Epidemiology and Infection

Meningococcal infection

Outbreak of Neisseria meningitidis C in workers at a large food-processing plant in Brazil: challenges of controlling disease spread to the larger community

B. P. M. ISERa1 c1, H. C. A. V. LIMAa1, C. De MORAESa1a2, R. P. A. De ALMEIDAa3, L. T. WATANABEa3, S. L. A. ALVESa4, A. P. S. LEMOSa5, M. C. O. GORLAa5, M. G. GONÇALVESa6, D. A. DOS SANTOSa1 and J. SOBELa1a7

a1 Field Epidemiology Training Program (FETP), Centre for Strategic Information in Health Surveillance (CIEVS), Secretariat of Health Surveillance, Ministry of Health, Brazil

a2 Vaccine Preventable Disease Branch, Secretariat of Health Surveillance, Ministry of Health, Brazil

a3 State Health Secretariat, Goias State, Brazil

a4 Public Health Laboratory Central, Goias State, Brazil

a5 Division of Medical Biology, Bacteriology Department, Adolfo Lutz Institute, São Paulo, Brazil

a6 Division of Medical Biology, Immunology Department, Adolfo Lutz Institute, São Paulo, Brazil

a7 Centers for Diseases Control and Prevention (CDC), Atlanta, GA USA


An outbreak of meningococcal disease (MD) with severe morbidity and mortality was investigated in midwestern Brazil in order to identify control measures. A MD case was defined as isolation of Neisseria meningitidis, or detection of polysaccharide antigen in a sterile site, or presence of clinical purpura fulminans, or an epidemiological link with a laboratory-confirmed case-patient, between June and August 2008. In 8 out of 16 MD cases studied, serogroup C ST103 complex was identified. Five (31%) cases had neurological findings and five (31%) died. The attack rate was 12 cases/100 000 town residents and 60 cases/100 000 employees in a large local food-processing plant. We conducted a matched case-control study of eight primary laboratory-confirmed cases (1:4). Factors associated with illness in single variable analysis were work at the processing plant [matched odds ratio (mOR) 22, 95% confidence interval (CI) 2·3–207·7, P<0·01], and residing <1 year in Rio Verde (mOR 7, 95% CI 1·11–43·9, P<0·02). Mass vaccination (>10 000 plant employees) stopped propagation in the plant, but not in the larger community.

(Accepted August 01 2011)

(Online publication August 30 2011)