{"id":1503,"date":"2023-03-06T16:39:56","date_gmt":"2023-03-06T16:39:56","guid":{"rendered":"https:\/\/www.vdh.virginia.gov\/clinicians\/?page_id=1503"},"modified":"2023-03-06T16:39:56","modified_gmt":"2023-03-06T16:39:56","slug":"meningococcal-disease-outbreak-update-invasive-group-a-strep-infections","status":"publish","type":"page","link":"https:\/\/www.vdh.virginia.gov\/clinicians\/meningococcal-disease-outbreak-update-invasive-group-a-strep-infections\/","title":{"rendered":"Meningococcal Disease Outbreak Update, Invasive Group A Strep Infections"},"content":{"rendered":"

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Meningococcal Disease Outbreak Update, Invasive Group A Strep Infections<\/strong><\/p>\n

March 6, 2023<\/p>\n

Dear Colleague:<\/p>\n

I am writing to provide you with important updates on several emerging conditions of public health significance.<\/p>\n

Meningococcal Disease Outbreak in Eastern Virginia<\/strong><\/p>\n

The Virginia Department of Health continues to respond to a community outbreak of meningococcal disease in the eastern region of Virginia.\u00a0 Twelve cases of invasive meningococcal disease (IMD) serogroup Y have been reported since June 2022 in eastern Virginia,\u00a0 a doubling of cases since VDH notified eastern region providers in September 2022<\/a>.\u00a0 Most case-patients have presented with symptoms of IMD meningococcemia, including fever, chills, nausea, and vomiting. \u00a0All isolates available for sequencing (9 out of 12) were genetically related and susceptible to ciprofloxacin and penicillin.\u00a0 VDH has not identified a common risk factor; we suspect the cases are connected by asymptomatic community transmission.\u00a0 Case-patients are all residents of Hampton Roads and most are Black or African American adults between 30-60 years of age.\u00a0 Eleven case-patients are unvaccinated for serogroup Y, and one is partially vaccinated. \u00a0Three case-patients have died from complications associated with the disease, indicating this outbreak strain may have a higher case fatality rate (25% CFR) than is commonly observed<\/a> in serogroup Y cases.\u00a0 This strain is believed to be circulating more widely, both in Virginia and other states.<\/p>\n

VDH responds to reports of suspect meningococcal disease by rapidly identifying close contacts for whom short-term antibiotics are recommended for prophylaxis and recommending one dose of the meningococcal conjugate vaccine (MenACWY) to all outbreak-associated close contacts who are identified as high-risk for meningococcal disease.<\/p>\n

Healthcare Providers should maintain a high index of suspicion for IMD.\u00a0 Immediately notify your local health department (LHD)<\/a> of clinical findings or laboratory results of gram-negative diplococci or Neisseria meningitidis<\/em> from a normally sterile site. Your LHD can coordinate sending specimens\/isolates from newly identified cases to the Division of Consolidated Laboratory Services (DCLS) for serotyping.\u00a0 Ensure that all individuals who are high-risk<\/a> for meningococcal disease are up-to-date on the MenACWY vaccine.\u00a0 Continue to encourage routine administration<\/a> of the MenACWY vaccine in younger children and adolescents, as required for students enrolled in the 7th and 12th grades.<\/p>\n

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Increase in Invasive Group A Strep Infections<\/strong><\/p>\n

The Centers for Disease Control and Prevention (CDC) have noted an increase in invasive group A Streptococcus (iGAS) infections<\/a> in children in the United States.\u00a0 Although the number of iGAS cases reported in children in Virginia is not above average for this time of year, we are observing increased activity in general.\u00a0 Group A Streptococcus bacteria can cause a range of illnesses; severe iGAS infections include necrotizing fasciitis and streptococcal toxic shock syndrome and require immediate treatment, including appropriate antibiotic therapy.<\/p>\n

VDH responds to reports of suspect iGAS infections by rapidly identifying close contacts for whom short-term antibiotics are recommended for prophylaxis, and urgently investigating clusters of GAS infections, especially in high-risk settings such as among residents of long-term care facilities and school aged children.<\/p>\n

Please consider the following actions:<\/p>\n