40%45%
<1 1-4 5-10 11-15 16-23 24-44 45-64 ≥65Percent of Cases
Age Group
ST1466
12Age distribution among NmY ST -1466 cases
0%5%10%15%20%25%30%35%40%45%
<1 1-4 5-10 11-15 16-23 24-44 45-64 ≥65Percent of Cases
Age Group
ST1466 NmY 2015-2019
13
NmY ST -1466 cases by state, 2022 –2023
14Health Alert Network (HAN) Health Advisory
Increase in Invasive Serogroup Y Meningococcal Disease in the United States (cdc.gov)
152024 Meningococcal Disease Cases
▪As of June 11 2024, 251 cases reported for 2024
–Increase from 164 in 2023
▪Serogroup missing for 28% of 2024 cases
–Of those with known serogroup, 103 (57%) are NmY
16Overall Meningococcal Disease Epidemiology
17Average Annual Meningococcal Disease Incidence by
Age Group and Serogroup―United States, 2012 –2021
Source: NNDSS data with additional serogroup data from ABCs and state health departments0.000.100.200.300.400.500.600.700.800.901.00
<1 year 1 year 2-4 years 5-10
years11-15
years16-20
years21-25
years26-44
years45-64
years65-84
years85+
yearsIncidence per 100,000
Age GroupB ACWY Oth/Unk
18Average Annual Meningococcal Disease Incidence by
Age Group and Serogroup―United States, 2012 –2021
Source: NNDSS data with additional serogroup data from ABCs and state health departments0.000.100.200.300.400.500.600.700.800.901.00
<1 year 1 year 2-4 years 5-10
years11-15
years16-20
years21-25
years26-44
years45-64
years65-84
years85+
yearsIncidence per 100,000
Age GroupB ACWY Oth/Unk
19Average Annual Meningococcal Disease Incidence by
Age Group and Serogroup―United States, 2012 –2021
Source: NNDSS data with additional serogroup data from ABCs and state health departments0.000.100.200.300.400.500.600.700.800.901.00
<1 year 1 year 2-4 years 5-10
years11-15
years16-20
years21-25
years26-44
years45-64
years65-84
years85+
yearsIncidence per 100,000
Age GroupB ACWY Oth/Unk
20Average Annual Meningococcal Disease Incidence by
Age Group and Serogroup―United States, 2012 –2021
Source: NNDSS data with additional serogroup data from ABCs and state health departments0.000.100.200.300.400.500.600.700.800.901.00
<1 year 1 year 2-4 years 5-10
years11-15
years16-20
years21-25
years26-44
years45-64
years65-84
years85+
yearsIncidence per 100,000
Age GroupB ACWY Oth/Unk
21Average Annual Meningococcal Disease Incidence by
Age Group and Serogroup―United States, 2012 –2021
Source: NNDSS data with additional serogroup data from ABCs and state health departments0.000.100.200.300.400.500.600.700.800.901.00
<1 year 1 year 2-4 years 5-10
years11-15
years16-20
years21-25
years26-44
years45-64
years65-84
years85+
yearsIncidence per 100,000
Age GroupB ACWY Oth/Unk
22Average Annual Meningococcal Disease Incidence by
Age Group and Serogroup―United States, 2012 –2021
Source: NNDSS data with additional serogroup data from ABCs and state health departments0.000.100.200.300.400.500.600.700.800.901.00
<1 year 1 year 2-4 years 5-10
years11-15
years16-20
years21-25
years26-44
years45-64
years65-84
years85+
yearsIncidence per 100,000
Age GroupB ACWY Oth/Unk
23Average Annual Meningococcal Disease Incidence by
Age Group and Serogroup―United States, 2022 –2023*
Source: NNDSS data with additional serogroup data from ABCs and state health departments
*2023 NNDSS data are preliminary.0.000.100.200.300.400.500.600.700.800.901.00
<1 year 1 year 2-4 years 5-10
years11-15
years16-20
years21-25
years26-44
years45-64
years65-84
years85+
yearsIncidence per 100,000
Age GroupB ACWY Oth/Unk
24Average Annual Meningococcal Disease Incidence by
Age Group and Serogroup―United States, 2022 –2023*
Source: NNDSS data with additional serogroup data from ABCs and state health departments
*2023 NNDSS data are preliminary.0.000.100.200.300.400.500.600.700.800.901.00
<1 year 1 year 2-4 years 5-10
years11-15
years16-20
years21-25
years26-44
years45-64
years65-84
years85+
yearsIncidence per 100,000
Age GroupB ACWY Oth/Unk
25Meningococcal Disease Incidence by Race―United
States, 2015 –2023*
Source: NNDSS data with additional serogroup data from ABCs and state health departments. *2023 NNDSS data are preliminary.
