Presentation with gastrointestinal symptoms and high case fatality associated with group W meningococcal disease (MenW) in teenagers, England, July 2015 to January 2016

Atypical clinical presentations associated with group W meningococcal disease (MenW) are well-described and include pneumonia, septic arthritis, endocarditis and epiglottitis/supraglottitis. Following anecdotal reports of teenagers presenting with predominantly gastrointestinal symptoms, we undertook a case review of MenW cases in 15 to 19 year-olds diagnosed in England between July 2015 and January 2016. Of the 15 cases, seven presented with a short history of nausea, vomiting and diarrhoea; five of these seven cases died within 24 hours of presentation to hospital. The United Kingdom is currently experiencing a national outbreak of group W invasive meningococcal disease (IMD) due to rapid expansion of a single endemic hyper-virulent strain belonging to sequence type (ST) 11 clonal complex (cc) [1]. Group W IMD is associated with atypical clinical presentations, including pneumonia, septic arthritis, endocarditis and epiglottitis/supraglottitis, mainly in older adults [2]. In early 2016, enhanced national surveillance conducted by Public Health England identified two fatal group W IMD cases in teenagers who presented with predominantly gastrointestinal symptoms, prompting a review of all 15 to 19 year-olds diagnosed with group W IMD in England in the current epidemiological year. Laboratory-confirmed cases were identified through national surveillance [1] and case records were rapidly reviewed on HPZone, a national web-based case management system used by health protection teams (HPTs) to record public health events and actions.