185944 Ciprofloxacin-Resistant Neisseria meningitidis in North Dakota – First case reported in the United States, 2007

Wednesday, October 29, 2008

Tracy K. Miller, MPH , Division of Disease Control, North Dakota Department of Health, Bismarck, ND
Molly Sander, MPH , Division of Disease Control, North Dakota Department of Health, Bismarck, ND
Current research on the spread of ciprofloxacin resistant Neisseria meningitidis is limited, as few cases have occurred worldwide. In 1992, the first documented case of ciprofloxacin resistance in N. meningitidis was reported from Greece. Since that time, additional reports of decreased susceptibility to ciprofloxacin have occurred in France in 1999, Spain in 2002, Australia in 1998, Argentina in 2002, and India in 2005.

In January 2007, the first U.S. case of ciprofloxacin-resistant N. meningitidis occurred in a North Dakota resident. Since that time, two additional ciprofloxacin-resistant cases of N. meningitidis occurred in Minnesota, along the North Dakota border. To date, both health departments have been unable to establish a link between the three ciprofloxacin-resistant cases. Investigations are ongoing.

Based on the ciprofloxacin-resistant meningococcal cases in both North Dakota and Minnesota, the following recommendations have been implemented

•Isolates from invasive meningococcal cases should be submitted to the respective Department of Health Laboratories. If cultures are not available, blood or CSF samples should be submitted.

•Susceptibility testing of all meningococcal isolates from cases of invasive disease should be conducted at the respective Department of Health laboratories.

•Prophylactic treatment with ciprofloxacin should be discontinued in counties along the North Dakota-Minnesota border.

Learning Objectives:
1. Assess the need for state health laboratories to conduct antimicrobial susceptibilities on all samples/isolates of invasive N. meningitides cases. 2. Determine the need for thorough epi investigations to be done on all cases identified. 3. Identify better communication methods between the states and CDC. 4. Develop studies and/or monitoring systems to determine the impact of the use of azithromycin as a prophylaxis. 5. Identify the need for further carriage studies in order to establish the extent of ciprofloxacin-resistance is in the United States.

Presenting author's disclosure statement:
Organization/institution whose products or services will be discussed: In this presentation there will be discussion of the use of azithromycin as prophylactic treatment for contacts to N. meningitis, although this treatment is not one of the currently recommended prophylactic treatments recommended by the ACIP.

Qualified on the content I am responsible for because: I have been with the North Dakota Department of Health for nine years where I am senior epidemiologist for the Division of Disease Control. Molly Sander, Immunization Program Manager, and myself have been working with the CDC, our field epidemiologists, division director, state health officer, MN Dept of Health, and both the ND and MN Dept. of Health laboratorians to gather additional information regarding this case and determine further follow up needs.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.

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