Race is unknown for 5 -12% of cases per year00.050.10.150.20.250.30.35
2015 2016 2017 2018 2019 2020 2021 2022 2023Incidence per 100,000
Year
White Black or African American American Indian or Alaska Native Asian or Pacific Islander
26Meningococcal Disease Incidence by Race―United
States, 2015 –2023*
Source: NNDSS data with additional serogroup data from ABCs and state health departments. *2023 NNDSS data are preliminary.
Race is unknown for 5 -12% of cases per year00.050.10.150.20.250.30.35
2015 2016 2017 2018 2019 2020 2021 2022 2023Incidence per 100,000
Year
White Black or African American American Indian or Alaska Native Asian or Pacific Islander
27Average Annual Meningococcal Disease Incidence by Race
among 11 –20 year olds―United States, 2015 –2023*
Source: NNDSS data with additional serogroup data from ABCs and state health departments. *2023 NNDSS data are preliminary.
Race is unknown for 6 -15% of cases per year00.010.020.030.040.050.060.070.080.090.1
White Black or African
AmericanAmerican Indian or
Alaska NativeAsian or Pacific
IslanderIncidence per 100,000
28Meningococcal Disease Incidence by Ethnicity―United
States, 2015 –2023*
Source: NNDSS data with additional serogroup data from ABCs and state health departments. *2023 NNDSS data are preliminary.
Ethnicity is unknown for 2 -16% of cases per year00.020.040.060.080.10.120.140.16
2015 2016 2017 2018 2019 2020 2021 2022 2023Incidence per 100,000
Year
Hispanic or Latino Not Hispanic or Latino
29Average Annual Meningococcal Disease Incidence by Ethnicity
among 11 –20 year olds―United States, 2015 –2023*
Source: NNDSS data with additional serogroup data from ABCs and state health departments. *2023 NNDSS data are preliminary.
Ethnicity is unknown for 3 -27% of cases per year00.010.020.030.040.050.060.070.080.09
Hispanic or Latino Not Hispanic or LatinoIncidence per 100,000
30Antibiotic -resistant Neisseria meningitidis
31Antibiotic -resistant N. meningitidis
▪Penicillin -resistant and ciprofloxacin - and penicillin -resistant
cases
–ST-3587
–Predominately among Hispanic or Latino individuals
▪Ciprofloxacin -resistant only cases
32
00.050.10.150.20.250.3
05101520253035404550
2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021 2022 2023 2024
Incidence per 100,000 populationNumber of cases
Ciprofloxacin-resistant Penicillin-resistant Dual-resistant Meningococcal Disease IncidenceN. meningitidis isolates with penicillin or ciprofloxacin
resistance Data are not final, and
numbers may increase
33
Resistant N. meningitidis, 2018 –2024
Geographic
clusters
Penicillin -resistant
Ciprofloxacin -resistant
Dual -resistant
Note: 3 dual -resistant cases missing county of residence/occurrence are excluded from the map
34Antibiotic -resistant N. meningitidis , 2018 –2024
Dual -resistantPenicillin -resistant
onlyCiprofloxacin -
resistant only
Total cases (2018 -2024) 72 73 20
Median age (range) 39 (0 -97) 50 (0 -89) 45 (3 -84)
% of cases among Hispanic
individuals74% (53/72) 53% (39/73) 10% (2/20)
% fatal 7% (5/72) 6% (4/73) 0%
35Antibiotic -resistant N. meningitidis , 2018 –2024
Dual -resistantPenicillin -
resistant onlyCiprofloxacin -
resistant only
All Serogroups 72 73 20
NmY or NG with NmY backbone 68/72 73/73 2/20
NmB 2/72 -- 7/20
NmC or NG with NmC backbone -- -- 3/20
NmW 1/72 2/20
NmNG -- -- 6/20
Not Sequenced Yet 1/69 --
36Travel history of antibiotic -resistant cases since 2018*
Dual -resistantPenicillin -resistant
onlyCiprofloxacin -
resistant only
Total 72 73 20
Travel History 11/72 9/73 3/20
Domestic 6/11 3/9
International 5/11 6/9 3/3
Mexico 2/5 6/6 --
Dominican Republic 1/5 -- --
Honduras 1/5
Kingdom of Saudi Arabia -- -- 3/3
*One additional dual -resistant case reported in an El Salvador resident and two beta -lactamase
positive cases reported in Mexico residents who were in the United States at the time of onset
37Dual -resistantPenicillin -resistant
onlyCiprofloxacin -
resistant only
