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BACKGROUND: On August 25, health authorities learned of Primary Meningococcal Conjunctivitis (PMC) cases among recruits at Military Training Facility X. PMC comprises <0.1% of acute bacterial conjunctivitis, is a rare presentation of N. meningitidis infection, and is a risk factor for developing systemic meningococcal disease. We described the cases and investigated potential sources of transmission.
METHODS: PMC cases were defined as a recruit at Military Training Facility X with a conjunctival swab that cultured N. meningitidis after August 1. Clinical and demographic information were abstracted from medical charts. Laboratory assessments included: serogrouping by slide agglutination and real-time polymerase chain reaction, and molecular typing (3 most recent cases) by multilocus sequence typing (MLST), typing of outer membrane proteins, and pulse field gel electrophoresis (PFGE).
RESULTS: Six cases meeting the PMC case definition occurred between August 20 and October 13. All were recently vaccinated with Menactra. Ages ranged from 17 to 19 years (median 18). All cases had a distinctive presentation of thick, copious, purulent conjunctivitis with severe scleral injection, and no other symptoms. Duration between symptom onset and treatment ranged from 1 to 3 days. All were treated with 500mg oral Ciprofloxacin and Vigamox eye drops, and nightly erythromycin ointment for 10 days, and all infections resolved without development of systemic meningococcal disease. All cases had serogroup Y N. meningitidis, and the 3 most recent cases belonged to clonal complex 23 (MLST strain 5733) and had an identical PFGE pattern 502 that was unique to the Centers for Disease Control and Prevention database. No obvious source of infection was identified, with cases occurring in separate battalions, companies, and platoons.
CONCLUSIONS: These PMC cases represented an unusual conjunctivitis etiology and an unusual instance of N. meningitidis not associated with any known systemic meningococcal disease. In accordance with national guidelines, chemoprophylaxis for close contacts was not recommended. Three additional suspected PMC cases occurred among a new set of recruits at Military Training Facility X in December 2014 and the investigation is ongoing.