{"id":2269,"date":"2024-04-11T14:15:35","date_gmt":"2024-04-11T14:15:35","guid":{"rendered":"https:\/\/www.vdh.virginia.gov\/clinicians\/?page_id=2269"},"modified":"2026-01-21T14:02:31","modified_gmt":"2026-01-21T14:02:31","slug":"increase-in-meningococcal-disease-ongoing-statewide-outbreak-and-local-detections-of-a-separate-antibiotic-resistant-strain","status":"publish","type":"page","link":"https:\/\/www.vdh.virginia.gov\/clinicians\/clinician-letters\/increase-in-meningococcal-disease-ongoing-statewide-outbreak-and-local-detections-of-a-separate-antibiotic-resistant-strain\/","title":{"rendered":"Increase in Meningococcal Disease: Ongoing Statewide Outbreak and Local Detections of a Separate Antibiotic Resistant Strain"},"content":{"rendered":"<p><img loading=\"lazy\" decoding=\"async\" class=\"aligncenter wp-image-2681 \" src=\"https:\/\/www.vdh.virginia.gov\/content\/uploads\/sites\/134\/Letterhead_Shelton-1024x381.png\" alt=\"VDH Letterhead: Karen Shelton, MD State Health Commissioner Commonwealth of Virginia Department of Health PO Box 2448 Richmond, VA 23218 800-828-1120 or TTY 7-1-1\" width=\"761\" height=\"283\" srcset=\"https:\/\/www.vdh.virginia.gov\/content\/uploads\/sites\/134\/Letterhead_Shelton-1024x381.png 1024w, https:\/\/www.vdh.virginia.gov\/content\/uploads\/sites\/134\/Letterhead_Shelton-300x112.png 300w, https:\/\/www.vdh.virginia.gov\/content\/uploads\/sites\/134\/Letterhead_Shelton-768x286.png 768w, https:\/\/www.vdh.virginia.gov\/content\/uploads\/sites\/134\/Letterhead_Shelton-1536x572.png 1536w, https:\/\/www.vdh.virginia.gov\/content\/uploads\/sites\/134\/Letterhead_Shelton-2048x763.png 2048w\" sizes=\"auto, (max-width: 761px) 100vw, 761px\" \/><\/p>\n<p style=\"text-align: center;\"><b><span data-contrast=\"none\">Increase in Meningococcal Disease: Ongoing Statewide Outbreak and Local Detections of a Separate Antibiotic Resistant Strain<\/span><\/b><span data-ccp-props=\"{&quot;201341983&quot;:0,&quot;335551550&quot;:2,&quot;335551620&quot;:2,&quot;335559740&quot;:240}\">\u00a0<\/span><\/p>\n<p style=\"text-align: center;\"><span data-contrast=\"none\">April 11, 2024<\/span><span data-ccp-props=\"{&quot;201341983&quot;:0,&quot;335551550&quot;:2,&quot;335551620&quot;:2,&quot;335557856&quot;:16777215,&quot;335559738&quot;:240,&quot;335559739&quot;:360,&quot;335559740&quot;:240}\">\u00a0<\/span><\/p>\n<p><span data-contrast=\"auto\">Dear Colleague:<\/span><span data-ccp-props=\"{&quot;201341983&quot;:0,&quot;335559740&quot;:240}\">\u00a0<\/span><\/p>\n<p><span data-contrast=\"auto\">The Virginia Department of Health (VDH) is reporting an increase in meningococcal disease activity. VDH continues to respond to the ongoing <\/span><a href=\"https:\/\/www.vdh.virginia.gov\/surveillance-and-investigation\/meningococcal-disease\/\"><span data-contrast=\"none\">statewide outbreak<\/span><\/a><span data-contrast=\"auto\"> caused by <\/span><i><span data-contrast=\"auto\">Neisseria meningitidis <\/span><\/i><span data-contrast=\"auto\">serogroup Y. Additionally, cases from a separate strain of ciprofloxacin and penicillin-resistant <\/span><i><span data-contrast=\"auto\">N. meningitidis <\/span><\/i><span data-contrast=\"auto\">serogroup Y continue to be detected in northern Virginia, impacting local post-exposure prophylaxis recommendations in this region. Healthcare providers should remain vigilant for additional cases.