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7 December 2016

Neisseria Meningitidis Cases Reported in Jackson County

An Urgent Public Health Activity Report

Neisseria Meningitidis Cases Reported in Jackson County

Jackson County Public Health is investigating one confirmed case of Neisseria meningitidis and one presumptive case at Hedrick Middle School and Hoover Elementary School.  Jackson County Public Health is actively working with the schools to notify parents, identify exposures and provide children with possible exposure a prescription of antibiotic. The serotype of the bacterium has not been subtyped at the time of this report.

Neisseria meningitidis—a Gram-negative diplococcal bacterium with nine serogroups that have been frequently associated with systemic disease: A, B, C, D, X, Y, Z, 29E, and W135. Serogroups B, C, and Y each account for about 1/3 of disease in the United States while in Oregon serogroup B makes up 55% of cases.

Unfortunately, the quadrivalent vaccination used to prevent the disease is only effective against groups A, C, W-135, and Y. Therefore, in Oregon the vaccine is less effective than in other parts of the United States.

This bacterium lives in the noses and throats of 5 to 10 percent of the population.  It causes serious disease only if it enters the blood stream and spreads through the body. Meningococcal meningitis occurs when the bacteria causes inflammation of the tissue surrounding the brain and spinal cord.

Meningococcal disease is not highly contagious. Close contacts of cases (household members, daycare center classroom contacts, close friends) are at elevated risk of disease; after a case occurs, these persons should take antibiotics to prevent the infection. School classmates, those living in other dormitory rooms, and healthcare workers attending the case are generally not at elevated risk.

Description of Illness

Disease is characterized by acute onset of fever, headache, weakness, hypotension, and rash. The rash may be initially urticarial, maculopapular, or petechial, and often appears in areas where elastic in underwear or socks applies pressure to the skin, or in the fingernail beds. Petechial hemorrhage is particularly common in the mucous membranes of the soft palate and conjunctiva. Invasive disease may occur without signs of meningitis.

In infants and small children, fever and vomiting are often the only symptoms. The classic triad of fever, neck stiffness, and altered mental status occurred in only 27% of patients with invasive meningococcal in a Dutch cohort. All clinical illnesses associated with N. meninigitidis are significant and warrant investigation. In the absence of associated invasive disease, finding N. meningitidis in sputum is not considered a remarkable event, and is not reportable. In addition to the more common presentations of bacteremia and meningitis, N. meningitidis can cause pneumonia or primary meningococcal conjunctivitis.

Jackson County Public Health is hopeful these are the only two cases, but at the same time Jackson County Public Health ask that providers consider the possibility of meningococcal infection in children presenting with unexplained high fever, headache, stiff neck exhaustion, nausea, rash, vomiting, and diarrhea.



More information about Meningococcal disease can be found at these websites: