Highlights from the Midi-Pyrénées Regional Health Agency - Resurgence of Meningitis C Cases

While the incidence of invasive meningococcal disease (IMD) caused by serogroup C had been declining since 2002 in Midi-Pyrénées (for example, one case in 2010, two in 2011), there is currently a resurgence of this infection. In fact, 11 cases have been reported in the past twelve months, including 9 since January 2012, representing a regional incidence rate of 0.38 cases per 100,000 inhabitants—more than double the national incidence rate (0.15) for this serogroup. Most cases were reported among residents of Haute-Garonne (6 cases), but 5 cases have been reported in three other departments since January 2012 (Ariège, Gers, Tarn).

As of June 20, 2012, the CNR had characterized 9 of the 11 meningococcal strains. They all belong to the ST11 clonal complex, which is currently circulating predominantly in France and is known to be highly pathogenic and epidemic.

No epidemiological link between these cases has been identified.

With the exception of one case in a very elderly person, the majority of cases involved children, adolescents, and young adults (age range 7–44 years). Three of them developed purpura fulminans (27%); one patient died, and another has severe sequelae (quadriplegia). Among these 11 patients, 8 were unvaccinated (information missing for 3 patients who were likely unvaccinated). However, 7 cases (64%) were in the age group covered by recent recommendations for meningococcal C vaccination.

Since 2009, vaccination against meningococcal type C has been recommended after the age of 1 year, with catch-up vaccination available up to age 24 (HCSP opinions of April 24 and June 26, 2009). This vaccination not only directly protects vaccinated individuals against the disease but also limits the spread of the pathogen in the community, thereby indirectly protecting the rest of the population, particularly adults in contact with children and adolescents. Vaccination coverage for the meningococcal C vaccine in France is very low: it was estimated at the end of 2011 to be 46.7% among 2-year-olds, 13.2% among 6- to 14-year-olds, and 4.1% among 15- to 24-year-olds (provisional data from a general practitioner sample of beneficiaries—CnamTS/InVS). It is therefore essential to emphasize the need for vaccination of infants and catch-up vaccination among those aged 1–24.