Total 72 73 20
Travel History 11/72 9/73 20
Domestic 6/11 3/9
International 5/11 6/9 3
Mexico 2/5 6/6 --
Dominican Republic 1/5 -- --
Honduras 1/5
Kingdom of Saudi Arabia -- -- 3
*One additional dual -resistant case reported in an El Salvador resident and two beta -lactamase
positive cases reported in Mexico residents who were in the United States at the time of onsetTravel history of antibiotic -resistant cases since 2018*
38
39
Counties Not Using Ciprofloxacin for Prophylaxis
Fall 2022 PresentTiming of Guidance Implementation
40Outbreaks
41Meningococcal Disease Outbreaks 2022 -Present
Outbreak Outbreak Period Serogroup Cases (deaths)
Florida MSM December 2021 – February 2023 C 46 (9)
New York PEH February 2022 C 3
Florida College February – March 2022 B 3
Virginia Statewide June 2022 – Present Y 36 (8)*
Iowa Community November 2022 – July 2023 W 12 (2)
Ohio Amish Community December 2023 – January 2024 B 6†
Colorado PEH Jan 2024 – Present Y 6*
Oklahoma Correctional Facility March 2024 – May 2024 C 2 (1)
Kingdom of Saudi Arabia Travel April 2024 – Present W§ 14*
Abbreviation: MSM, men who have sex with men; PEH, people experiencing homelessness
*Ongoing
†5 additional suspect cases
§One additional serogroup C case and one additional nongroupable case
42Recent Meningococcal Disease Outbreaks
*The outbreak is ongoing. Case counts may change.▪Ongoing Statewide NmY ST -1466 Outbreak in Virginia
–June 2022 –present*
–36 cases, 7 deaths (19% CFR)
–28/36 cases in Black or African American persons
–Age range 16 -82 years, median 47
43Recent Meningococcal Disease Outbreaks
▪Amish community outbreak
–6 confirmed serogroup B cases
–5 additional suspected cases
–Age range 1 -10 years
▪Response measures
–Mass prophylaxis with ciprofloxacin
•83% coverage achieved but not all at once
•One additional case occurred ~1 month after prophylaxis
–Bexsero recommended for all community members aged 8 weeks and older
•First time MenB vaccine has been recommended for people <10 years of age in the
United States
•Recommendation based on extensive safety data in infants in UK and elsewhere
•94% coverage achieved with first dose
•56% coverage achieved with second dose
44Recent Meningococcal Disease Outbreaks
▪People experiencing homelessness in Colorado*
–6 serogroup Y cases
–Age range 5 months -76 years
–Penicillin -resistant ST -3587 strain
•Not ciprofloxacin -resistant
•Different population from the one primarily affected by the strain
*The outbreak is ongoing. Case counts may change.
45Recent Meningococcal Disease Outbreaks
▪People with travel to the Kingdom of Saudi Arabia (KSA)*
–14 total cases in 4 countries: United States (6), France (4),
United Kingdom (3), Norway (1)
•10 cases in adults with travel history to KSA, 4 cases in children who
were close contacts of travelers
–12 serogroup W, 1 serogroup C, 1 nongroupable
–All travelers participated in Umrah
–No travelers known to be vaccinated
–4 cases (2 NmW , 1 NmC , 1 NmNG ) resistant to ciprofloxacin
*The outbreak is ongoing. Case counts may change.
46
▪Recommend
preferential use of
alternative prophylaxis
agents for cases
associated with KSA
travel
47Conclusions
▪Incidence of meningococcal disease increased in 2023,
primarily due to NmY ST -1466
–ST-1466 primarily observed among those aged 30 -60 years
▪Ciprofloxacin resistance is increasing
–Multiple jurisdictions have discontinued ciprofloxacin use
–Increasing number of resistant isolates not serogroup Y
48Conclusions
▪New strains emerging in the United States
–Predominantly affecting racial minority groups leading to an
increasing disparity in incidence among Black persons
compared to other racial groups
▪Large number of outbreaks since 2022
–Affecting minorities or disadvantaged populations
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.
Thank you
50Backup slides
51No confirmed instances of
prophylaxis failure with
ciprofloxacin reported to date…
but concerning anecdotes