Three Outbreak-causingNeisseria meningitidis SerogroupC Clones, Brazil1

During 2003-2012, 8 clusters of meningococcal disease were identified in Rio de Janeiro State, Brazil, all caused by serogroup C Neisseria meningitidis.The isolates were assigned to 3 clonal complexes (cc): cc11, cc32, and cc103.These hyperinvasive disease lineages were associated with endemic disease, outbreaks, and high case-fatality rates.T he last epidemic of Neisseria meningitidis serogroup C meningococcal disease in Rio de Janeiro State, Brazil, occurred in 1994.It was caused by C:2b:P1.10 isolates that belonged to cluster A4 (1).Although the number of cases of serogroup C disease subsequently declined after a vaccination campaign, rates of serogroup C disease again began to increase in 2000.During 2003-2012, public health surveillance identified 8 clusters of serogroup C meningococcal disease in Rio de Janeiro State.We report the investigation of these meningococcal disease clusters and typing information of the causative agent. The StudyPublic health surveillance of meningococcal disease in Rio de Janeiro State is conducted by the Meningitis Advisory Committee of the State Department of Health,