title: An outbreak of serogroup C (ST-11) meningococcal disease in Tijuana, Mexico.
abstract: BACKGROUND
  Invasive meningococcal disease (IMD) has been reported to be endemic in children from Tijuana, Mexico and the risk of an outbreak was always a threat.
  
  
  OBJECTIVE
  To describe all clinical, epidemiological and microbiological features of a meningococcal outbreak that occurred in Tijuana, Mexico.
  
  
  METHODS
  All cases with IMD were admitted at different emergency departments within the city and diagnosed by culture and agglutination tests. Further restriction fragment length polymorphism pulse field gel electrophoresis (RFLP-PFGE) and multi locus sequence typing (MLST) were performed. All clinical and epidemiological characteristics and interventions were evaluated, as well as risk factors associated with mortality.
  
  
  RESULTS
  From 30 January 2013 to 30 March 2013 there were 19 cases of IMD all caused by Neisseria meningitidis serogroup C. The median age was 16 years (2-47), with higher frequency among individuals at least 13 years old (73.7%). At admission, meningitis was the main clinical presentation (94.7%), followed by purpura (78.9%), septic shock (42.1%) and disseminated intravascular coagulation (DIC, 36.8%). Overall mortality was seven (36.8%). Variables associated with higher mortality were, at admission, presence of septic shock, DIC and thrombocytopenia less than 70,000. All 19 cases had no identifiable site or cluster as the source of the outbreak. RFLP-PFGE showed a discriminatory power for only one profile on all N. meningitidis strains analyzed and a clone ST-11 was identified in all strains. Public health interventions were continuous case reporting of all suspected cases of IMD, an increase in active surveillance in all hospitals, training of medical and laboratory personnel, massive and rapid chemoprophylaxis to all close contacts as indicated, and promotion of good health habits.
  
  
  CONCLUSIONS
  An outbreak with high mortality of IMD occurred in Tijuana, Mexico. This event and evidence of endemicity should encourage health authorities to evaluate meningococcal vaccination in the region.
authors.affiliation: Hospital General de Tijuana, Paseo Centario S/N, Zona del Rio, Tijuana, 22010, Mexico.
authors.forename: Enrique
authors.initials: E
authors.lastname: Chacon-Cruz
authors.affiliation: Hospital Dr Manuel Gea Gonzalez, Mexico City, Mexico.
authors.forename: Luz Elena
authors.initials: LE
authors.lastname: Espinosa-De Los Monteros
authors.affiliation: Hospital General de Tijuana, Tijuana, Mexico.
authors.forename: Samuel
authors.initials: S
authors.lastname: Navarro-Alvarez
authors.affiliation: Tijuana's Health Jurisdiction, Tijuana, Mexico.
authors.forename: Jose Luis
authors.initials: JL
authors.lastname: Aranda-Lozano
authors.affiliation: Hospital General de Tijuana, Tijuana, Mexico.
authors.forename: Maria Luisa
authors.initials: ML
authors.lastname: Volker-Soberanes
authors.affiliation: Hospital General de Tijuana, Tijuana, Mexico.
authors.forename: Rosa Maria
authors.initials: RM
authors.lastname: Rivas-Landeros
authors.affiliation: Hospital General de Tijuana, Tijuana, Mexico.
authors.forename: Ariadna Annete
authors.initials: AA
authors.lastname: Alvelais-Arzamendi
authors.affiliation: Carlos III Institute of Health, Madrid, Spain.
authors.forename: Julio Alberto
authors.initials: JA
authors.lastname: Vazquez
keywords: meningococcal clonal complex ST-11; meningococcal disease; neisseria meningitidis; neisseria meningitidis serogroup C; outbreak