<\/span><span data-ccp-props=\"{&quot;201341983&quot;:0,&quot;335559740&quot;:240}\">\u00a0<\/span><\/p>\n<p><span data-contrast=\"auto\">Please consider the following actions:<\/span><span data-ccp-props=\"{&quot;201341983&quot;:0,&quot;335559740&quot;:240}\">\u00a0<\/span><\/p>\n<ul>\n<li data-leveltext=\"\uf0b7\" data-font=\"Symbol\" data-listid=\"10\" data-list-defn-props=\"{&quot;335552541&quot;:1,&quot;335559683&quot;:0,&quot;335559684&quot;:-2,&quot;335559685&quot;:720,&quot;335559991&quot;:360,&quot;469769226&quot;:&quot;Symbol&quot;,&quot;469769242&quot;:[8226],&quot;469777803&quot;:&quot;left&quot;,&quot;469777804&quot;:&quot;\uf0b7&quot;,&quot;469777815&quot;:&quot;hybridMultilevel&quot;}\" data-aria-posinset=\"1\" data-aria-level=\"1\"><b><span data-contrast=\"auto\">Maintain a heightened index of suspicion for meningococcal disease.<\/span><\/b><span data-contrast=\"auto\"> Be aware that patients with invasive meningococcal disease may present with bloodstream infection or septic arthritis and\u202fwithout\u202f<\/span><a href=\"https:\/\/www.cdc.gov\/meningococcal\/about\/symptoms.html\"><span data-contrast=\"none\">symptoms typical of meningitis<\/span><\/a><span data-contrast=\"auto\"> (e.g., headache, stiff neck).\u00a0<\/span><span data-ccp-props=\"{&quot;134233117&quot;:false,&quot;134233118&quot;:false,&quot;201341983&quot;:0,&quot;335557856&quot;:16777215,&quot;335559738&quot;:0,&quot;335559739&quot;:0,&quot;335559740&quot;:240}\">\u00a0<\/span><\/li>\n<\/ul>\n<ul>\n<li data-leveltext=\"\uf0b7\" data-font=\"Symbol\" data-listid=\"10\" data-list-defn-props=\"{&quot;335552541&quot;:1,&quot;335559683&quot;:0,&quot;335559684&quot;:-2,&quot;335559685&quot;:720,&quot;335559991&quot;:360,&quot;469769226&quot;:&quot;Symbol&quot;,&quot;469769242&quot;:[8226],&quot;469777803&quot;:&quot;left&quot;,&quot;469777804&quot;:&quot;\uf0b7&quot;,&quot;469777815&quot;:&quot;hybridMultilevel&quot;}\" data-aria-posinset=\"2\" data-aria-level=\"1\"><b><span data-contrast=\"auto\">Immediately notify your <\/span><\/b><a href=\"https:\/\/www.vdh.virginia.gov\/health-department-locator\/\"><b><span data-contrast=\"none\">local health department<\/span><\/b><\/a><b><span data-contrast=\"auto\"> (LHD) <\/span><\/b><span data-contrast=\"auto\">if meningococcal disease is suspected based on clinical findings or laboratory results of gram-negative diplococci or <\/span><i><span data-contrast=\"auto\">N. meningitidis<\/span><\/i><span data-contrast=\"auto\"> from a normally sterile site. Please coordinate with your LHD to send specimens\/isolates for newly identified cases to Virginia\u2019s state public health laboratory, the Department of General Services Division of Consolidated Laboratory Services (DCLS), for serotyping.