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Published Date: 2010-06-25 12:00:07
Subject: PRO/EDR> Meningitis, meningococcal - USA: (CO) fatal
Archive Number: 20100625.2115

MENINGITIS, MENINGOCOCCAL - USA: (COLORADO) FATAL
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International Society for Infectious Diseases
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Date: Wed 23 Jun 2010
Source: AOL News [edited]
<http://www.aolnews.com/health/article/fatal-meningitis-outbreak-in-colorado-linked-to-hockey-game/19528409>

Two hockey players have died and 2 other people are hospitalized from
an outbreak of a particularly virulent strain of meningitis. Health
officials said today [23 Jun 2010] they have traced the bacteria to a
death in Denver in April [2010].

Officials are speculating that players at the end of a [9 Jun 2010]
hockey game in Fort Collins removed their mouth guards, then shook
hands, spreading the bacteria through saliva on their hands, said
Jane Viste, a spokeswoman for the Larimer County Department of Health
and Environment. Since meningitis is spread through contact with
infected saliva or nasal fluids, it is also possible that this
outbreak was transmitted through spitting during the game or sharing
of water bottles, she said. "This clustering among the hockey players
is very unusual," said Dr Adrienne LeBailly, the department's director.

[N.S., a] 28-year-old mechanical engineer whose wife is 6 months
pregnant, died Tuesday [? 22 Jun 2010]. Another hockey player, B.W.,
a 29-year-old father of 2, died on 14 Jun 2010. A 3rd hockey player,
W.J., remained hospitalized in critical condition in Montana, where
he had been vacationing, Karen Ogden, a spokeswoman for Benefis
Health System Hospital in Great Falls, Montana, told AOL News.

The 4th person, a Colorado State University [CSU] student who has not
been publicly identified was transferred to a hospital in Denver
after falling ill during Memorial Day weekend [29-31 May 2010], Viste
said. Although B.W.'s wife works at CSU, the connection between the
hockey players and the ill CSU student is unknown and possibly
remote, Viste said.

What is known is that the bacteria responsible for 4 of the 5 cases
are genetically identical, meaning they come from the same source.
The test results for W.J. haven't been sent from Montana to Fort
Collins yet, but they are likely to be genetically identical to the
others, officials said.

"Even with this information, we will be very unlikely to tie the
cases together directly," LeBailly said. "Many people carry these
bacteria in their throats but have no symptoms."

Less than 1 percent of the people who harbor the bacteria become ill,
but they can transmit it to others. The bacteria can cause either
meningitis, an infection of the membranes covering the brain and
spinal cord, or sepsis, an infection of the bloodstream.
Meningococcal sepsis has a mortality rate of up to 15 percent or
more, Viste said.

County health officials are vaccinating all Fort Collins Adult Hockey
League players. So far, 65 people have received preventative
antibiotics, and about 55 have received vaccinations, Viste said.
College students are routinely advised to get vaccinated for
meningitis before attending school.

Officials are optimistic the outbreak might be over. "Enough time has
passed for the incubation period, and we've seen no new cases, so
that's very good news for now," Viste said.

Ironically, Fort Collins, a community of 120 000 residents 65 miles
[105 km] north of Denver, is home to one of the research laboratories
of the federal Centers for Disease Control and Prevention.

[Byline: Karen Schwartz]

--
Communicated by:
ProMED-mail
<promed@promedmail.org>

[Fort Collins, the location for 4 of the 5 cases of meningitis due to
a genetically identical strain of _Neisseria meningitidis_ , is home
to Colorado State University (CSU). The city is the county seat of
Larimer County, Colorado and is located about 60 miles north of the
Colorado State Capitol in Denver
(<http://en.wikipedia.org/wiki/Fort_Collins,_Colorado>). Three of the
Fort Collins cases occurred among adult hockey league players who
participated in a game on 9 Jun 2010 in Fort Collins; the 4th Fort
Collins case, apparently unrelated to hockey playing, occurred in CSU
student in late May 2010. The 5th case, whose epidemiologic link to
the other cases is apparently unknown, occurred in Denver in April 2010.

_N. meningitidis_ causes bacterial meningitis and sepsis. The
bacteria are transmitted from person to person via droplets of
respiratory secretions mostly from asymptomatic nasopharyngeal
carriers of the microorganism. It is estimated that between 10 to 25
percent of the population carry _N. meningitidis_ at any given time,
and the carriage rate may be much higher in epidemic situations.
Close and prolonged contact (such as kissing, sneezing and coughing
on someone, living in close quarters or dormitories (military
recruits, students), sharing eating or drinking utensils, etc.)
facilitates the spread of the disease. The average incubation period
for meningococcal meningitis is 4 days, ranging between 2 and 10 days
(<http://www.who.int/mediacentre/factsheets/fs141/en/>).

Each year, up to 3000 people in the USA develop meningococcal
disease. The annual incidence generally ranges from 0.5 to 1.1 cases
per 100 000. The incidence peaks in late winter and early spring.
Most cases are sporadic; less than 2 percent occur in outbreaks
(<http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5407a1.htm>; updated at
<http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5631a3.htm>). Outbreaks
tend to occur in semi-closed communities, such military recruit
camps, college dormitories, schools, and day-care centers.
Community-based outbreaks in towns, cities, and counties may also
occur among persons who are not close contacts of each other and who
do not share a common affiliation.

An outbreak of meningococcal disease in either an organization or
community is defined as the occurrence of 3 or more confirmed or
probable cases during a period of less than or equal to 3 months,
resulting in a primary disease attack rate in the population at risk
(such as, hockey team in the outbreak in the news release above) of
at least 10 cases per 100 000 persons, which is about 10 times
greater than the normal occurrence
(<http://www.cdc.gov/mmwr/preview/mmwrhtml/00046237.htm>).

Chemoprophylaxis is given to appropriate contacts whose risk for
acquiring meningococcal disease is 500-800 times greater than among
the total population
(<http://www.cdc.gov/mmwr/preview/mmwrhtml/00046237.htm>). Close
contacts of patients are household members, day-care center contacts,
and persons directly exposed to the patient's oral secretions.

In an outbreak, the population at risk should be vaccinated with the
meningococcal vaccine appropriate for the serogroup causing the
outbreak as soon as possible after an outbreak has been declared
(<http://www.cdc.gov/mmwr/PDF/rr/rr5407.pdf>). Because available
vaccines are not effective against _N. meningitidis_ serogroup B,
vaccination is not considered during serogroup B outbreaks. Although
the serogroup is not specified for the hockey team outbreak, since
the hockey team was vaccinated, presumably the serogroup is not serogroup B.

A quadrivalent A, C, Y, and W135 meningococcal conjugate vaccine was
licensed in the United States in January 2005. The conjugate vaccine
induces a T-cell-dependent response, resulting in an improved immune
response, providing long-lasting immunity and preventing
nasopharyngeal carriage of _N. meningitidis_ and thus reducing
bacterial transmission of this microorganism
(<http://www.nfid.org/pdf/publications/meningococcalepid.pdf>).

Fort Collins in northern Colorado can be seen on the
HealthMap/ProMED-mail interactive map of the US at
<http://healthmap.org/r/00-s>. - Mod.ML]

See Also