Background
Following the lifting of COVID-19 social restrictions, several countries reported resurgence of invasive meningococcal disease (IMD). However, data from Central Asia remain extremely limited. We describe the largest reported IMD outbreak from Uzbekistan and evaluate clinical presentation, laboratory confirmation, healthcare-seeking delay, and public health response during the 2026 Tashkent outbreak.
Methods
A prospective population-based outbreak investigation was conducted using mandatory surveillance registry data from the Tashkent City Center for Sanitary-Epidemiological Welfare and Public Health between January 1 and April 14, 2026. Confirmed and probable IMD cases were included. Demographic, clinical, laboratory, and epidemiological variables were analysed using SPSS v26. Associations with mortality were assessed using logistic regression and odds ratios with 95% confidence intervals.
Results
A total of 290 IMD cases were identified during the outbreak period, with children aged 2–5 years accounting for 41.0% of all cases. Overall case fatality ratio was 8.3% (24/290). Median age was 36 months (IQR 18–72). Blood culture confirmed Neisseria meningitidis in 60.7% of patients, while nasopharyngeal swabs were positive in 56.6%. Cerebrospinal fluid was not collected in 80.7% of cases, reflecting the predominance of meningococcemia and mixed clinical forms.
Meningeal signs were documented in only 3.1% of patients but were strongly associated with mortality (OR 11.65; 95% CI 2.71–50.13; p=0.003). Older age independently predicted fatal outcome (OR per month 1.005; p=0.005). Children attending daycare or school presented significantly later than home-reared children (Welch ANOVA p=0.013). Ring vaccination coverage among contacts reached only 35.5%, while chemoprophylaxis was documented in 6.9% of cases.
Conclusions
The 2026 Tashkent outbreak represents a major post-pandemic resurgence of IMD in Central Asia and revealed substantial gaps in early recognition, laboratory diagnostics, and outbreak response. The predominance of fulminant meningococcemia with minimal meningeal manifestations may contribute to delayed diagnosis and severe outcomes. Strengthening molecular surveillance, rapid diagnostics, and implementation of MenACWY vaccination strategies should become public health priorities in Uzbekistan and neighboring countries.