<\/span><span data-ccp-props=\"{&quot;134233118&quot;:false,&quot;201341983&quot;:0,&quot;335559739&quot;:0,&quot;335559740&quot;:240}\">\u00a0<\/span><\/li>\n<\/ul>\n<ul>\n<li data-leveltext=\"\uf0b7\" data-font=\"Symbol\" data-listid=\"10\" data-list-defn-props=\"{&quot;335552541&quot;:1,&quot;335559683&quot;:0,&quot;335559684&quot;:-2,&quot;335559685&quot;:720,&quot;335559991&quot;:360,&quot;469769226&quot;:&quot;Symbol&quot;,&quot;469769242&quot;:[8226],&quot;469777803&quot;:&quot;left&quot;,&quot;469777804&quot;:&quot;\uf0b7&quot;,&quot;469777815&quot;:&quot;hybridMultilevel&quot;}\" data-aria-posinset=\"3\" data-aria-level=\"1\"><b><span data-contrast=\"auto\">Because of the risks of severe morbidity and death, <\/span><\/b><a href=\"https:\/\/www.cdc.gov\/meningococcal\/clinical-info.html#treatment\"><b><span data-contrast=\"none\">effective antibiotics<\/span><\/b><\/a><b><span data-contrast=\"auto\"> should be administered promptly to patients suspected of having meningococcal disease. <\/span><\/b><span data-contrast=\"auto\">Empirical therapy for suspected meningococcal disease should include an extended-spectrum cephalosporin, such as cefotaxime or ceftriaxone.<\/span><span data-contrast=\"auto\"> Ascertain susceptibility of <\/span><i><span data-contrast=\"auto\">N. meningitidis<\/span><\/i><span data-contrast=\"auto\"> isolates<\/span><span data-contrast=\"auto\"> to penicillin before using penicillin or ampicillin <\/span><a href=\"https:\/\/www.cdc.gov\/meningococcal\/surveillance\/index.html\"><span data-contrast=\"none\">for treatment<\/span><\/a><span data-contrast=\"auto\">.<\/span><span data-ccp-props=\"{&quot;134233118&quot;:false,&quot;201341983&quot;:0,&quot;335559739&quot;:0,&quot;335559740&quot;:240}\">\u00a0<\/span><\/li>\n<\/ul>\n<ul>\n<li data-leveltext=\"\uf0b7\" data-font=\"Symbol\" data-listid=\"10\" data-list-defn-props=\"{&quot;335552541&quot;:1,&quot;335559683&quot;:0,&quot;335559684&quot;:-2,&quot;335559685&quot;:720,&quot;335559991&quot;:360,&quot;469769226&quot;:&quot;Symbol&quot;,&quot;469769242&quot;:[8226],&quot;469777803&quot;:&quot;left&quot;,&quot;469777804&quot;:&quot;\uf0b7&quot;,&quot;469777815&quot;:&quot;hybridMultilevel&quot;}\" data-aria-posinset=\"4\" data-aria-level=\"1\"><b><span data-contrast=\"auto\">Health care providers in <\/span><\/b><a href=\"https:\/\/www.vdh.virginia.gov\/content\/uploads\/2020\/05\/Locality-to-HD-to-HPR.pdf\"><b><span data-contrast=\"none\">northern Virginia<\/span><\/b><\/a><b><span data-contrast=\"auto\"> should suspend use of ciprofloxacin as post-exposure prophylaxis (PEP)<\/span><\/b><span data-contrast=\"auto\"> to prevent PEP failure in contacts. <\/span><a href=\"https:\/\/www.cdc.gov\/mmwr\/volumes\/73\/wr\/mm7305a2.htm#B1_down\"><span data-contrast=\"none\">Alternative PEP options<\/span><\/a><span data-contrast=\"auto\"> for northern Virginia include rifampin, ceftriaxone, or azithromycin.<\/span><span data-ccp-props=\"{&quot;134233118&quot;:false,&quot;201341983&quot;:0,&quot;335559739&quot;:0,&quot;335559740&quot;:240}\">\u00a0<\/span><\/li>\n<\/ul>\n<ul>\n<li data-leveltext=\"\uf0b7\" data-font=\"Symbol\" data-listid=\"10\" data-list-defn-props=\"{&quot;335552541&quot;:1,&quot;335559683&quot;:0,&quot;335559684&quot;:-2,&quot;335559685&quot;:720,&quot;335559991&quot;:360,&quot;469769226&quot;:&quot;Symbol&quot;,&quot;469769242&quot;:[8226],&quot;469777803&quot;:&quot;left&quot;,&quot;469777804&quot;:&quot;\uf0b7&quot;,&quot;469777815&quot;:&quot;hybridMultilevel&quot;}\" data-aria-posinset=\"5\" data-aria-level=\"1\"><b><span data-contrast=\"auto\">Ensure that all patients who are at increased risk for meningococcal disease are up to date on MenACWY vaccine.