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Clinicians should be alert for invasive serogroup Y meningococcal disease in at-risk populations and those with unusual symptoms amid the highest annual number of cases reported since 2014, according to a .

Sequence type (ST) 1466, a strain of Neisseria meningitidis serogroup Y, is fueling the majority of cases seen so far this year. Notably, a large percentage of cases have not presented with symptoms of meningitis, such as headache and stiff neck. Of cases reported in 2023, 64% presented with bacteremia and at least 4% presented with septic arthritis.

Another key feature of the ST 1466 strain is that it is disproportionately affecting people ages 30 to 60 years, Black or African American people, and those living with HIV, the CDC advisory emphasized.

Alarmingly, the case fatality rate among patients infected with the ST 1466 strain is 18% -- far higher than the 11% case fatality rate reported for serogroup Y in earlier years.

In 2023, 422 cases of invasive serogroup Y meningococcal disease were reported in the U.S. As of March 25, 143 cases had already been reported for 2024, a dramatic increase over the 81 cases reported at the same time last year. In 2023, ST 1466 was responsible for 68% of cases of serogroup Y meningococcal disease reported to the CDC. In the U.S., the B, C, W, and Y N. meningitidis serogroups cause most cases of meningococcal disease.

To date, ST 1466 isolates have been susceptible to all first-line antibiotics recommended for prophylaxis and treatment. This is in contrast to circulating ciprofloxacin-resistant serogroup Y strains, which have disproportionately affected Hispanic people.

The CDC recommended that clinicians should have a heightened suspicion for meningococcal disease, particularly among populations disproportionately affected by the current increase and be aware that patients may present with atypical symptoms not indicative of meningitis. Blood and cerebrospinal fluid cultures should be obtained in those with suspected meningococcal disease.

Clinicians should also ensure that people in whom the meningococcal vaccine is recommended are up to date on the vaccine. The that all kids ages 11 to 12 years receive the MenACWY vaccine and a booster at age 16. People at increased risk for the disease, such as those with HIV, should receive a two-dose primary MenACWY series, with booster doses every 3 to 5 years, depending on age.

Clinicians should also immediately notify health departments if invasive meningococcal disease is suspected or confirmed. State and local health departments can answer questions about treatment and contact prophylaxis based on local resistance patterns.

Public health departments should make efforts to alert clinicians to the risk for invasive meningococcal disease among Black or African-American people and those ages 30 to 60 years. Health departments should submit all meningococcal isolates to the CDC to test for antimicrobial resistance and whole-genome sequencing.

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