CDC Reports Antibiotic Resistant Strain of Meningitis

Per a June 19, 2020 notice from the CDC: “During 2019–2020, 11 meningococcal isolates from U.S. patients had isolates containing a blaROB-1 β-lactamase gene associated with penicillin resistance and mutations associated with ciprofloxacin resistance. An additional 22 cases reported during 2013–2020 contained blaROB-1 but did not have mutations associated with ciprofloxacin resistance.”

With a disease that causes a sudden and severe illness, with a case-fatality rate of 10%-15%, healthcare professionals, who usually implement a treatment consisting of ceftriaxone and cefotaxime, should now also “ascertain susceptibility of meningococcal isolates to penicillin before switching to penicillin or ampicillin” to treat the patient.

What is Meningococcal Disease?

Meningococcal disease is an uncommon, but sometimes a life-threatening illness. The disease is a result of a bacterial infection of the blood and/or the membranes that line the spinal cord and brain.

According the CDC, “Bacteria called Neisseria meningitidis cause meningococcal disease. About 1 in 10 people have these bacteria in the back of their nose and throat without being ill. This is called being ‘a carrier’. Sometimes the bacteria invade the body and cause certain illnesses, which are known as meningococcal disease.”

The majority of the types (serogroups) that cause the illness in the United States are the B, C and Y serogroups, but there are a total of six serogroups of Neisseria meningitidis.

Meningococcal infection can cause serious complications, including:

• Meningitis – an infection of the covering of the brain and spinal cord
• Septicaemia – an infection of the blood
• Infections in other parts of the body, such as in the joints.

The CDC recently reported multiple cases of β-lactamase-producing N. meningitidis serogroup Y in the United States, including eleven cases also resistant to ciprofloxacin. This new discovery prompted the CDC to provide new information for healthcare providers and public health staff regarding:

• Treatment
• Prophylaxis
• Surveillance Activities

How do you get Meningococcal Disease?

Meningococcal bacteria is spread person to person usually via coughing or kissing between individuals, resulting in the sharing of saliva or spit. Meningococcal bacteria is not as contagious as germs that cause the common cold or flu and it is not transmitted through casual contact or the breathing area near a contaminated individual. Therefore the spread of meningococcal bacteria is usually limited to people in the same household, roommates or any direct contact with a contaminated individuals oral secretion.

Below are several factors that can place an individuals in an increased risk for meningococcal disease:

• Age: infants, teens and young adults are more susceptible
• Group Settings: Large gatherings allow the disease to spread more rapidly
• Medical Conditions: Individuals who take complement inhibitors such as eculizumab (Soliris®) and ravulizumab (Ultomiris™). These medications are often prescribed for individuals suffering from:
  • Atypical hemolytic uremic syndrome (aHUS), a blood disorder
  • Paroxysmal nocturnal hemoglobinuria (PNH), a blood disorder
  • Generalized myasthenia gravis (MG), a disorder that leads to muscle weakness
• Travel: Individuals traveling in sub-Saharan Africa are at a greater risk due to the known risk in these areas and greater cases of meningococcal disease

What are the Signs and Symptoms of Meningococcal Disease?

The two most most common types of meningococcal infections are meningitis and septicemia. Both of these types of infection are serious and can be deadly in a matter of hours. With meningococcal meningitis, common symptoms include: fever, headache and stiff neck. Additional symptoms of meningococcal meningitis could include: nausea, vomiting, photophobia (eyes being more sensitive to light) and altered mental status (confusion).

With meningococcal septicemia (meningococcemia) the infection is a bloodstream infection caused by Neisseria meningitidis meningococcal septicemia or meningococcemia and includes symptoms such as: fever/chills, fatigue, vomiting, cold hands & feet, severe aches or pain in the muscles (joints, chest or abdomen), rapid breathing, diarrhea, and in later states a dark purple rash.

