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May 1991

A Cluster of Meningococcal Disease on a School Bus Following Epidemic Influenza

Author Affiliations

From the Meningitis and Special Pathogens Branch, Division of Bacterial Diseases (Drs Harrison and Broome and Ms Ajello) and Influenza Branch, Division of Viral Diseases (Dr Harmon), Center for Infectious Diseases, Centers for Disease Control, Atlanta, Ga, and the Office of Epidemiology, Virginia Department of Health, Richmond (Drs Armstrong, Jenkins, and Miller). Dr Harrison is now with the Department of International Health, The Johns Hopkins School of Hygiene and Public Health, Baltimore, Md.

Arch Intern Med. 1991;151(5):1005-1009. doi:10.1001/archinte.1991.00400050141028

An outbreak of meningococcal disease among children on a school bus offered the opportunity to study a proposed association between this infection and preceding influenza infection. Five students who rode the bus became ill with invasive group C meningococcus. Transmission was limited to the bus; there was no evidence for school transmission. All five students reported influenzalike symptoms within several weeks before the development of meningococcal disease. School absenteeism, principally due to upper respiratory tract illness, was higher during the 3 weeks before the outbreak of meningococcal disease than during any period in the preceding 3 1/2 years, suggesting an unusually severe outbreak of respiratory illness. A case-control study comparing students with and without influenza symptoms revealed that the outbreak of respiratory disease was due to B/Ann Arbor/1/86 influenza (geometric mean titers, 86 for 80 patients and 33 for 47 controls [P=.0007]). These data add to the evidence suggesting that influenza respiratory infection predisposes to meningococcal disease.

(Arch Intern Med. 1991;151:1005-1009)