MMWR Morb Mortal Wkly Rep. 2024 Oct 31;73(43):973-977. doi: 10.15585/mmwr.mm7343a3.
Invasive meningococcal disease (IMD) is a severe illness that can have devastating effects; outbreaks are uncommon in the United States. Vaccination is the preferred control measure for IMD outbreaks when a defined population at risk (e.g., college students or persons experiencing homelessness) can be identified. In August 2022, the Virginia Department of Health (VDH) began investigating an IMD outbreak in Virginia's Eastern Health Planning Region, prompted by the detection of four confirmed cases within 8 weeks. Clinical isolates available from three cases were characterized as Neisseria meningitidis serogroup Y, sequence type 1466. A subsequent statewide investigation identified 36 genetically related cases, including seven deaths (case fatality rate = 19.4%) as of March 1, 2024. A majority of patients (63.9%) were in an age group (30-60 years) not generally considered at increased risk for IMD; 78.0% were non-Hispanic Black or African American. No common exposures, affiliations, or risk factors were identified, and a defined population could not be identified for vaccination. VDH recommended quadrivalent (serogroups A, C, W, and Y) meningococcal conjugate vaccination of a subset of close contacts of patients based on IMD risk factors and age range similar to that of patients with identified cases. IMD outbreaks might affect populations without established IMD risk factors. Lack of a well-defined population at risk might prompt exploration of novel control strategies, such as selective vaccination of close contacts.
侵袭性脑膜炎球菌病 (IMD) 是一种严重的疾病，可能产生破坏性的影响；在美国，这种疾病的爆发并不常见。当能够确定特定的风险人群（例如大学生或无家可归者）时，疫苗接种是针对 IMD 爆发的首选控制措施。2022 年 8 月，弗吉尼亚州卫生署 (VDH) 开始调查弗吉尼亚州东部卫生规划区的 IMD 爆发，此前在 8 周内发现了 4 例确诊病例。从 3 例病例中获得的临床分离株被鉴定为脑膜炎奈瑟菌血清群 Y，序列型 1466。随后的全州范围调查确定了 36 例具有遗传相关性的病例，截至 2024 年 3 月 1 日，包括 7 例死亡（病死率为 19.4%）。大多数患者（63.9%）处于一个通常不被认为 IMD 风险增加的年龄组（30-60 岁）；78.0%是非西班牙裔黑人或非裔美国人。没有发现共同的暴露、关联或风险因素，也无法确定一个特定的人群进行疫苗接种。VDH 建议根据 IMD 风险因素和与确诊病例相似的年龄范围，对患者的密切接触者进行四价（血清群 A、C、W 和 Y）脑膜炎球菌结合疫苗接种。 IMD 爆发可能会影响没有既定 IMD 风险因素的人群。由于缺乏明确的风险人群，可能需要探索新的控制策略，例如选择性接种密切接触者。
