Outbreak of meningococcal disease linked to a sports club

Meningococcal Disease Outbreaks: A Moving Target and a Case for Routine Preventative Vaccination

Outbreaks of invasive meningococcal disease (IMD) are unpredictable, can be sudden and have devastating consequences. We conducted a non-systematic review of the literature in PubMed (1997-2020) to assess outbreak response strategies and the impact of vaccine interventions. Since 1997, IMD outbreaks due to serogroups A, B, C, W, Y and X have occurred globally. Reactive emergency mass vaccination campaigns have encompassed single institutions (schools, universities) through to whole sections of the population at regional/national levels (e.g. serogroup B outbreaks in Saguenay-Lac-Saint-Jean region, Canada and New Zealand). Emergency vaccination responses to IMD outbreaks consistently incurred substantial costs (expenditure on vaccine supplies, personnel costs and interruption of other programmes). Impediments included the limited pace of transmission of information to parents/communities/healthcare workers; issues around collection of informed consents; poor vaccine uptake by older adolescents/young adults, often a target age group; issues of reimbursement, particularly in the USA; and difficulties in swift supply of large quantities of vaccines. For serogroup B outbreaks, the need for two doses was a significant issue that contributed substantially to costs, delayed onset of protection and non-compliance with dose 2. Real-world descriptions of outbreak control strategies and the associated challenges systematically show that reactive outbreak management is administratively, logistically and financially costly, and that its impact can be difficult to measure. In view of the unpredictability, fast pace and potential lethality of outbreak-associated IMD, prevention through routine vaccination appears the most effective mitigation tool. Highly effective vaccines covering five of six disease-causing serogroups are available. Preparedness through routine vaccination programmes will enhance the speed and effectiveness of outbreak responses, should they be needed (ready access to vaccines and need for a single booster dose rather than a primary series).

Meningococcal disease burden and transmission in crowded settings and mass gatherings other than Hajj/Umrah: A systematic review

BACKGROUND

Mass gatherings (MGs) such as the Hajj and Umrah pilgrimages are known to amplify the risk of invasive meningococcal disease (IMD) due to enhanced transmission of the organism between attendees. The burden of IMD at MGs other than Hajj and Umrah has not previously been quantified through a systematic review.

METHODS

A systematic search for relevant articles in PubMed and Embase was conducted using MeSH terms; this was buttressed by hand searching. Following data abstraction, a narrative synthesis was conducted to quantify the burden of IMD at MGs and identify potential risk factors and mitigation measures.

RESULTS

Thirteen studies reporting occurrence of IMD at MGs or similar crowded settings were identified. Eight studies reported cases or outbreaks in MGs of ≥1000 people; five others reported IMD in other crowded settings; all occurred between 1991 and 2015. All age groups were involved in the identified studies; however the majority of cases (∼80%) were young people aged 15-24 years. The number of affected people ranged from one to 321 cases and the overall crude estimate of incidence was calculated as 66 per 100,000 individuals. Serogroups A, C, B and W were identified, with serogroups A and C being most common. Of 450 cases of IMD reported in non-Hajj/Umrah MGs, 67 (14.9%) had fatal outcomes.

CONCLUSION

IMD outbreaks at non-Hajj/Umrah MGs are generally much smaller than Hajj-related outbreaks and affect mainly young people. Health education and vaccination should be considered for attendees of high risk non-Hajj/Umrah MGs, especially those involving adolescents and young adults.

Meningitis in the athlete

Infectious diseases among athletic teams commonly present challenges for team physicians and primary care doctors. There is some evidence to suggest that athletes are more susceptible to infection during an outbreak of the general population. The frequent physical contact and close travel arrangements associated with many team sports may put athletes at even greater risk. Viral meningitis is the most commonly reported central nervous system infection in the literature, and transmission seems to be increased among U.S. high school football teams. Septic meningitis is a life-threatening emergency that can occur in outbreaks affecting populations frequently involved in organized athletics (adolescents and young adults). The purpose of this review is to identify current medical literature on the epidemiology, diagnosis, treatment, and prevention of meningitis in the athletic population.

