Investigation and public health response to a cluster of serogroup C Neisseria meningitidis in a Western Cape Province community, South Africa, 2025
1
Department of Health and Wellness, Communicable Disease Control, Cape Town, South Africa
Popul. Med. 2026;8(Supplement Supplement 1):A645
ABSTRACT
INTRODUCTION:
Meningococcal disease is a notifiable condition requiring urgent public health action due to its rapid progression, high case fatality rate, and outbreak potential. Although vaccines targeting common Neisseria meningitidis serogroups are available in South Africa, they are not included in the Expanded Programme on Immunisation (EPI) and remain largely inaccessible. This study describes the investigation and public health response to a cluster of invasive meningococcal disease caused by serogroup C in a Western Cape community during 2025.
METHODS:
A descriptive implementation study design was used to document the detection, investigation, planning, coordination, and execution of public health interventions in response to a meningococcal outbreak. Surveillance data, epidemiological investigations, and response activities were reviewed.
RESULTS:
Between July and November 2025, five laboratory-confirmed cases of serogroup C invasive meningococcal disease were reported from a single Western Cape community. Cases ranged in age from 2 to 26 years. The initial two cases occurred within 14 days in July 2025, among children attending the same primary school in different grades, prompting identification of a possible institutional outbreak. Close contacts received prophylaxis, and targeted prophylaxis was extended to 565 foundation phase learners (65% coverage) and 48 school staff members. Subsequently three cases occurred in November 2025, including an adult, a non–school-attending child, and school-going child, with no direct epidemiological links. Three of these cases are attending the same primary school, resulting in a community outbreak with an estimated attack rate of 42 per 100 000 population, and zero fatalities. A community-wide quadrivalent conjugate meningococcal vaccination campaign was recommended.
CONCLUSIONS:
While chemoprophylaxis temporarily reduced transmission within the school setting, continued cases highlighted sustained community spread. Challenges related to emergency funding, vaccine procurement, and response implementation persist due to the exclusion of meningococcal vaccine in the EPI schedule, underscoring the need to strengthen national outbreak preparedness.
Meningococcal disease is a notifiable condition requiring urgent public health action due to its rapid progression, high case fatality rate, and outbreak potential. Although vaccines targeting common Neisseria meningitidis serogroups are available in South Africa, they are not included in the Expanded Programme on Immunisation (EPI) and remain largely inaccessible. This study describes the investigation and public health response to a cluster of invasive meningococcal disease caused by serogroup C in a Western Cape community during 2025.
METHODS:
A descriptive implementation study design was used to document the detection, investigation, planning, coordination, and execution of public health interventions in response to a meningococcal outbreak. Surveillance data, epidemiological investigations, and response activities were reviewed.
RESULTS:
Between July and November 2025, five laboratory-confirmed cases of serogroup C invasive meningococcal disease were reported from a single Western Cape community. Cases ranged in age from 2 to 26 years. The initial two cases occurred within 14 days in July 2025, among children attending the same primary school in different grades, prompting identification of a possible institutional outbreak. Close contacts received prophylaxis, and targeted prophylaxis was extended to 565 foundation phase learners (65% coverage) and 48 school staff members. Subsequently three cases occurred in November 2025, including an adult, a non–school-attending child, and school-going child, with no direct epidemiological links. Three of these cases are attending the same primary school, resulting in a community outbreak with an estimated attack rate of 42 per 100 000 population, and zero fatalities. A community-wide quadrivalent conjugate meningococcal vaccination campaign was recommended.
CONCLUSIONS:
While chemoprophylaxis temporarily reduced transmission within the school setting, continued cases highlighted sustained community spread. Challenges related to emergency funding, vaccine procurement, and response implementation persist due to the exclusion of meningococcal vaccine in the EPI schedule, underscoring the need to strengthen national outbreak preparedness.
| eISSN: | 2654-1459 |
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