Epidemiologic investigation and targeted vaccination initiative in response to an outbreak of meningococcal disease among illicit drug users in brooklyn, New York

Don Weiss, Eric J. Stern, Christopher Zimmerman, Brooke Bregman, Alice Yeung, Debjani Das, Catherine M. Dentinger, Melissa Hewett-Marx, John Kornblum, Lillian Lee, Tanya A. Halse, Leonard W. Mayer, Cynthia P. Hatcher, M. Jordan Theodore, Susanna Schmink, Brian H. Harcourt, Jane R. Zucker, Marci Layton, Thomas A. Clark

Research output: Contribution to journalArticle

Abstract

Background. An outbreak of serogroup C meningococcal disease that involved illicit drug users and their contacts occurred in Brooklyn, New York, during 2005 and 2006. Methods. The objectives of this study were to identify the population at risk for meningococcal disease, describe efforts to interrupt disease transmission, and assess the impact of a vaccine initiative. Descriptive and molecular epidemiological analysis was used to define the extent of the outbreak and the common risk factors among outbreak- related cases. A vaccine initiative that used community-based service providers was targeted to illicit drug users and their close contacts. The vaccine initiative was assessed through cessation of outbreak-related cases and the reduction in carriage rate. Results. The investigation identified 23 outbreak-related cases of serogroup C meningococcal disease; 17 isolates were indistinguishable and 4 isolates were closely related according to pulsed-field gel electrophoresis. Two additional culture-negative cases had epidemiological links to laboratory-confirmed cases. The median age of patients with outbreak-related cases was 41 years, and 19 (83%) of 23 patients reported an association with illicit drug use. There were 7 outbreak-related deaths. Vaccination was administered to 2763 persons at 29 community locations, including methadone treatment centers, syringe-exchange programs, and soup kitchens. Three additional cases of meningococcal disease due to strains with the same pulsed-field gel electrophoresis pattern were identified after the vaccination initiative. Conclusions. Community-based outbreaks of meningococcal disease are difficult to control, and the decision to vaccinate is not straightforward. Current national guidelines for implementing a vaccination campaign are not strict criteria and cannot be expected to accommodate the myriad of factors that occur in community-based invasive meningococcal disease outbreaks, such as the inability to enumerate the population at risk.

Original languageEnglish (US)
Pages (from-to)894-901
Number of pages8
JournalClinical Infectious Diseases
Volume48
Issue number7
DOIs
StatePublished - Apr 1 2009
Externally publishedYes

Fingerprint

Street Drugs
Drug Users
Disease Outbreaks
Vaccination
Vaccines
Pulsed Field Gel Electrophoresis
Needle-Exchange Programs
Immunization Programs
Social Welfare
Methadone
Guidelines

ASJC Scopus subject areas

  • Infectious Diseases
  • Microbiology (medical)

Cite this

Epidemiologic investigation and targeted vaccination initiative in response to an outbreak of meningococcal disease among illicit drug users in brooklyn, New York. / Weiss, Don; Stern, Eric J.; Zimmerman, Christopher; Bregman, Brooke; Yeung, Alice; Das, Debjani; Dentinger, Catherine M.; Hewett-Marx, Melissa; Kornblum, John; Lee, Lillian; Halse, Tanya A.; Mayer, Leonard W.; Hatcher, Cynthia P.; Theodore, M. Jordan; Schmink, Susanna; Harcourt, Brian H.; Zucker, Jane R.; Layton, Marci; Clark, Thomas A.

In: Clinical Infectious Diseases, Vol. 48, No. 7, 01.04.2009, p. 894-901.

