Age: 20.0
Sex: M
Vaccine: MNQ
Symptoms: Bacterial test positive, Meningococcal bacteraemia, Neisseria test positive
Clinical narrative: Initial information retrieved on 04 April 2011 via a scientific literature article. This literature article described epidemiological characteristics of breakthrough cases of meningococcal disease in MENACTRA recipients, and provided an early estimate of MENACWY effectiveness within 3 to 4 years after vaccination. The article suggested that MENACTRA effectiveness is 80% to 85%, similar to the VE (vaccine effectiveness) reported for MENOMUNE. Materials and methods: Active, laboratory-based surveillance for disease caused by N. meningitidis is conducted as part of Active Bacterial Core surveillance (ABCs) which is supported by Centers for Disease Control and Prevention (CDC) Emerging Infectious Program; and MeningNet (an enhanced passive surveillance for meningococcal disease) supported by CDC Epidemiology and Laboratory Capacity for Infectious Diseases Program. Reports of meningococcal disease after vaccination with MENACWY were collected from ABCs and MeningNet participating sites. The cases were restricted to residents of ABCs or MeningNet surveillance areas between 01 January 2005 and 31 December 2008. A case of meningococcal disease in a MENACWY recipient was defined as isolation of Neisseria meningitidis (serogroup A, C, Y, or W-135), or detection of N. meningitidis DNA by polymerase chain reaction (PCR), from cerebrospinal fluid specimens taken from a normally sterile site greater than or equal to 10 days after vaccination with MENACWY, or a clinical diagnosis of meningitidis in the medical record with a blood stream isolate, and bacteremia that was defined as isolation of N. meningitidis from the blood and no clinical diagnosis of meningitis, or other type of infection in the medical record. Laboratory: Serogrouping of N. meningitidis were done by state public health laboratories. Their results were used as the final serogroup if it was confirmed by CDC slide agglutination or PCR testing. If CDC slide agglutination or PCR results differed from state results, the CDC results were used as final serogroup. State laboratory results were used if specimens sent to CDC were nonviable or contaminated after 2 sends. All available isolates were performed at CDC for multilocus sequence typing (MLST). DNA sequences were determined using both forward and reverse strands. Thirteen of the 14 cases were confirmed by culture, and 1 was detected by PCR alone. Eight were serogroup C, and 6 were serogroup Y. Isolates were available for 12 of the 14 cases, of the 12, 7 of the available Serogroup C isolates were ST-11 complex, and 5 of the available serogroup Y isolates were ST-23 complex. Between years 2005 and 2008 a total of 14 breakthrough cases of meningococcal disease in MENACTRA recipients (previously reported as 13 cases), including 3 deaths, were reported from 20 participating surveillance sites of ABCs and MeningNet. All 14 cases received MENACTRA with no identified common lot of vaccine. Tables of all 14 cases were included in the article. Of the 14 cases, all but 1 patient was hospitalized. Regarding this case which involves a male patient who at 20 years of age received MENACTRA vaccination, and at age 20 years, which was 43 days post vaccination, had culture presenting with Neisseria meningitidis serogroup Y, bacteremia. Days of hospitalization were reported as "unknown". Underlying medical conditions were unknown. There were no recognized diagnoses of complement deficiencies on medical record review, and no record of testing for complement deficiencies was found. Outcome was reported as "survived". Recovery status was not reported. This case pertains to one of the 14 identified breakthrough cases of meningococcal disease in MENACTRA recipients. Three of the 14 cases involved death that is captured in case numbers 2009-00015, 2009-00016, and 2007-03425. Information regarding the other 10 patients is captured in case numbers 2007-03383, 2008-00387, 00531 and 02355, 2009-00012-00014, 2009-00017-00018, 2009-00381. An additional case (case number 2008-04011) contains the collective report of all 14 cases. Documents held by sender: None.