Infectious disease outbreaks in competitive sports: a review of the literature

Recent outbreaks of infectious diseases in athletes in competitive sports have stimulated considerable interest. The environments in which these athletes compete, practice, receive therapy for injuries, and travel, both domestically and internationally, provide varied opportunities for the transmission of infectious organisms. The purpose of this medical literature review is to identify the agents most commonly reported in the medical literature as responsible for infectious disease outbreaks in specific sports and their modes of transmission and to guide targeted prevention efforts. A literature review of English-language articles in medical publications that reported outbreaks of infectious diseases in competitive athletes was conducted in PubMed MEDLINE from 1966 through May 2005. Outbreaks that were solely food borne were excluded. Fifty-nine reports of infectious disease outbreaks in competitive sports were identified in the published medical literature. Herpes simplex virus infections appear to be common among wrestlers and rugby players, with no single strain responsible for the outbreaks. Methicillin-resistant Staphylococcus aureus was responsible for several recent outbreaks of soft tissue and skin infections among collegiate and professional athletes. The most common mode of transmission in outbreaks was direct, person-to-person (primarily skin-to-skin) contact. Blood-borne exposure was implicated in 2 confirmed outbreaks of hepatitis. Airborne and vector transmissions were rarely reported. This review provides an overview of infectious disease outbreaks thought to be either serious enough or unusual enough to report. Appropriate surveillance of the frequency of infections will allow sports medicine staff to identify outbreaks quickly and take necessary measures to contain further transmission and prevent future outbreaks.

Meningococcal vaccines: a progress report

Neisseria meningitidis causes a wide range of human disease and remains a common cause of septicaemia and meningitis. Meningococcal serogroups A, B, C and Y cause the majority of cases of invasive disease in the US and throughout the world, with epidemics usually caused by serogroups A and C. Most patients with meningococcaemia, with or without meningitis, respond to standard antimicrobial therapy with either penicillin or ampicillin, but the recent emergence of meningococcal strains that are intermediately resistant to penicillin may alter these recommendations in the future. Given the devastating nature of meningococcal disease and emergence of these resistant strains, prevention (specifically through vaccination) remains the best approach to control this serious infection. A polysaccharide meningococcal vaccine is efficacious against disease caused by serogroups A, C, Y and W135, but is not effective in infants and children aged <2 years, and the duration of efficacy decreases markedly during the first 3 years after a single dose of the vaccine. Conjugate meningococcal vaccines have been developed to address these concerns. Initial studies with the meningococcal C conjugate vaccine have shown that the vaccine is safe and immunogenic and provides a T cell-dependent antigen that can be boosted by further doses of vaccine, or following exposure to the homologous organism or cross-reacting antigens. The UK recently implemented routine vaccination with the meningococcal C conjugate vaccine to all infants, and to all persons aged >1 year in a catch-up programme to immunise all school-aged children and young adults up to 20 years of age. Early postlicensure data indicate that this vaccine has shown significant efficacy in reduction of invasive meningococcal disease in these age groups. The full impact of vaccination will be determined once all age groups are immunised.

Special feature for the Olympics: effects of exercise on the immune system: infections and exercise in high-performance athletes

The elite athlete has a potentially increased sensitivity to respiratory infections, rendering protective measures particularly important. Some other infections that may appear in clusters in the sports setting, such as gastroenteritis, leptospirosis, herpes simplex and viral hepatitis, also require special precautionary attention. Strenuous exercise during ongoing infection and fever may be hazardous and should always be avoided. In addition, early symptoms of infection warrant caution until the nature and severity of the infection become apparent. Because myocarditis may or may not be accompanied by fever, malaise or catarrhal symptoms, athletes should be informed about the symptoms suggestive of this disease. Although sudden unexpected death resulting from myocarditis is rare, exercise should be avoided whenever myocarditis is suspected. Guidelines are suggested for the management and counselling of athletes suffering from infections, including recommendations on when to resume training. Acute febrile infections are associated with decreased performance resulting from muscle wasting, circulatory deregulation and impaired motor coordination, which require variable amounts of time to become normalized once the infection is over.