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Although most invasive meningococcal disease (IMD) cases are sporadic without identified transmission links, outbreaks can occur. We report three cases caused by meningococcus B (MenB) at a Belgian nursery school over 9 months. The first two cases of IMD occurred in spring and summer 2018 in healthy children (aged 3–5 years) attending the same classroom. Chemoprophylaxis was given to close contacts of both cases following regional guidelines. The third case, a healthy child of similar age in the same class as a sibling of one case, developed disease in late 2018. Microbiological analyses revealed MenB with identical finetype clonal complex 269 for Case 1 and 3 (unavailable for Case 2). Antimicrobial susceptibility testing revealed no antibiotic resistance. Following Case 3, after multidisciplinary discussion, chemoprophylaxis and 4CMenB (Bexsero) vaccination were offered to close contacts. In the 12-month follow-up of Case 3, no additional cases were reported by the school. IMD outbreaks are difficult to manage and generate public anxiety, particularly in the case of an ongoing cluster, despite contact tracing and management. This outbreak resulted in the addition of MenB vaccination to close contacts in Wallonian regional guidelines, highlighting the potential need and added value of vaccination in outbreak management.


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  1. Nuttens C, Findlow J, Balmer P, Swerdlow DL, Tin Tin Htar M. Evolution of invasive meningococcal disease epidemiology in Europe, 2008 to 2017. Euro Surveill. 2022;27(3):2002075.  https://doi.org/10.2807/1560-7917.ES.2022.27.3.2002075  PMID: 35057902 
  2. Edmond K, Clark A, Korczak VS, Sanderson C, Griffiths UK, Rudan I. Global and regional risk of disabling sequelae from bacterial meningitis: a systematic review and meta-analysis. Lancet Infect Dis. 2010;10(5):317-28.  https://doi.org/10.1016/S1473-3099(10)70048-7  PMID: 20417414 
  3. Olbrich KJ, Müller D, Schumacher S, Beck E, Meszaros K, Koerber F. Systematic review of invasive meningococcal disease: sequelae and quality of life impact on patients and their caregivers. Infect Dis Ther. 2018;7(4):421-38.  https://doi.org/10.1007/s40121-018-0213-2  PMID: 30267220 
  4. Schiess N, Groce NE, Dua T. The impact and burden of neurological sequelae following bacterial meningitis: a narrative review. Microorganisms. 2021;9(5):900.  https://doi.org/10.3390/microorganisms9050900  PMID: 33922381 
  5. World Health Organization (WHO). Meningitis. Geneva: WHO; 28 Sep 2021. Available from: https://www.who.int/news-room/fact-sheets/detail/meningitis
  6. Jacquinet S, Mattheus W, Lajot A, Wyndham-Thomas C. Epidemiological surveillance of invasive meningococcal diseases - 2019. Brussels: Sciensano; 2020. Available from: https://www.sciensano.be/sites/default/files/epidemiologische_surveillance_van_invasieve_meningokokkeninfecties_-_2019_1.pdf
  7. Hoebe CJ, de Melker H, Spanjaard L, Dankert J, Nagelkerke N. Space-time cluster analysis of invasive meningococcal disease. Emerg Infect Dis. 2004;10(9):1621-6.  https://doi.org/10.3201/eid1009.030992  PMID: 15498165 
  8. Gobin M, Hughes G, Foulkes S, Bagnall H, Trindall A, Decraene V, et al. The epidemiology and management of clusters of invasive meningococcal disease in England, 2010-15. J Public Health (Oxf). 2020;42(1):e58-65. https://doi.org/10.1093/pubmed/fdz028  PMID: 30942387 
  9. Davison KL, Andrews N, White JM, Ramsay ME, Crowcroft NS, Rushdy AA, et al. Clusters of meningococcal disease in school and preschool settings in England and Wales: what is the risk? Arch Dis Child. 2004;89(3):256-60.  https://doi.org/10.1136/adc.2003.031369  PMID: 14977705 
  10. European Commission. Commission decision of 22 June 2018 2018/945 amending decision 1082/2013/EU on the communicable diseases and related special health issues to be covered by epidemiological surveillance as well as relevant case definition. Official Journal of the European Union. Luxembourg: Publications Office of the European Union. 6.7.2018: L170/30. Available from: https://eur-lex.europa.eu/legal-content/EN/TXT/PDF/?uri=CELEX:32018D0945
  11. Agence pour une vie de qualité (AVIQ). Infections invasives à méningocoques. [Invasive meningococcal infections]. Charleroi: AVIQ; 2016. French. Available from: https://www.wiv-isp.be/matra/Fiches/Meningo.pdf
  12. Agenschap zorg and gezonheid. Richlijn infectieziektebestrijding vlaanderen - meningokokkose - meningokokkenziekte. [Infection control guideline Flanders – mening coccosis -meningococcal disease]. Brussels: Agenschap zorg and gezonheid; 2018. https://www.zorg-en-gezondheid.be/sites/default/files/atoms/files/Meningokokken%20Final_0.pdf
  13. The European Committee on Antimicrobial Susceptibility Testing (EUCAST). Breakpoint tables for interpretation of MICs and zone diameters. Version 8.0. Växjö, EUCAST, 2018. Available from; http://www.eucast.org.
