A Drexel University undergraduate has died from an infection caused by Neisseria meningitidis. Stephanie Ross, a 19-year-old sophomore, was found unresponsive by housemates on Monday, March 10. She died later that day at Penn Presbyterian Medical Center in Philadelphia.
Caroline Johnson, MD, of the Philadelphia Health Department was quoted as saying that Ross “…had an overwhelming bacterial…infection, and she went into shock, and she had symptoms of diffuse hemorrhaging.” Esther Chernak, MD, MPH, who is associate professor at Drexel University School of Public Health and a History of Vaccines advisor, noted that “the course of bloodstream infections with N. meningitidis (meningococcemia) is often rapid and fulminant, which is why this disease is among the most terrifying infections.” Ross’s housemates and other close contacts have been offered prophylactic antibiotics.
I spoke with Jeff Moran at the Philadelphia Public Health Department, and he confirmed that the Pennsylvania state public health laboratory determined that the cause of Ross’s death was infection with N. meningitidis serogroup B. I’ve written here about recent meningitis group B outbreaks at Princeton University, where there have been eight cases, and University of California Santa Barbara, where there have been four cases. All individuals survived, but one student had his feet amputated as a result of the infection.
The US-licensed meningococcal vaccine is ineffective against group B meningococcal bacteria, though it protects against strains from the A, C, Y, and W-135 serogroups, which have been more common in this country.
I asked Dr. Chernak, who is not involved with the case, about the course the investigation of Ross’s death will likely take. She said, “In cases like this, there will be heightened surveillance for additional cases, by both Philadelphia Department of Public Health as well as at student health at Drexel. Other local universities will probably step up surveillance, given the attention to this case and concern.”
Dr. Chernak surmises that the public health investigation in Ross’s case has probably been seeking links to known outbreaks at other universities. When I asked her about linking the actual organism to other outbreaks, she said, “If an organism is recovered from this case (and they cannot always be recovered), it can be sent to CDC for molecular fingerprinting to see if the strain matches the strain associated with other university outbreaks. This presumes that CDC tested isolates from those other outbreaks, which is likely.” She stressed, however, that the Ross’s case may very well not be linked. Serogroup b meningococcal disease crops up periodically, though at low levels. The Princeton and UCSB outbreaks were not found to be related. [UPDATE 3/18/2014: The CDC has confirmed that the strain responsible for Ross’s death was genetically linked to the strain in the Princeton outbreak, and that Ross had had recent contacts with Princeton students. More here.]
The FDA approved a meningitis B vaccine for use in the Princeton and UCSB outbreaks under an Expanded Access to Investigational New Drug protocol. Regulatory agencies in European Union, Canada, and Australia approved this meningitis B vaccine in 2013. Its unwieldy generic name is Meningococcal group B Vaccine [rDNA, component, adsorbed], though it is most often referred to by its trade name, Bexsero. Novartis manufactures the vaccine at sites in Europe.
Novartis has completed phase 2 trials of a combination meningitis serogroups A, C, Y, W-135, and B vaccine for potential licensure in the United States. A spokesperson for Novartis informed me that the company is evaluating plans to advance the vaccine into phase 3 trials. Given how long phase 3 trials take and the time required for FDA review and approval, it’s unlikely that this new vaccine will be available soon.
A single case of serogroup b meningococcal infection would not be sufficient to initiate a mass vaccination program with Bexsero at Drexel. Drexel’s official statement on the case is here.
Bacterial meningitis killed Drexel student. http://www.nbcphiladelphia.com/news/breaking/Drexel-Ross-Meningitis-Death-249433661.html
CDC. Meningococcal disease. http://www.cdc.gov/meningococcal/about/index.html