title: Prolonged university outbreak of meningococcal disease associated with a serogroup B strain rarely seen in the United States.
abstract: BACKGROUND
  College students living in residential halls are at increased risk of meningococcal disease. Unlike that for serogroups prevented by quadrivalent meningococcal vaccines, public health response to outbreaks of serogroup B meningococcal disease is limited by lack of a US licensed vaccine.
  
  
  METHODS
  In March 2010, we investigated a prolonged outbreak of serogroup B disease associated with a university. In addition to case ascertainment, molecular typing of isolates was performed to characterize the outbreak. We conducted a matched case-control study to examine risk factors for serogroup B disease. Five controls per case, matched by college year, were randomly selected. Participants completed a risk factor questionnaire. Data were analyzed using conditional logistic regression.
  
  
  RESULTS
  Between January 2008 and November 2010, we identified 13 meningococcal disease cases (7 confirmed, 4 probable, and 2 suspected) involving 10 university students and 3 university-linked persons. One student died. Ten cases were determined to be serogroup B. Isolates from 6 confirmed cases had an indistinguishable pulsed-field gel electrophoresis pattern and belonged to sequence type 269, clonal complex 269. Factors significantly associated with disease were Greek society membership (matched odds ratio [mOR], 15.0; P = .03), >1 kissing partner (mOR, 13.66; P = .03), and attending bars (mOR, 8.06; P = .04).
  
  
  CONCLUSIONS
  The outbreak was associated with a novel serogroup B strain (CC269) and risk factors were indicative of increased social mixing. Control measures were appropriate but limited by lack of vaccine. Understanding serogroup B transmission in college and other settings will help inform use of serogroup B vaccines currently under consideration for licensure.
authors.affiliation: Meningitis and Vaccine Preventable Diseases Branch, Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, 1600 Clifton Rd NE, MS C-25, Atlanta, GA 30329, USA. smandal1@cdc.gov
authors.forename: Sema
authors.initials: S
authors.lastname: Mandal
authors.forename: Henry M
authors.initials: HM
authors.lastname: Wu
authors.forename: Jessica R
authors.initials: JR
authors.lastname: MacNeil
authors.forename: Kimberly
authors.initials: K
authors.lastname: Machesky
authors.forename: Jocelyn
authors.initials: J
authors.lastname: Garcia
authors.forename: Brian D
authors.initials: BD
authors.lastname: Plikaytis
authors.forename: Kim
authors.initials: K
authors.lastname: Quinn
authors.forename: Larry
authors.initials: L
authors.lastname: King
authors.forename: Susanna E
authors.initials: SE
authors.lastname: Schmink
authors.forename: Xin
authors.initials: X
authors.lastname: Wang
authors.forename: Leonard W
authors.initials: LW
authors.lastname: Mayer
authors.forename: Thomas A
authors.initials: TA
authors.lastname: Clark
authors.forename: James R
authors.initials: JR
authors.lastname: Gaskell
authors.forename: Nancy E
authors.initials: NE
authors.lastname: Messonnier
authors.forename: Mary
authors.initials: M
authors.lastname: DiOrio
authors.forename: Amanda C
authors.initials: AC
authors.lastname: Cohn
mesh_terms: D000293:Adolescent; D016022:Case-Control Studies; D004196:Disease Outbreaks; D005260:Female; D006801:Humans; D008297:Male; D008585:Meningitis, Meningococcal / Q000453:epidemiology* / Q000382:microbiology*; D038541:Neisseria meningitidis, Serogroup B / Q000145:classification* / Q000302:isolation & purification*; D012307:Risk Factors; D012703:Serotyping; D011795:Surveys and Questionnaires; D014481:United States / Q000453:epidemiology; D014495:Universities; D055815:Young Adult
keywords: meningococcal disease; outbreak; risk factors; serogroup B; university