Objective To understand the epidemiological and etiological characteristics of the first fatal case of fulminant meningococcal meningitis caused by Neisseria meningitidis serogroup Y in Beijing, and provide evidence for the improvement of prevention and control strategies and immunization programs of meningococcal meningitis in Beijing.

Methods On July 2, 2025, the first fatal case of N. meningitidis serogroup Y disease were reported in F district, Beijing. The case investigation was conducted. Blood sample from the case and throat swab from close contacts were collected. Real-time fluorescence quantitative polymerase chain reaction was conducted for nucleic acid detection, followed by selective culture media inoculation for pathogen isolation. After obtaining pure cultures, the isolates underwent serogrouping, antimicrobial susceptibility testing, and whole genome sequencing.

Results This case was the first death caused by the infection of N. meningitidis serogroup Y in Beijing. This outbreak was classified as a public health emergency, and no secondary cases occurred due to the timely case management and effective prevention measures. The strain showed susceptibility to 11 antimicrobial agents, i.e. ceftriaxone, meropenem, azithromycin, chloramphenicol, rifampicin, ampicillin, penicillin, cefotaxime, tetracycline, ciprofloxacin, and levofloxacin, but showed resistance to trimethoprim-sulfamethoxazole. Whole-genome sequencing identified the strain as sequence type-1655, clonal complex 23(CC23), with genotypic profiles of ferric enterobactin receptor A (fetA: F4-1) and major outer membrane protein A (porA: P1.5-1,10-1).

Conclusion This study confirmed the first fatal case of meningococcal meningitis caused by N. meningitidis Y in Beijing. The case showed fulminant shock syndrome with atypical onset symptoms, indicating the existence of local CC23 transmission chain and N. meningitidis Y as a potential public health threat that cannot be neglected. The current group A and C meningococcal polysaccharide vaccine (MPSV-AC) provides insufficient protection. It is suggested to further strengthen pathogen surveillance to understand serogroup composition and genetic changes of N. meningitidis, improve the antimicrobial resistance surveillance to guide clinical treatment, evaluate the effects of including group ACYW135 meningococcal polysaccharide vaccine into the free immunization program to provide more effective protection for adolescents, and further conduct public health education through multiple channels to improve public awareness of early symptoms of the infection and the importance of vaccination to reduce the morbidity and mortality of meningococcal meningitis.