<\/span><\/b> <span data-contrast=\"none\">People at <\/span><span data-contrast=\"auto\">increased risk<\/span><span data-contrast=\"none\"> due to <\/span><a href=\"https:\/\/www.cdc.gov\/meningococcal\/about\/risk-factors.html#conditions\"><span data-contrast=\"none\">certain medical conditions<\/span><\/a><span data-contrast=\"none\"> include: people with HIV, those whose spleen is damaged or removed, people with sickle cell disease, anyone with a rare immune condition called complement deficiency, or people taking complement inhibitors. <\/span><span data-contrast=\"auto\">A MenACWY booster is recommended every five years for people with increased risk due to medical conditions. <\/span><span data-ccp-props=\"{&quot;134233118&quot;:false,&quot;201341983&quot;:0,&quot;335559739&quot;:0,&quot;335559740&quot;:240}\">\u00a0<\/span><\/li>\n<\/ul>\n<ul>\n<li data-leveltext=\"\uf0b7\" data-font=\"Symbol\" data-listid=\"10\" data-list-defn-props=\"{&quot;335552541&quot;:1,&quot;335559683&quot;:0,&quot;335559684&quot;:-2,&quot;335559685&quot;:720,&quot;335559991&quot;:360,&quot;469769226&quot;:&quot;Symbol&quot;,&quot;469769242&quot;:[8226],&quot;469777803&quot;:&quot;left&quot;,&quot;469777804&quot;:&quot;\uf0b7&quot;,&quot;469777815&quot;:&quot;hybridMultilevel&quot;}\" data-aria-posinset=\"6\" data-aria-level=\"1\"><b><span data-contrast=\"auto\">Continue to encourage <\/span><\/b><a href=\"https:\/\/www.vdh.virginia.gov\/immunization\/immunization-manual\/acip\/\"><b><span data-contrast=\"none\">routine administration<\/span><\/b><\/a><b><span data-contrast=\"auto\"> of MenACWY vaccine in adolescents. <\/span><\/b><span data-contrast=\"auto\">As a reminder, <\/span><span data-contrast=\"auto\">a dose of MenACWY vaccine is <\/span><a href=\"https:\/\/www.vdh.virginia.gov\/immunization\/requirements\/\"><span data-contrast=\"none\">required<\/span><\/a><span data-contrast=\"auto\"> for students prior to 7th and 12th grade.<\/span><span data-ccp-props=\"{&quot;134233118&quot;:false,&quot;201341983&quot;:0,&quot;335559739&quot;:0,&quot;335559740&quot;:240}\">\u00a0<\/span><\/li>\n<\/ul>\n<p><span style=\"text-decoration: underline;\">Situation Updates:<\/span><\/p>\n<p><span data-contrast=\"auto\">From June 2022 to March <\/span><span data-contrast=\"auto\">2024<\/span><span data-contrast=\"auto\">, <\/span><span data-contrast=\"auto\">36 <\/span><a href=\"https:\/\/www.vdh.virginia.gov\/surveillance-and-investigation\/meningococcal-disease-outbreak-response\/\"><span data-contrast=\"none\">outbreak-associated cases<\/span><\/a><span data-contrast=\"auto\"> of <\/span><i><span data-contrast=\"auto\">N. meningitidis <\/span><\/i><span data-contrast=\"auto\">serogroup Y<\/span><span data-contrast=\"auto\">, including seven deaths, have been reported in Virginia. All isolates available for sequencing (34\/36) were found to be the same strain and highly genetically related (specifically, sequence type 1466 within clonal complex 174).