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Infection

, Volume 22, Issue 2, pp 69–71 | Cite as

First recorded outbreaks of meningococcal disease in the Israel Defence Force: Three clusters due to serogroup C and the emergence of resistance to rifampicin

  • R. Almog
  • M. Gdalevich
  • B. Lev
  • M. Wiener
  • S. Ashkenazi
  • C. Block
Originalia

Summary

Outbreaks of meningococcal disease were observed for the first time in the Israel Defence Force (I. D. F.) in 1992 and 1993, while in previous years, cases appeared in sporadic fashion. Two episodes in the winter of 1992 involving three and two individuals, respectively, were caused byNeisseria meningitidis group C, which was notypable and nonsubtypable (C:NT:-). Three cases in one event in early 1993 were due to group C:NT:P1.2, the two secondary cases being caused by strains completely resistant to rifampicin. While these outbreaks were small, they should be seen against a background of the emergence of relatively virulent clones of serogroup C which have caused significant outbreaks in several countries. This and the drug resistance problem will require medical decision-makers to review strategies for the prevention of meningococcal disease, taking into account alternative agents for chemoprophylaxis as well as a possible role for vaccination.

Keywords

Internal Medicine Infectious Disease General Practice Drug Resistance Rifampicin 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Ausbrüche von Meningokokkenerkrankungen im israelischen Militär: Erste Dokumentation mit drei Erkrankungsherden durch Serogruppe C und Resistenzentwicklung gegen Rifampicin

Zusammenfassung

In den Jahren 1992 und 1993 wurden erstmals im israelischen Militär Ausbrüche von Meningokokkenerkrankungen beobachtet, vorher waren nur sporadische Fälle aufgetreten. Bei zwei Episoden im Winter 1992 waren drei beziehungsweise zwei Personen betroffen. Der Erreger warNeisseria meningitidis Gruppe C; die Isolate waren nicht typisierbar oder subtypisierbar (C : NT :-). Drei Fälle, die Anfang 1993 auftraten, wurden durch Gruppe C : NT : P1.2 verursacht; die beiden sekundären Fälle wurden durch Stämme ausgelöst, die gegen Rifampicin vollständig resistent waren. Wenn diese Ausbrüche auch klein waren, sollte bedacht werden, daß in verschiedenen Ländern relativ virulente Stämme von Serogruppe C auftraten, die umfangreiche Epidemien ausgelöst haben. Aus diesem Grund und wegen des Problems der Antibiotikaresistenz sollten Fachgremien die Strategien für die Prävention der Meningokokkeninfektion neu überdenken und alternative Substanzen für die Chemoprophylaxe einbeziehen sowie die Bedeutung der Impfung berücksichtigen.

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References

  1. 1.
    Sacchi, C. T., Zanella, R. C., Caugant, D. A., Frasch, C. E., Hidalgo, N. T., Milagres, L. G., Pessoa, L. L., Ramos, S. R., Camargo, M. C. C., Melles, C. E. A. Emergence of a new clone of serogroup CNeisseria meningitidis in Sao Paulo, Brazil. J. Clin. Microbiol. 30 (1992) 1282–1286.Google Scholar
  2. 2.
    Ashton, F. E., Ryan, J. A., Borczyk, A., Caugant, D. A., Mancino, L., Huang, D. Emergence of a virulent clone ofNeisseriameningitidis serotype 2a that is associated with meningococcal group C disease in Canada. J. Clin. Microbiol. 29 (1991) 2489–2493.Google Scholar
  3. 3.
    Almog, R., Block, C., Gdalevich, M., Wiener, M., Lev, B., Ashkenazi, S. Two outbreaks of meningococcal disease: an unusual event in the I. D. F. Public Health Rev. 18 (1991) 364 (Abstract).Google Scholar
  4. 4.
    Yagupsky, P., Ashkenazi, S., Block, C. Rifampicin-resistant meningococci causing invasive disease and failure of chemoprophylaxis. Lancet 341 (1993) 1152–1153.Google Scholar
  5. 5.
    Brundage, J. F., Zollinger, W. D. Evolution of meningococcal disease epidemiology in the U. S. Army. In:Vedros, N. A. (ed.): Evolution of meningococcal disease, C. R. C. Press, Boca Raton, Florida 1987, pp. 5–25.Google Scholar
  6. 6.
    Wehrli, W. Rifampin: mechanisms of action and resistance. Rev. Infect. Dis. 5 (suppl. 3) (1983) S407-S411.Google Scholar
  7. 7.
    Stroffolini, T. Vaccination campaign against meningococcal disease in army recruits in Italy. Epidemiol. Infect. 105 (1990) 579–583.Google Scholar
  8. 8.
    Masterton, R. G., Youngs, E. R., Wardle, J. C., Croft, K. F., Jones, D. M. Control of an outbreak of group C meningococcal meningitis with a polysaccharide vaccine. J. Infect. 17 (1988) 177–182.Google Scholar
  9. 9.
    Thomas, J. C., Bendana, N. S., Waterman, S. H., Rathbun, M., Arakere, G., Frasch, C. E., Wenger, J. D., Magsombol, V., Clark, J. H. Risk factors for carriage of meningococcus in the Los Angeles County men's jail system. Am. J. Epidemiol. 133 (1991) 286–295.Google Scholar
  10. 10.
    Samuelsson, S., Gustavsen, S., Ronne, T. Epidemiology of meningococcal disease in Denmark. Scand. J. Infect. Dis. 23 (1991) 723–730.Google Scholar
  11. 11.
    Harrison, L. H., Armstrong, C. W., Jenkins, S. R., Harmon, M. W., Ajello, G. W., Miller, G. B. J., Broome, C. V. A cluster of meningococcal disease on a school bus following epidemic influenza. Arch. Intern. Med. 151 (1991) 1005–1009.Google Scholar
  12. 12.
    Block, C., Roitman, M., Bogkokowsky, B., Meizlin, S., Slater P. E. Forty years of meningococcal disease in Israel. Clin. Infect. Dis. 17 (1993) 126–132.Google Scholar
  13. 13.
    Hubert, B., Watier, L., Garnerin, P., Richardson, S. Meningococcal disease and influenza-like syndrome: a new approach to an old question. J. Infect. Dis. 166 (1992) 542–545.Google Scholar
  14. 14.
    Cartwright, K. A., Jones, D. M., Smith, A. J., Stuart, J. M., Kaczmarski, E. B., Palmer, S. R. Influenza A and meningococcal disease. Lancet 338 (1991) 554–557.Google Scholar
  15. 15.
    Judson, F. N., Ehret, J. M. Single dose ceftriaxone to eradicate pharyngealNeisseria meningitidis. Lancet ii (1984) 1462–1463.Google Scholar
  16. 16.
    Gaunt, P. M., Lambert, B. E. Single dose ciprofloxacin for the eradication of pharyngeal carriage ofNeisseria meningitidis. J. Antimicrob. Chemother. 21 (1988) 489–496.Google Scholar

Copyright information

© MMV Medizin Verlag GmbH München 1994

Authors and Affiliations

  • R. Almog
    • 1
  • M. Gdalevich
    • 1
  • B. Lev
    • 1
  • M. Wiener
    • 1
  • S. Ashkenazi
    • 1
  • C. Block
    • 2
  1. 1.Medical CorpsIsrael Defence ForcePetah Tiqva
  2. 2.Clinical Microbiology UnitHadasseh HospitalJerusalemIsrael

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