Research output: Contribution to journalArticle

Weiss, D, Stern, EJ, Zimmerman, C, Bregman, B, Yeung, A, Das, D, Dentinger, CM, Hewett-Marx, M, Kornblum, J, Lee, L, Halse, TA, Mayer, LW, Hatcher, CP, Theodore, MJ, Schmink, S, Harcourt, BH, Zucker, JR, Layton, M & Clark, TA 2009, 'Epidemiologic investigation and targeted vaccination initiative in response to an outbreak of meningococcal disease among illicit drug users in brooklyn, New York', Clinical Infectious Diseases, vol. 48, no. 7, pp. 894-901. https://doi.org/10.1086/597257
Weiss, Don ; Stern, Eric J. ; Zimmerman, Christopher ; Bregman, Brooke ; Yeung, Alice ; Das, Debjani ; Dentinger, Catherine M. ; Hewett-Marx, Melissa ; Kornblum, John ; Lee, Lillian ; Halse, Tanya A. ; Mayer, Leonard W. ; Hatcher, Cynthia P. ; Theodore, M. Jordan ; Schmink, Susanna ; Harcourt, Brian H. ; Zucker, Jane R. ; Layton, Marci ; Clark, Thomas A. / Epidemiologic investigation and targeted vaccination initiative in response to an outbreak of meningococcal disease among illicit drug users in brooklyn, New York. In: Clinical Infectious Diseases. 2009 ; Vol. 48, No. 7. pp. 894-901.
@article{c1546b573f12406c8eece376c70692f6,
title = "Epidemiologic investigation and targeted vaccination initiative in response to an outbreak of meningococcal disease among illicit drug users in brooklyn, New York",
abstract = "Background. An outbreak of serogroup C meningococcal disease that involved illicit drug users and their contacts occurred in Brooklyn, New York, during 2005 and 2006. Methods. The objectives of this study were to identify the population at risk for meningococcal disease, describe efforts to interrupt disease transmission, and assess the impact of a vaccine initiative. Descriptive and molecular epidemiological analysis was used to define the extent of the outbreak and the common risk factors among outbreak- related cases. A vaccine initiative that used community-based service providers was targeted to illicit drug users and their close contacts. The vaccine initiative was assessed through cessation of outbreak-related cases and the reduction in carriage rate. Results. The investigation identified 23 outbreak-related cases of serogroup C meningococcal disease; 17 isolates were indistinguishable and 4 isolates were closely related according to pulsed-field gel electrophoresis. Two additional culture-negative cases had epidemiological links to laboratory-confirmed cases. The median age of patients with outbreak-related cases was 41 years, and 19 (83{\%}) of 23 patients reported an association with illicit drug use. There were 7 outbreak-related deaths. Vaccination was administered to 2763 persons at 29 community locations, including methadone treatment centers, syringe-exchange programs, and soup kitchens. Three additional cases of meningococcal disease due to strains with the same pulsed-field gel electrophoresis pattern were identified after the vaccination initiative. Conclusions. Community-based outbreaks of meningococcal disease are difficult to control, and the decision to vaccinate is not straightforward. Current national guidelines for implementing a vaccination campaign are not strict criteria and cannot be expected to accommodate the myriad of factors that occur in community-based invasive meningococcal disease outbreaks, such as the inability to enumerate the population at risk.",
author = "Don Weiss and Stern, {Eric J.} and Christopher Zimmerman and Brooke Bregman and Alice Yeung and Debjani Das and Dentinger, {Catherine M.} and Melissa Hewett-Marx and John Kornblum and Lillian Lee and Halse, {Tanya A.} and Mayer, {Leonard W.} and Hatcher, {Cynthia P.} and Theodore, {M. Jordan} and Susanna Schmink and Harcourt, {Brian H.} and Zucker, {Jane R.} and Marci Layton and Clark, {Thomas A.}",
year = "2009",
month = "4",
day = "1",
doi = "10.1086/597257",
language = "English (US)",
volume = "48",
pages = "894--901",
journal = "Clinical Infectious Diseases",
issn = "1058-4838",
publisher = "Oxford University Press",
number = "7",

}

TY - JOUR

T1 - Epidemiologic investigation and targeted vaccination initiative in response to an outbreak of meningococcal disease among illicit drug users in brooklyn, New York

AU - Weiss, Don

AU - Stern, Eric J.

AU - Zimmerman, Christopher

AU - Bregman, Brooke

AU - Yeung, Alice

AU - Das, Debjani

AU - Dentinger, Catherine M.

AU - Hewett-Marx, Melissa

AU - Kornblum, John

AU - Lee, Lillian

AU - Halse, Tanya A.

