CDC sounds alarm on rising cases of meningococcal disease with atypical presentation

Late last month, the Centers for Disease Control and Prevention (CDC) issued a health advisory alerting healthcare providers of an increase in invasive meningococcal disease. According to the agency, the increase is mainly due to Neisseria meningitidis serogroup Y, which is often caused by a specific strain of meningococcal disease called sequence type (ST) 1466.^[]

Cases are disproportionately increasing for adults between ages of 30 through 60, as well as for Black people and people with HIV. Further, some patients are displaying symptoms not commonly associated with invasive meningococcal disease, such as septic arthritis.^[] 

Now, the CDC is urging doctors to be on alert for potential meningococcal cases with atypical symptom presentations.

Incident and fatality rates climbing 

In 2023, the US recorded 422 cases of invasive meningococcal disease—its largest annual report since 2014. Of 94 patients with known outcomes,17 patients, or 18%, died, according to the CDC. That number was higher than the historical case fatality rate of 11% reported for serogroup Y cases reported from 2017 to 2021.

This year, rates in the first few months of 2024 are already higher than this time last year, suggesting that the country could be on track to beat the previous record. From January 1 to March 25, 2025, a total of 143 cases were reported to the CDC—62 more cases than reported this time last year.

Still, as exemplified by the percentages, the disease is not always fatal. Erica Susky, a certified infection control practitioner and instructor at  Infection Prevention and Control (IPAC) Canada, tells MDLinx that serious infections are not common across all groups and that some people can carry N. meningitidis without symptoms. 

“Though serious infections are less common, there are still groups at higher risk, as the bacterium is carried by many people in their respiratory tracts, and is thus able to spread from person to person,” Susky says.

As a refresher: Meningococcal disease can be spread through respiratory droplets of people who carry the specific bacteria, although transmission is more likely through close-contact like coughing and kissing than breathing, according to the CDC.

Serogroup Y’s disproportionate impact

Reports show that this strain is disproportionately striking adults ages 30 through 60, people who are Black or African American, and people with HIV.

Not separating for strain, meningococcal disease in the US has historically presented the highest rates in children younger than 1 year old, followed by children and young adults ages 16 through 23 years old, according to the CDC.^[]

“Young children, adolescents or young adults, immune-compromised people, and those living in close quarters,” like people in the military or those living in university dormitories, prisons, and shelters, can also be at higher risk of developing the disease, Susky says.

Meningococcal disease signs and symptoms

Invasive meningococcal disease is a disease that can be caused by 12 different serogroups of the bacteria N. meningitidis. Usually, cases present with symptoms of meningitis or as meningococcal bloodstream infection, though current reports show different symptoms that doctors should be mindful of.^[]

If presenting like meningitis, invasive meningococcal disease has been seen to cause symptoms like:

• Fever

• Headache

• Stiff neck

• Nausea

• Vomiting

• Photophobia

• Altered mental status

If presenting like meningococcal bloodstream infection, meningococcal disease has been seen to cause symptoms like:

• Fever and chills

• Fatigue

• Vomiting

• Cold hands and feet

• Severe aches and pains

• Rapid breathing

• Diarrhea

• A dark purple rash (in later stages)

The CDC warns that, “[w]hile initial symptoms of meningococcal disease can at first be non-specific, they worsen rapidly, and the disease can become life-threatening within hours.”

How to protect against invasive meningococcal disease

To treat this fast-paced disease, immediate antibiotic treatment is critical. For patients, Susky points to the importance of public health measures.

“People should practice cough etiquette and wash their hands frequently”—and stay home and mask up if they feel ill and have a cough—Susky says. “This is because the bacterium colonizes the oropharynx and can spread via the droplet route from coughs and sneezes,” she adds.

CDC advice for responding to the spread

To diagnose and catch cases, the CDC is asking doctors to heighten their suspicion for meningococcal disease and unusual presentations of the illness. The agency is also encouraging providers to:

1. Be increasingly on guard for meningococcal disease, particularly among those disproportionately affected by the current increase, including Black and African American adults and people with HIV. (Providers should remember, however, that anyone can contract the disease.)

2. Note that this strain can cause different symptoms than are seen in typical meningitis,  such as bacteremia and septic arthritis.

3. Ensure that people who are recommended to get the meningococcal vaccination are up to date on their vaccine.

4. Start people with suspected meningococcal disease on immediate antibiotic treatment

5. Notify health departments of any suspected or confirmed cases of invasive meningococcal disease.