Epidemiologic investigation and targeted vaccination initiative in response to an outbreak of meningococcal disease among illicit drug users in Brooklyn, New York.
BACKGROUND
An outbreak of serogroup C meningococcal disease that involved illicit drug users and their contacts occurred in Brooklyn, New York, during 2005 and 2006.


METHODS
The objectives of this study were to identify the population at risk for meningococcal disease, describe efforts to interrupt disease transmission, and assess the impact of a vaccine initiative. Descriptive and molecular epidemiological analysis was used to define the extent of the outbreak and the common risk factors among outbreak-related cases. A vaccine initiative that used community-based service providers was targeted to illicit drug users and their close contacts. The vaccine initiative was assessed through cessation of outbreak-related cases and the reduction in carriage rate.


RESULTS
The investigation identified 23 outbreak-related cases of serogroup C meningococcal disease; 17 isolates were indistinguishable and 4 isolates were closely related according to pulsed-field gel electrophoresis. Two additional culture-negative cases had epidemiological links to laboratory-confirmed cases. The median age of patients with outbreak-related cases was 41 years, and 19 (83%) of 23 patients reported an association with illicit drug use. There were 7 outbreak-related deaths. Vaccination was administered to 2763 persons at 29 community locations, including methadone treatment centers, syringe-exchange programs, and soup kitchens. Three additional cases of meningococcal disease due to strains with the same pulsed-field gel electrophoresis pattern were identified after the vaccination initiative.


CONCLUSIONS
Community-based outbreaks of meningococcal disease are difficult to control, and the decision to vaccinate is not straightforward. Current national guidelines for implementing a vaccination campaign are not strict criteria and cannot be expected to accommodate the myriad of factors that occur in community-based invasive meningococcal disease outbreaks, such as the inability to enumerate the population at risk.
Weiss
Don
D
New York City Department of Health and Mental Hygiene, New York, USA.
Stern
Eric J
EJ
Zimmerman
Christopher
C
Bregman
Brooke
B
Yeung
Alice
A
Das
Debjani
D
Dentinger
Catherine M
CM
Marx
Melissa A
MA
Kornblum
John
J
Lee
Lillian
L
Halse
Tanya A
TA
Mayer
Leonard W
LW
Hatcher
Cynthia P
CP
Theodore
M Jordan
MJ
Schmink
Susanna
S
Harcourt
Brian H
BH
Zucker
Jane R
JR
Layton
Marci
M
Clark
Thomas A
TA
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015373:Bacterial Typing Techniques; D002648:Child; D002675:Child, Preschool; D016172:DNA Fingerprinting; D004196:Disease Outbreaks; D055030:Drug Users; D016521:Electrophoresis, Gel, Pulsed-Field; D005260:Female; D005838:Genotype; D006801:Humans; D007223:Infant; D008297:Male; D008585:Meningitis, Meningococcal / Q000453:epidemiology* / Q000401:mortality / Q000517:prevention & control*; D022401:Meningococcal Vaccines / Q000008:administration & dosage* / Q000276:immunology*; D008875:Middle Aged; D038542:Neisseria meningitidis, Serogroup C / Q000145:classification / Q000235:genetics / Q000302:isolation & purification*; D009519:New York City / Q000453:epidemiology; D016896:Treatment Outcome; D055815:Young Adult
D022401:Meningococcal Vaccines