A cluster of meningococcal disease on a school bus following epidemic influenza

A report is presented of an outbreak of invasive meningococcal disease (inflammation due to infection by Neisseria meningitidis) in five children who rode the same school bus. All five children survived the disease, which affected the meninges (membranes surrounding the brain and spinal cord) in three children and the blood in two children. The bus, which held a maximum of 66 passengers, transported 72 students each day to a preschool, an elementary school, a middle school, and a high school. Four middle-school children and one elementary-school child became ill. Before the outbreak, an unusually large proportion of children had been absent from school at all levels because of respiratory infections due to influenza. The five affected children had had influenza-like symptoms several weeks previously. After the outbreak, rifampin (an antibiotic) was given as a preventive measure to all who rode the school bus, and a meningococcal vaccine was administered to 1,200 people in the schools attended by the children. It is likely that upper respiratory tract infections predisposed these children to meningococcal disease; the mechanisms by which this can occur are discussed. However, risk factors for that disease could not be identified because the number of cases was small and rifampin had been given. (Consumer Summary produced by Reliance Medical Information, Inc.)