Vaccines and Treatment for Meningococcal Disease:

There are currently two types of meningococcal vaccines available in the United States:

• Meningococcal conjugate or MenACWY vaccines
• Serogroup B meningococcal or MenB vaccines

The CDC recommends the vaccinating for meningococcal based on the following age groups and situations:

• Babies and Children between the ages of 2 months and 10 years should receive the MenACWY vaccine if the child:
  • Has a rare type of immune disorder called complement component deficiency
  • Is taking a type of medicine called a complement inhibitor (for example, Soliris® or Ultomiris®)
  • Has a damaged spleen or their spleen has been removed
  • Has HIV
  • Is traveling to or residing in countries in which the disease is common
  • Is part of a population identified to be at increased risk because of a serogroup A, C, W, or Y meningococcal disease outbreak
• Children over the age of 10, should receive the MenB vaccine if the child:
  • Has a rare type of immune disorder called complement component deficiency
  • Is taking a type of medicine called a complement inhibitor
  • Has a damaged spleen or their spleen has been removed
  • Is part of a population identified to be at increased risk because of a serogroup B meningococcal disease outbreak
• Preteens and Teens between the ages of 11 to 12 years should receive the MenACWY vaccine with a booster dose at age 16 if the adolescent:
  • Has a rare type of immune disorder called complement component deficiency
  • Is taking a type of medicine called a complement inhibitor
  • Has a damaged spleen or their spleen has been removed
  • Is part of a population identified to be at increased risk because of a serogroup B meningococcal disease outbreak
• Adults should receive the MenACWY vaccine if the adult:
  • Has a rare type of immune disorder called complement component deficiency
  • Is taking a type of medicine called a complement inhibitor
  • Has a damaged spleen or their spleen has been removed
  • Has HIV
  • Is a microbiologist who is routinely exposed to Neisseria meningitidis
  • Is traveling to or residing in countries in which the disease is common
  • Is part of a population identified to be at increased risk because of a serogroup A, C, W, or Y meningococcal disease outbreak
  • Is not up to date with this vaccine and are a first-year college student living in a residence hall
  • Is a military recruit

Patients are also cautioned to consult their doctor regarding any vaccine booster shots that may be needed and to discuss certain restrictions that would not be favorable for vaccination, such as life-threatening allergic reaction history, pregnancy or breastfeeding or if the patient is currently ill.

With the identification of penicillin-resistant and ciprofloxacin-resistant, β-lactamase–producing N. meningitidis, healthcare professionals can no longer depend on the disease's history of being incredibly sensitive to antibiotics. Quick treatment with antibiotics has been considered essential as the disease can cause death within a matter of hours.

With the COVID-19 pandemic still consuming the majority of our healthcare resources, it has limited the submission of meningococcal isolates and collection of epidemiologic data that is needed for additional testing. The CDC is asking all state and territorial health departments for assistance: “to facilitate ongoing monitoring of antimicrobial resistance... health departments are asked to continue submitting all meningococcal isolates to CDC for antimicrobial susceptibility testing and WGS and to report any suspected meningococcal treatment or prophylaxis failures. In states that have experienced meningococcal disease cases caused by ciprofloxacin-resistant strains during the past 1–2 years, clinicians and public health staff members should consider antimicrobial susceptibility testing on meningococcal isolates to inform prophylaxis decisions.† Antimicrobial susceptibility testing should not delay the initiation of prophylaxis. Jurisdictions with capacity for β-lactamase screening or WGS might also wish to assess β-lactamase production or presence of β-lactamase genes and ciprofloxacin resistance-associated mutations. States conducting their own antimicrobial susceptibility testing, β-lactamase screening, or WGS are requested to share results and sequences with CDC. For cases with isolates determined to be β-lactamase screen-positive or ciprofloxacin-resistant, jurisdictions are requested to obtain and submit a supplementary case report form (https://www.cdc.gov/meningococcal/surveillance/index.html).”