MENINGOCOCCAL DISEASE CLUSTER – LOS ANGELES COUNTY – UPDATE 4/27/11

FYI – in case you didn’t receive it. If you did then please pardon me for duplication.

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For your information, the e-mail below from Dr. David Dassey, is being is being sent to you for your information as you provide services in the area of Skid Row.

Dear colleagues,

On 30 March 11, I informed you of a cluster of 3 cases of meningococcal disease in Los Angeles County, two of which were associated with the same downtown homeless shelter. An advisory was sent to key providers in every Los Angeles area hospital and the Sheriff’s Medical Program asking for increased surveillance for this disease. Thru 08 April 11 we confirmed 7 cases of meningococcal disease, of which 6 were serotype C; 4 of the 6 had a matching molecular subtype and were linked epidemiologically to the homeless. The remaining 2 cases with serotype C carried a different molecular subtype. The seventh case was due to serotype Y. Two cases died.

Since 26 April 11, we have received 3 new reports of meningococcal disease. Serotype and subtype information will not be available until the isolates can be processed in the Public Health Laboratory. One of the new cases is a male who resides in low-income housing in downtown Los Angeles. The other 2 new cases reside in Torrance and  Carson; gathering of epidemiological information is in progress. All three cases are still being treated in hospital and are likely to survive.

Therefore the following updated advisory is being sent to emergency departments, infection preventionists, and laboratory directors at all acute care hospitals in Los Angeles County, again asking that they keep a high index of suspicion for this disease, and to alert us quickly of any suspected or confirmed cases.

You may speak to Dr Mascola or me if you have any questions.

This is an update to a Public Health Advisory dated 30 Mar 2011 on meningococcal disease in Los Angeles County.

Since mid March, the Los Angeles County Department of Public Health has now identified a total of 10 cases of meningococcal disease (meningococcal meningitis or meningococcemia).

A cluster of 4 cases with serotype C infection was detected among persons associated with the downtown [skid row] region of Los Angeles; the isolates from these cases matched by both serotype and molecular methods. Two other cases with serotype C infection with a different molecular pattern were not linked epidemiologically to each other. The seventh case had infection with serotype Y. Two of the earlier cases died.

Since 27 April 11, 3 additional cases of meningococcal disease have been confirmed, including another case who lives in the downtown area and has contacts among the homeless. Collection of epidemiological information on the other 2 new cases is in progress. Serotype and molecular subtype information on these three newest cases will not be available for several days.
Public Health is again requesting all health care providers to have a high index of suspicion for this disease, and to report any suspected cases of meningococcal disease immediately to the Los Angeles County Acute Communicable Disease Control Program at 213-240-7941*. Prompt reporting of suspect cases is vital to prevent secondary spread.

Patients may present with acute onset of fever, headache, nausea, vomiting, lethargy, irritability and stiff neck (in those with meningitis) or petecchial rash or purpura in those with bloodstream infection (meningococcemia). Delirium and coma are not uncommon and fulminate cases may present with ecchymosis and shock.

DO NOTwait for laboratory confirmation of blood and cerebral spinal fluid (CSF) gram stain and culture before reporting a suspected case.

For patients with a clinically compatible presentation for meningococcal disease, but without laboratory confirmation of Neisseria meningitidis, healthcare providers should instruct their laboratory to send the specimens (e.g. blood and CSF) to the Los Angeles County Public Health Laboratory for further testing.

Because of the cluster of cases associated with downtown exposure, healthcare providers should make a specific, detailed inquiry as to where the patient has been living (e.g. residential home, shelter, on the streets, jail). Physicians should have a lower threshold for the consideration of bacterial meningitis or meningococcemia in homeless individuals, those who have been recently incarcerated, or those who may have had contact with these populations.

Meningococcal disease is transmitted via direct contact or droplet spread with an infected person’s oral secretions. When assessing a patient for possible meningococcal disease, staff should follow droplet precautions in addition to standard precautions until 24 hours after the start of antibiotic therapy.

Prophylaxis is indicated for household members, others who frequently eat or sleep in the same dwelling, and anyone having direct or close contact with the case during the 7 days prior to onset of illness. Public Health takes responsibility for identifying contacts and providing prophylaxis to these individuals.
*For cases among residents of the Cities of Long Beach or Pasadena, call the Long Beach City Health Department (562-570-4302) or the Pasadena City Health Department (626-744-6000).
David E. Dassey MD, MPH
Deputy Chief, Acute Communicable Disease Control
Los Angeles County Department of Public Health
313 N. Figueroa St. #212
Los Angeles, CA 90012
213.240.7941
213.482.4856 Fax
ddassey@ph.lacounty.gov

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