Emergence of fluoroquinolone-resistant Neisseria meningitidis--Minnesota and North Dakota, 2007-2008

Abstract

Meningoccocal disease causes substantial morbidity and mortality; approximately 10% of cases are fatal. Among those who survive, 10%-15% have long-term sequelae. Nasopharyngeal carriage of Neisseria meningitidis is a precursor to disease; however, the majority of carriers do not develop disease. Household and other close contacts of persons with meningococcal disease have a higher risk for carriage and therefore invasive disease. These persons should receive antibiotic chemoprophylaxis to eliminate nasopharyngeal carriage of N. meningitidis as soon as possible. The rate of secondary disease for close contacts is highest immediately after onset of disease in the index patient; secondary cases rarely occur after 14 days. Ciprofloxacin, a second-generation fluoroquinolone, is an effective single-dose oral chemoprophylaxis agent. Although isolated cases of ciprofloxacin-resistant meningoccocal disease have been described in Argentina, Australia, China, France, India, and Spain, resistance has not been reported in North America. This report describes a cluster of three cases of fluoroquinolone-resistant meningococcal disease that occurred among residents of the border area of North Dakota and Minnesota during January 2007-January 2008. The first of these cases was epidemiologically linked and had closely related molecular features to a 2006 case of fluoroquinolone-susceptible meningococcal disease that occurred in the same geographic region. Until further notice, ciprofloxacin should not be used for chemoprophylaxis of close contacts of persons with meningococcal disease in selected counties in North Dakota and Minnesota. Ceftriaxone, rifampin, and azithromycin are alternative agents.