  14. Bogaerts B, Winand R, Fu Q, Van Braekel J, Ceyssens PJ, Mattheus W, et al. Validation of a bioinformatics workflow for routine analysis of whole-genome sequencing data and related challenges for pathogen typing in a european national reference center: Neisseria meningitidis as a proof-of-concept. Front Microbiol. 2019;10:362.  https://doi.org/10.3389/fmicb.2019.00362  PMID: 30894839 
  15. Jolley KA, Bray JE, Maiden MCJ. Open-access bacterial population genomics: BIGSdb software, the PubMLST.org website and their applications. Wellcome Open Res. 2018;3:124.  https://doi.org/10.12688/wellcomeopenres.14826.1  PMID: 30345391 
  16. Bratcher HB, Corton C, Jolley KA, Parkhill J, Maiden MC. A gene-by-gene population genomics platform: de novo assembly, annotation and genealogical analysis of 108 representative Neisseria meningitidis genomes. BMC Genomics. 2014;15(1):1138.  https://doi.org/10.1186/1471-2164-15-1138  PMID: 25523208 
  17. Muzzi A, Brozzi A, Serino L, Bodini M, Abad R, Caugant D, et al. Genetic Meningococcal Antigen Typing System (gMATS): A genotyping tool that predicts 4CMenB strain coverage worldwide. Vaccine. 2019;37(7):991-1000.  https://doi.org/10.1016/j.vaccine.2018.12.061  PMID: 30661831 
  18. Delisle E, Larrieu S, Simões J, Laylle N, De Pommerol M, Taha MK, et al. Community outbreak of group B meningococcal disease in southwest France--December 2008 to September 2009. Euro Surveill. 2010;15(37):19665.  https://doi.org/10.2807/ese.15.37.19665-en  PMID: 20929645 
  19. Rouaud P, Perrocheau A, Taha MK, Sesboué C, Forgues AM, Parent du Châtelet I, et al. Prolonged outbreak of B meningococcal disease in the Seine-Maritime department, France, January 2003 to June 2005. Euro Surveill. 2006;11(7):178-81.  https://doi.org/10.2807/esm.11.07.00635-en  PMID: 16966800 
  20. Soeters HM, Whaley M, Alexander-Scott N, Kanadanian KV, MacNeil JR, Martin SW, et al. Meningococcal carriage evaluation in response to a serogroup B meningococcal disease outbreak and mass vaccination campaign at a college-Rhode Island, 2015-2016. Clin Infect Dis. 2017;64(8):1115-22.  https://doi.org/10.1093/cid/cix091  PMID: 28158417 
  21. McNamara LA, Thomas JD, MacNeil J, Chang HY, Day M, Fisher E, et al. Meningococcal carriage following a vaccination campaign with MenB-4C and MenB-FHbp in response to a university serogroup B meningococcal disease outbreak-Oregon, 2015-2016. J Infect Dis. 2017;216(9):1130-40.  https://doi.org/10.1093/infdis/jix446  PMID: 28968661 
  22. Soeters HM, McNamara LA, Blain AE, Whaley M, MacNeil JR, Hariri S, et al. University-based outbreaks of meningococcal disease caused by serogroup B, United States, 2013-2018. Emerg Infect Dis. 2019;25(3):434-40.  https://doi.org/10.3201/eid2503.181574  PMID: 30789140 
  23. Chatt C, Gajraj R, Hawker J, Neal K, Tahir M, Lawrence M, et al. Four-month outbreak of invasive meningococcal disease caused by a rare serogroup B strain, identified through the use of molecular PorA subtyping, England, 2013. Euro Surveill. 2014;19(44):20949.  https://doi.org/10.2807/1560-7917.ES2014.19.44.20949  PMID: 25394258 
