title: Meningococcal carriage among Georgia and Maryland high school students.
abstract: BACKGROUND
  Meningococcal disease incidence in the United States is at an all-time low. In a previous study of Georgia high school students, meningococcal carriage prevalence was 7%. The purpose of this study was to measure the impact of a meningococcal conjugate vaccine on serogroup Y meningococcal carriage and to define the dynamics of carriage in high school students.
  
  
  METHODS
  This was a prospective cohort study at 8 high schools, 4 each in Maryland and Georgia, during a school year. Students at participating schools received quadrivalent meningococcal conjugate vaccine that uses diphtheria toxoid as the protein carrier (MCV4-DT). In each state, 2 high schools were randomly assigned for MCV4-DT receipt by students at the beginning of the study, and 2 were randomly assigned for MCV4-DT receipt at the end. Oropharyngeal swab cultures for meningococcal carriage were performed 3 times during the school year.
  
  
  RESULTS
  Among 3311 students, the prevalence of meningococcal carriage was 3.21%-4.01%. Phenotypically nongroupable strains accounted for 88% of carriage isolates. There were only 5 observed acquisitions of serogroup Y strains during the study; therefore, the impact of MCV4-DT on meningococcal carriage could not be determined.
  
  
  CONCLUSIONS
  Meningococcal carriage rates in US high school students were lower than expected, and the vast majority of strains did not express capsule. These findings may help explain the historically low incidence of meningococcal disease in the United States.
authors.affiliation: Department of International Health, Johns Hopkins Bloomberg School of Public Health Infectious Diseases Epidemiology Research Unit, University of Pittsburgh, Pennsylvania.
authors.forename: Lee H
authors.initials: LH
authors.lastname: Harrison
authors.affiliation: Infectious Diseases Epidemiology Research Unit, University of Pittsburgh, Pennsylvania.
authors.forename: Kathleen A
authors.initials: KA
authors.lastname: Shutt
authors.affiliation: Georgia Emerging Infections Program Division of Public Health, Georgia Department Human of Resources.
authors.forename: Kathryn E
authors.initials: KE
authors.lastname: Arnold
authors.affiliation: National Center for Immunization and Respiratory Diseases Epidemic Intelligence Service Program, Centers for Disease Control and Prevention.
authors.forename: Eric J
authors.initials: EJ
authors.lastname: Stern
authors.affiliation: National Center for Immunization and Respiratory Diseases.
authors.forename: Tracy
authors.initials: T
authors.lastname: Pondo
authors.affiliation: Maryland Department of Health and Mental Hygiene, Baltimore, Maryland.
authors.forename: Julia A
authors.initials: JA
authors.lastname: Kiehlbauch
authors.affiliation: Maryland Department of Health and Mental Hygiene, Baltimore, Maryland.
authors.forename: Robert A
authors.initials: RA
authors.lastname: Myers
authors.affiliation: Department of International Health, Johns Hopkins Bloomberg School of Public Health.
authors.forename: Rosemary A
authors.initials: RA
authors.lastname: Hollick
authors.affiliation: National Center for Immunization and Respiratory Diseases.
authors.forename: Susanna
authors.initials: S
authors.lastname: Schmink
authors.affiliation: Georgia Emerging Infections Program Division of Public Health, Georgia Department Human of Resources.
authors.forename: Marianne
authors.initials: M
authors.lastname: Vello
authors.affiliation: Georgia Emerging Infections Program Emory University School of Medicine VA Medical Center, Atlanta, Georgia.
authors.forename: David S
authors.initials: DS
authors.lastname: Stephens
authors.affiliation: National Center for Immunization and Respiratory Diseases.
authors.forename: Nancy E
authors.initials: NE
authors.lastname: Messonnier
authors.affiliation: National Center for Immunization and Respiratory Diseases.
authors.forename: Leonard W
authors.initials: LW
authors.lastname: Mayer
authors.affiliation: National Center for Immunization and Respiratory Diseases.
authors.forename: Thomas A
authors.initials: TA
authors.lastname: Clark
mesh_terms: D000293:Adolescent; D000328:Adult; D002353:Carrier State / Q000453:epidemiology* / Q000276:immunology / Q000382:microbiology* / Q000517:prevention & control; D005260:Female; D005845:Georgia / Q000453:epidemiology; D006801:Humans; D008297:Male; D008396:Maryland / Q000453:epidemiology; D008589:Meningococcal Infections / Q000453:epidemiology* / Q000276:immunology / Q000382:microbiology* / Q000517:prevention & control; D022401:Meningococcal Vaccines / Q000276:immunology; D009345:Neisseria meningitidis / Q000145:classification / Q000276:immunology*; D011446:Prospective Studies; D012307:Risk Factors; D013334:Students / Q000706:statistics & numerical data*; D055815:Young Adult
chemical_list: D022401:Meningococcal Vaccines
keywords: Neisseria meningitidis; high school students; meningococcal; meningococcal conjugate vaccine; meningococcus; oropharyngeal carriage