<\/span> <span data-contrast=\"none\">This strain is susceptible to ciprofloxacin and penicillin and is known to be contributing to a <\/span><a href=\"https:\/\/emergency.cdc.gov\/han\/2024\/han00505.asp?ACSTrackingID=USCDC_511-DM125473&amp;ACSTrackingLabel=HAN%20505%20-%20General%20Public&amp;deliveryName=USCDC_511-DM125473\"><span data-contrast=\"none\">nationwide increase in meningococcal disease<\/span><\/a><span data-contrast=\"none\">. <\/span><span data-contrast=\"auto\">Populations disproportionately affected by this outbreak include Black or African American adults 30-60 years of age and adults with HIV. The majority of case-patients (67%; 24\/36) developed septicemia, with common symptoms including fever, nausea, vomiting, diarrhea, muscle aches, and altered mental status. Ninety-seven percent (35\/36) of case-patients were unvaccinated for serogroup Y.\u00a0\u00a0<\/span><span data-ccp-props=\"{&quot;201341983&quot;:0,&quot;335559740&quot;:240}\">\u00a0<\/span><\/p>\n<p><span data-contrast=\"auto\">Additionally, c<\/span><span data-contrast=\"auto\">ases of meningococcal disease caused by ciprofloxacin and penicillin-resistant <\/span><i><span data-contrast=\"auto\">N. meningitidis<\/span><\/i><span data-contrast=\"auto\"> serogroup Y continue to be detected sporadically in northern Virginia. As such, VDH is advising local health departments and providers in northern Virginia to suspend the use of ciprofloxacin as PEP to prevent prophylaxis failure in known contacts. <\/span><span data-contrast=\"auto\">VDH will continue to monitor<\/span><span data-contrast=\"auto\"> antibiotic resistance patterns of <\/span><i><span data-contrast=\"auto\">N. meningitidis<\/span><\/i><span data-contrast=\"auto\"> isolates in Virginia through surveillance and healthcare provider reporting of prophylaxis failures; this information will be used to guide future updates to PEP recommendations for meningococcal disease.<\/span><span data-ccp-props=\"{&quot;201341983&quot;:0,&quot;335559740&quot;:240}\">\u00a0<\/span><\/p>\n<p><span data-contrast=\"auto\">VDH remains dedicated to increasing access to meningococcal conjugate vaccine (MenACWY), which provides protection against serogroup Y, and asks for your help in doing so. Contact your <\/span><a href=\"https:\/\/www.vdh.virginia.gov\/local-health-districts\/\"><span data-contrast=\"none\">local health department<\/span><\/a><span data-contrast=\"auto\"> if you have questions about accessing MenACWY vaccine for eligible patients. <\/span><span data-ccp-props=\"{&quot;201341983&quot;:0,&quot;335559740&quot;:240}\">\u00a0<\/span><\/p>\n<p><span data-contrast=\"auto\">Thank you for your attention and cooperation.<\/span><span data-ccp-props=\"{&quot;201341983&quot;:0,&quot;335559740&quot;:240}\">\u00a0<\/span><\/p>\n<p>&nbsp;<\/p>\n<p><span data-contrast=\"auto\">Sincerely,<\/span><span data-ccp-props=\"{&quot;201341983&quot;:0,&quot;335559740&quot;:240}\">\u00a0<\/span><\/p>\n<p><span data-contrast=\"auto\">Karen Shelton, MD<\/span><span data-ccp-props=\"{&quot;201341983&quot;:0,&quot;335559740&quot;:276}\">\u00a0<\/span><\/p>\n<p><span data-contrast=\"auto\">State Health Commissioner<\/span><span data-ccp-props=\"{&quot;201341983&quot;:0,&quot;335559740&quot;:276}\">\u00a0<\/span><\/p>\n","protected":false},"excerpt":{"rendered":"<p>Increase in Meningococcal Disease: Ongoing Statewide Outbreak and Local Detections of a Separate Antibiotic Resistant Strain\u00a0 April 11, 2024\u00a0 Dear Colleague:\u00a0 The Virginia Department of