Wisconsin DHS Health Alert #60: Ciprofloxacin-Resistant Meningococcal Disease Cases in Wisconsin

Wisconsin Department of Health Services sent this bulletin at 09/18/2024 10:31 AM CDT
Wisconsin Department of Health Services

DHS Health Alert Network

Wisconsin DHS Health Alert #60: Ciprofloxacin-Resistant Meningococcal Disease Cases in Wisconsin 

Bureau of Communicable Diseases 

September 18, 2024 

Key points 

  • Wisconsin is experiencing an increase in meningococcal disease cases with six cases reported in 2024, five of which have been reported since June.
  • Of the cases of meningococcal disease reported, at least two cases have been resistant to the antibiotic ciprofloxacin. 
  • The Wisconsin Department of Health Services (DHS) encourages clinicians to be alert for signs and symptoms of meningitis and bacteremia. Health care providers should suspect meningococcal disease in ill and rapidly worsening patients.
  • Health care providers should not prescribe ciprofloxacin to prevent meningococcal disease in close contacts of people with invasive meningococcal disease. Instead, providers should prescribe rifampin or ceftriaxone in accordance with CDC recommended chemoprophylaxis regimens for high-risk contacts. 

Background 

Wisconsin is experiencing an increase of meningococcal disease cases. Five of the six cases reported in 2024 have been reported since June with several being detected in eastern Wisconsin. Of the cases reported, at least two have been resistant to the antibiotic ciprofloxacin. More bacteremia and less meningitis than usual have also been reported among patients with cipro-resistant meningococcal disease.  

Additionally, some of the recent cases in eastern Wisconsin have been serogroup Y. These cases may be part of the increase in meningococcal Y disease being reported across the United States. The CDC (Center for Disease Control and Prevention) issued a Health Alert Network (HAN) notification about the increasing trend in meningococcal Y cases in March 2024.  

Meningococcal bacteria are spread from person to person through saliva, for example, when coughing or kissing. The bacteria can spread to people who’ve had close or lengthy contact with someone who has meningococcal disease. Close contact also includes sharing items that come in contact with the mouth (water bottles, eating utensils, lip balm, cigarettes, and smoking materials).

People don’t catch the bacteria through casual contact or by breathing air where someone with meningococcal disease has been. Sometimes the bacteria can spread to people who spend a long time in the same space together, such as roommates.

Recommendations  

Clinicians should be alert for signs and symptoms of both meningitis and bacteremia and suspect meningococcal disease in ill and rapidly worsening patients.  

  • Meningitis causes fever, headache, stiff neck, vomiting, photophobia, and/or altered mental status. 
  • Bacteremia does not usually cause headache and stiff neck. Instead, bacteremia causes more non-specific symptoms such as fever, chills, fatigue, vomiting, cold hands and feet, severe aches and pains, rapid breathing, and diarrhea.

For ill and worsening patients suspected to have meningococcal disease: 

  •  Prompt treatment is critical. Immediately start antibiotics in accordance with the CDC Clinical Guidance for Meningococcal Disease. 
  • Order gram stain, culture, and polymerase chain reaction (PCR) testing on blood and cerebrospinal fluid (CSF) and/or other usually sterile fluids (not urine or sputum).
    • If CSF suggests bacterial meningitis or blood or CSF show gram-negative diplococci: 
      • Report the results immediately by telephone to the patient’s local health department upon identification of a confirmed or suspected case. The local health department shall then notify the state epidemiologist immediately of any confirmed or suspected cases. Submit a case report within 24 hours either electronically through the Wisconsin Electronic Disease Surveillance System (WEDSS), by mail, for fax using the Acute and Communicable Disease Case Report, F44151 (Word), or by other means.  
  • If culture grows Neisseria meningitidis:
    • Send an isolate to the Wisconsin State Laboratory of Hygiene (WSLH) for sensitivities and serotyping*.
    • Contact WSLH at 800-862-1013 with questions.

*We understand some facilities use refence laboratories for testing. DHS is requesting that an additional isolate be sent to WSLH to save time and avoid needing to request specimens from out of state reference labs. Isolates sent to reference labs can also be lost, discarded, or become non-viable during the process. Additionally, reference labs usually do not perform the necessary serotyping. 

To prevent the spread of meningococcal disease:

Further information regarding meningococcal vaccines, disease and case reporting can be found on the DHS website.  

Sincerely,
Sheryl A. Bedno, MD, DrPH, FACOEM (she/her/hers)
Chief Medical Officer and State Epidemiologist
Bureau of Environmental and Occupational Health 
Division of Public Health
Wisconsin Department of Health Services

 Questions 

Questions regarding this health alert may be directed to the Bureau of Communicable Disease at dhsdphbcd@dhs.wisconsin.gov.