  24. Mbaeyi SA, Blain A, Whaley MJ, Wang X, Cohn AC, MacNeil JR. Epidemiology of meningococcal disease outbreaks in the United States, 2009-2013. Clin Infect Dis. 2019;68(4):580-5.  https://doi.org/10.1093/cid/ciy548  PMID: 29982382 
  25. Zhou J, Lefebvre B, Deng S, Gilca R, Deceuninck G, Law DK, et al. Invasive serogroup B Neisseria meningitidis in Quebec, Canada, 2003 to 2010: persistence of the ST-269 clone since it first emerged in 2003. J Clin Microbiol. 2012;50(5):1545-51.  https://doi.org/10.1128/JCM.06835-11  PMID: 22337990 
  26. Bertrand S, Van Meervenne E, De Baere T, Vanhoof R, Collard JM, Ruckly C, et al. Detection of a geographical and endemic cluster of hyper-invasive meningococcal strains. Microbes Infect. 2011;13(7):684-90.  https://doi.org/10.1016/j.micinf.2011.02.006  PMID: 21376133 
  27. Retchless AC, Chen A, Chang HY, Blain AE, McNamara LA, Mustapha MM, et al. Using Neisseria meningitidis genomic diversity to inform outbreak strain identification. PLoS Pathog. 2021;17(5):e1009586.  https://doi.org/10.1371/journal.ppat.1009586  PMID: 34003852 
  28. McNamara LA, MacNeil JR, Cohn AC, Stephens DS. Mass chemoprophylaxis for control of outbreaks of meningococcal disease. Lancet Infect Dis. 2018;18(9):e272-81.  https://doi.org/10.1016/S1473-3099(18)30124-5  PMID: 29858150 
  29. European Centre for Disease Prevention and Control (ECDC). Public health management of sporadic cases of invasive meningococcal disease and their contacts. Stockholm: ECDC; 2010 https://www.ecdc.europa.eu/sites/default/files/media/en/publications/Publications/1010_GUI_Meningococcal_guidance.pdf
  30. Thabuis A, Tararbit K, Taha M-K, Dejour-Salamanca D, Ronin V, Parent du Chatelet I, et al. Community outbreak of serogroup B invasive meningococcal disease in Beaujolais, France, February to June 2016: from alert to targeted vaccination. Euro Surveill. 2018;23(28).  https://doi.org/10.2807/1560-7917.ES.2018.23.28.1700590  PMID: 30017022 
  31. United States (US) Centers for Disease Control and Prevention (CDC). Guidance for the evaluation and public health management of suspected outbreaks of meningococcal disease. Atlanta: US CDC; 2019. Available from: https://www.cdc.gov/meningococcal/downloads/meningococcal-outbreak-guidance.pdf
  32. Public Health England (PHE). Guidance for public health management of meningococcal disease in the UK. London: PHE; 2019. Available from: https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/829326/PHE_meningo_disease_guideline.pdf
  33. Haut Conseil de la santé publique. Vaccination contre les infections invasives à méningocoque B Place du vaccin Bexsero®. [Vaccination against invasive meningococcal B infections. Place of the Bexsero® vaccine]. Paris: HCSP; 2013. French. Available from: https://www.hcsp.fr/explore.cgi/avisrapportsdomaine?clefr=386
  34. MDCalc. Pediatric SIRS, sepsis, and septic shock criteria. MDCalc. [Accessed: 11 Jan 2021]. https://www.mdcalc.com/pediatric-sirs-sepsis-septic-shock-criteria
  35. Huson DH, Bryant D. Application of phylogenetic networks in evolutionary studies. Mol Biol Evol. 2006;23(2):254-67.  https://doi.org/10.1093/molbev/msj030  PMID: 16221896 

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