Health (VDH) is reporting an increase in meningococcal disease activity. VDH continues to respond to the ongoing statewide outbreak caused by Neisseria meningitidis serogroup Y. Additionally, cases from a separate [&hellip;]<\/p>\n","protected":false},"author":510,"featured_media":0,"parent":25,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"_lmt_disableupdate":"no","_lmt_disable":"","footnotes":""},"tags":[],"class_list":["post-2269","page","type-page","status-publish","hentry"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.4 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>Increase in Meningococcal Disease: Ongoing Statewide Outbreak and Local Detections of a Separate Antibiotic Resistant Strain - Clinicians<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/www.vdh.virginia.gov\/clinicians\/clinician-letters\/increase-in-meningococcal-disease-ongoing-statewide-outbreak-and-local-detections-of-a-separate-antibiotic-resistant-strain\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Increase in Meningococcal Disease: Ongoing Statewide Outbreak and Local Detections of a Separate Antibiotic Resistant Strain - Clinicians\" \/>\n<meta property=\"og:description\" content=\"Increase in Meningococcal Disease: Ongoing Statewide Outbreak and Local Detections of a Separate Antibiotic Resistant Strain\u00a0 April 11, 2024\u00a0 Dear Colleague:\u00a0 The Virginia Department of Health (VDH) is reporting an increase in meningococcal disease activity. VDH continues to respond to the ongoing statewide outbreak caused by Neisseria meningitidis serogroup Y. Additionally, cases from a separate [&hellip;]\" \/>\n<meta property=\"og:url\" content=\"https:\/\/www.vdh.virginia.gov\/clinicians\/clinician-letters\/increase-in-meningococcal-disease-ongoing-statewide-outbreak-and-local-detections-of-a-separate-antibiotic-resistant-strain\/\" \/>\n<meta property=\"og:site_name\" content=\"Clinicians\" \/>\n<meta property=\"article:modified_time\" content=\"2026-01-21T14:02:31+00:00\" \/>\n<meta property=\"og:image\" content=\"https:\/\/www.vdh.virginia.gov\/content\/uploads\/sites\/134\/Letterhead_Shelton.png\" \/>\n\t<meta property=\"og:image:width\" content=\"2344\" \/>\n\t<meta property=\"og:image:height\" content=\"873\" \/>\n\t<meta property=\"og:image:type\" content=\"image\/png\" \/>\n<meta name=\"twitter:card\" content=\"summary_large_image\" \/>\n<meta name=\"twitter:label1\" content=\"Est. reading time\" \/>\n\t<meta name=\"twitter:data1\" content=\"4 minutes\" \/>\n<script type=\"application\/ld+json\" class=\"yoast-schema-graph\">{\"@context\":\"https:\\\/\\\/schema.org\",\"@graph\":[{\"@type\":\"WebPage\",\"@id\":\"https:\\\/\\\/www.vdh.virginia.gov\\\/clinicians\\\/clinician-letters\\\/increase-in-meningococcal-disease-ongoing-statewide-outbreak-and-local-detections-of-a-separate-antibiotic-resistant-strain\\\/\",\"url\":\"https:\\\/\\\/www.vdh.virginia.gov\\\/clinicians\\\/clinician-letters\\\/increase-in-meningococcal-disease-ongoing-statewide-outbreak-and-local-detections-of-a-separate-antibiotic-resistant-strain\\\/\",\"name\":\"Increase in Meningococcal Disease: Ongoing Statewide Outbreak and Local Detections of a Separate Antibiotic Resistant Strain - 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