AU - Mayer, Leonard W.

AU - Hatcher, Cynthia P.

AU - Theodore, M. Jordan

AU - Schmink, Susanna

AU - Harcourt, Brian H.

AU - Zucker, Jane R.

AU - Layton, Marci

AU - Clark, Thomas A.

PY - 2009/4/1

Y1 - 2009/4/1

N2 - Background. An outbreak of serogroup C meningococcal disease that involved illicit drug users and their contacts occurred in Brooklyn, New York, during 2005 and 2006. Methods. The objectives of this study were to identify the population at risk for meningococcal disease, describe efforts to interrupt disease transmission, and assess the impact of a vaccine initiative. Descriptive and molecular epidemiological analysis was used to define the extent of the outbreak and the common risk factors among outbreak- related cases. A vaccine initiative that used community-based service providers was targeted to illicit drug users and their close contacts. The vaccine initiative was assessed through cessation of outbreak-related cases and the reduction in carriage rate. Results. The investigation identified 23 outbreak-related cases of serogroup C meningococcal disease; 17 isolates were indistinguishable and 4 isolates were closely related according to pulsed-field gel electrophoresis. Two additional culture-negative cases had epidemiological links to laboratory-confirmed cases. The median age of patients with outbreak-related cases was 41 years, and 19 (83%) of 23 patients reported an association with illicit drug use. There were 7 outbreak-related deaths. Vaccination was administered to 2763 persons at 29 community locations, including methadone treatment centers, syringe-exchange programs, and soup kitchens. Three additional cases of meningococcal disease due to strains with the same pulsed-field gel electrophoresis pattern were identified after the vaccination initiative. Conclusions. Community-based outbreaks of meningococcal disease are difficult to control, and the decision to vaccinate is not straightforward. Current national guidelines for implementing a vaccination campaign are not strict criteria and cannot be expected to accommodate the myriad of factors that occur in community-based invasive meningococcal disease outbreaks, such as the inability to enumerate the population at risk.

AB - Background. An outbreak of serogroup C meningococcal disease that involved illicit drug users and their contacts occurred in Brooklyn, New York, during 2005 and 2006. Methods. The objectives of this study were to identify the population at risk for meningococcal disease, describe efforts to interrupt disease transmission, and assess the impact of a vaccine initiative. Descriptive and molecular epidemiological analysis was used to define the extent of the outbreak and the common risk factors among outbreak- related cases. A vaccine initiative that used community-based service providers was targeted to illicit drug users and their close contacts. The vaccine initiative was assessed through cessation of outbreak-related cases and the reduction in carriage rate. Results. The investigation identified 23 outbreak-related cases of serogroup C meningococcal disease; 17 isolates were indistinguishable and 4 isolates were closely related according to pulsed-field gel electrophoresis. Two additional culture-negative cases had epidemiological links to laboratory-confirmed cases. The median age of patients with outbreak-related cases was 41 years, and 19 (83%) of 23 patients reported an association with illicit drug use. There were 7 outbreak-related deaths. Vaccination was administered to 2763 persons at 29 community locations, including methadone treatment centers, syringe-exchange programs, and soup kitchens. Three additional cases of meningococcal disease due to strains with the same pulsed-field gel electrophoresis pattern were identified after the vaccination initiative. Conclusions. Community-based outbreaks of meningococcal disease are difficult to control, and the decision to vaccinate is not straightforward. Current national guidelines for implementing a vaccination campaign are not strict criteria and cannot be expected to accommodate the myriad of factors that occur in community-based invasive meningococcal disease outbreaks, such as the inability to enumerate the population at risk.

UR - http://www.scopus.com/inward/record.url?scp=63649092191&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=63649092191&partnerID=8YFLogxK

U2 - 10.1086/597257

DO - 10.1086/597257

M3 - Article

C2 - 19231975

AN - SCOPUS:63649092191

VL - 48

SP - 894

EP - 901

JO - Clinical Infectious Diseases

JF - Clinical Infectious Diseases

SN - 1058-4838

IS - 7

ER -