Surveillance
Due to recent reports of β-lactamase-producing N. meningitidis serogroup Y in the United States, including 11 cases also resistant to ciprofloxacin:
- Healthcare providers should ascertain susceptibility of meningococcal isolates to penicillin before using penicillin or ampicillin for treatment.
- Clinicians and public health staff should consider antimicrobial susceptibility testing (AST) on meningococcal isolates to inform prophylaxis decisions if their state has reported a case of meningococcal disease caused by ciprofloxacin-resistant strains within the past 2 years.
- Update prophylaxis practices around N. meningitidis cases as needed based on detection of ciprofloxacin-resistance cases.
- View CDC guidance on changing prophylaxis antibiotics in areas with ciprofloxacin resistance.
- State and territorial health departments are asked to
- Continue submitting all meningococcal isolates to CDC for AST and whole genome sequencing
- Report any suspected meningococcal treatment or prophylaxis failures
- Complete a supplemental case report form [2 pages] for cases with isolates determined to be β-lactamase screen-positive or ciprofloxacin-resistant; forms can be submitted to CDC via secure email (meningnet@cdc.gov) or FTP site
Rates of meningococcal disease are at historic lows in the United States. Tracking for meningococcal disease is very good in this country. Health departments respond to every case of meningococcal disease and implement control measures to reduce spread of the disease.
Disease trends
Rates of meningococcal disease have declined in the United States since the 1990s and remain low today. In 2020, there were about 240 total cases of meningococcal disease reported (See Figure 1). Anyone can get meningococcal disease, but rates of disease are highest in children younger than 1 year old, followed by a second peak in adolescence. Among adolescents and young adults, those 16 through 23 years old have the highest rates of meningococcal disease (See Figure 2). The proportion of cases caused by each serogroup varies by age group (See Figure 3).
Meningococcal disease is also seasonal: the number of cases generally peaks each year in January, February, and March.
Figure 1 shows incidence rates (per 100,000 persons) of meningococcal disease in the United States by year from 1970 to 2020. The incidence rate began declining in 1995 and has remained low in 2020. View data for this chart.
Figure 2 shows incidence rates (per 100,000 persons) of meningococcal disease by age group from 2011 to 2020. Infants, young adults, and adults >80 years of age have the highest rates of meningococcal disease in the United States. View data for this chart.
Figure 3 shows incidence rates (per 100,000 persons) of meningococcal disease caused by serogroup B compared to serogroups A, C, W, and Y by age group from 2011 to 2020. Serogroup B caused approximately 60% of cases among children less than 5 years old. Serogroups C, Y, or W, which are covered by meningococcal conjugate vaccines, caused approximately two in three cases of meningococcal disease among persons 11 years old or older during this time period. View data for this chart.
Surveillance systems
Analyze and visualize ABCs N. meningitidis data using Bact Facts Interactive.
Meningococcal disease is a reportable condition in all states, with cases immediately reported to the local and state health departments. CDC closely tracks meningococcal disease through the National Notifiable Diseases Surveillance System and Active Bacterial Core surveillance.
In 2015, CDC implemented enhanced meningococcal disease surveillance. The goals for this surveillance are to:
- Collect more complete data on key variables for monitoring meningococcal disease epidemiology
- Inform vaccine policy decisions
- Collect meningococcal isolates from a broad and representative population
The health departments of all 50 states and several large jurisdictions now routinely collect enhanced meningococcal disease data and isolates.
The most recent Council of State and Territorial Epidemiologists (CSTE) case classification (2015) for meningococcal disease is:
Suspected
- Clinical purpura fulminans in the absence of a positive blood culture; or
- Gram-negative diplococci, not yet identified, isolated from a normally sterile body site (e.g., blood or cerebrospinal fluid [CSF])
Probable
- Detection of Neisseria meningitidis antigen
- In formalin-fixed tissue by immunohistochemistry (IHC); or
- In CSF by latex agglutination
Confirmed
- Detection of N. meningitidis-specific nucleic acid in a specimen obtained from a normally sterile body site (e.g., blood or CSF), using a validated polymerase chain reaction (PCR) assay; or
- Isolation of N. meningitidis
- From a normally sterile body site (e.g., blood or CSF, or less commonly, synovial, pleural, or pericardial fluid); or
- From purpuric lesions.
Enhanced meningococcal disease surveillance reports
View meningococcal disease data, including case counts and incidence by serogroup and age. Reports also include vaccination history of cases, meningococcal related deaths, incidence by serogroup and college attendance, and HIV status.
- Surveillance manual’s chapter on meningococcal disease
- Active Bacterial Core surveillance reports
(see Neisseria meningitidis)
- Bact Facts interactive
- Health advisory: Ciprofloxacin-resistant, β-lactamase-producing Neisseria meningitidis serogroup Y, United States, 2019–2020