National Center for Immunization & Respiratory Diseases

Epidemiology of Meningococcal Disease 

United States

Amy Rubis, MPH

Advisory Committee on Immunization Practices Meetin

February 23, 2023
Agenda Overall epidemiology of meningococcal disease in t

United States

 Recent notable epidemiology – Ciprofloxacin- and penicillin-resistant serogroup 

meningococcal disease cases –Outbreaks
Meningococcal Disease Surveillance Cases reported through National Notifiable Disease

Surveillance System (NNDSS)

 Additional serogroup, outcome, and clinical charact

collected nationally through Enhanced MeningococSurveillance (EMDS)

– Isolates submitted for whole genome sequencing
Meningococcal Disease Surveillance Data, 20 2020 data are final Delays in obtaining and finalizing surveillance data 

and 2022

– Serogroup missing for 17% of cases – Clinical characteristics not yet complete for 2022–All available isolates not yet received and tested 

serogroup and antimicrobial susceptibility
Meningococcal Disease Incidence –

United States, 1996–2019

Abbreviations: MenACWY vaccine = quadrivalent conjugate meningococcal vaccine against serogroups A, C, W, Y; MenB vaccine = serogrSource: 1996–2019 NNDSS Data

0.000.200.400.600.801.001.201.40

1996 2000 2005 2010 2015 

Incidence per 100,000

Year

0.11 

MenACWY vaccine

1.2 cases/100,000 

population

MenB vaccine
Meningococcal Disease Incidence –

United States, 1996–2021*

0.000.200.400.600.801.001.201.40

1996 2000 2005 2010 2015 

Incidence per 100,000

Year

Abbreviations: MenACWY vaccine = quadrivalent conjugate meningococcal vaccine against serogroups A, C, W, Y; MenB vaccine = serogrSource: 1996–2021 NNDSS Data. *2021 NNDSS data are preliminary.

MenACWY vaccine

1.2 cases/100,000 

population

MenB vaccine
Meningococcal Disease Incidence –

United States, 1996–2022*

0.000.200.400.600.801.001.201.40

1996 2000 2005 2010 2015 

Incidence per 100,000

Year

Abbreviations: MenACWY vaccine = quadrivalent conjugate meningococcal vaccine against serogroups A, C, W, Y; MenB vaccine = serogrSource: 1996–2022 NNDSS Data. *2021–2022 NNDSS data are preliminary.

MenACWY vaccine

1.2 cases/100,000 

population

MenB vaccine
Trends in Meningococcal Disease Inciden

Serogroup – United States, 2006–202

0

0.020.040.060.08

0.1

0.12

2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 20

Incidence per 100,000

Year

B

C

Y

Source: NNDSS data with additional serogroup data from Active Bacterial Core surveillance (ABCs) and state health departments*2021 and 2022 data are preliminary
Average Annual Meningococcal Disease Inci

Age-Group and Serogroup―United States, 2

Source: NNDSS data with additional serogroup data from ABCs and state health departments 

0

0.20.40.60.8

1

1.21.4

<1 year 1 year 2-4 years 5-10

years

11-15

years

16-20

years

21-25

years

26-44

years

45-64

years

Incidence per 100,000

Age Group

B ACWY Oth/Unk
Average Annual Meningococcal Disease Inci

Age-Group and Serogroup―United States, 20

Source: NNDSS data with additional serogroup data from ABCs and state health departments *2021 and 2022 data are preliminary

0

0.20.40.60.8

1

1.21.4

<1 year 1 year 2-4

years

5-10

years

11-15

years

16-20

years

21-25

years

26-44

years

45-64

years

Incidence per 100,000

Age Group

B ACWY Oth/Unk
Recent Meningococcal Disease Cases Historically resistance in N. meningitidis was rare Ciprofloxacin- and penicillin-resistant serogroup Y 

detected in 2020

– 27 cases from 2019–2022– 78% among Hispanic or Latino persons– Age range <1–97 years, mean 31, median 23

• Only 1 case 11–20 years of age

– No cases in vaccinated individuals
05

10152025

2013 2014 2015 2016 2017 2018 2019 2020 202

Number of cases

β-lactamase-positive only Dual-resistant Meningococcal Disease 

Resistant Serogroup Y Meningococcal Di

Cases―United States, 2013–2022

*2021 and 2022 data are preliminary

Data a

numbe
Recent Meningococcal Disease Outbreaks Largest outbreak predominantly in men who have 

men (MSM) reported to date 

– January 2022–present*– 43 serogroup C cases, 9 deaths (21% CFR)– 12/43 non-MSM (5 women) in outbreak– 15 (35%) cases in people living with HIV– Age range 20–77 years, mean 35, median 31

*The outbreak is ongoing. Case counts may change.
Recent Meningococcal Disease Outbreaks Unusually lethal strain of serogroup Y 

– June 2022–present*– 11 cases, 3 deaths (27% CFR)– 10/11 cases in Black or African American perso– Age range 30–78 years, mean 46, median 39– Sequence type 1466, clonal complex 174

*The outbreak is ongoing. Case counts may change.
Recent Meningococcal Disease Outbreaks People experiencing homelessness

– 2021

• 1 outbreak of 3 serogroup C cases• Age range 22–37 years

– 2022

• 1 outbreak of 2 serogroup C cases at the sam• Ages: 37 and 41 years
Conclusions Incidence of meningococcal disease declined durin

2021, but increased in 2022

 New strains emerging in the US – Predominantly affecting racial and ethnic minorit

– Unclear how this will change overall epidemiolog

 More complete 2021 and 2022 data are needed More years of data needed to understand post-COV

epidemiology
For more information, contact CDC

1-800-CDC-INFO (232-4636)TTY: 1-888-232-6348 www.cdc.govThe findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention.

Thank You