Meningococcal Disease

Common symptoms of meningitis in anyone over the age of two include a high fever, headache, and a stiff neck. These symptoms can develop over several hours, or they may take one to two days.

Other symptoms may include:

• nausea
• vomiting
• discomfort looking into bright lights
• confusion
• sleepiness
• rash, sometimes associated with areas of bleeding

In newborns and small infants, the classic symptoms of fever, headache, and neck stiffness may be absent or difficult to detect. The infant may only appear slow or inactive. They may appear irritable, have vomiting, or be feeding poorly. As the disease progresses, patients of any age may have seizures.

Common symptoms of meningococcemia include abrupt onset of fever, chills, and rash. Symptoms of both meningitis and meningococcemia may occur 1 to 10 days after exposure, but usually appear within 3 to 4 days.

Meningitis can also be caused by other bacteria and viruses. Laboratory testing is indicated to identify the organism causing the infection. Rapid testing is performed looking at the blood or cerebral spinal fluid (CSF) under a microscope to identify what kind of cells are seen.

Prompt accurate diagnosis is necessary as meningococcal disease is very serious and must be treated immediately with hospitalization and intravenous (IV) antibiotics. It is important, however, that treatment be started early in the course of the disease, sometimes before laboratory testing is complete.

Early diagnosis and treatment are very important. If symptoms occur, the patient should see a doctor or visit an Emergency Facility immediately. Growing bacteria in culture from a sample of the blood or CSF is usually sufficient for the diagnosis of meningitis or meningococcemia.

Meningococcal disease is not as contagious as the common cold or the flu, and it is not spread by casual contact or by simply breathing the air where a person with meningococcal disease has been. People in the same household or child care center, or anyone with direct contact with a patient’s oral secretions (such as a boyfriend or girlfriend) would be considered at increased risk of acquiring infection. Classmates and co-workers are NOT considered to be at high risk for getting meningococcal disease unless they have some special close contact with an ill person as described above.

Some people carry the meningococcus in the back of their nose and throat without ever becoming ill. Most of these people do not even know that they have it. This bacterium is spread from person to person through the exchange of respiratory and throat secretions. For example, it may be spread through sharing beverages or smoking materials, kissing or coughing.

Meningococcal disease is uncommon and it is very unusual for more than one case to occur in a community. It is NOT a highly infectious disease. Rarely, a community may experience an outbreak of a few cases. If more than one case is identified in a small area, the Vermont Department of Health studies the situation carefully and may suggest other special prevention measures, including vaccination.

After a case has been identified in the community, the general public may be advised to learn the symptoms of meningococcal disease. For the next few weeks, they can watch their family members for signs of illness and check promptly with their doctor if anyone in their household develops any of the symptoms.

The use of antibiotics has dramatically reduced mortality due to meningococcal disease. Before antibiotics were available, the case-fatality ratio for meningococcal disease was between 70% and 85%. Now with the widespread use of antibiotics, the case-fatality ratio for meningococcal disease is 10% to 14%, although mortality may be as high as 40% among patients with meningococcemia. Even with prompt treatment the case-fatality ratio for this condition remains high.

Because of the risks of severe morbidity and death, effective antibiotics should be administered promptly to patients suspected of having meningococcal disease. Multiple antimicrobial agents, including penicillins, are effective against N. meningitidis.

When a diagnosis is made, the doctor or hospital notifies the Vermont Department of Health. The doctor and the Health Department work with the patient and the patient’s family to identify close contacts who may have been exposed to the disease. Close contacts are referred to their own health care provider to receive antibiotics that will kill the bacteria if the individual was unknowingly infected.

People who are not close contacts of the patient do not need to receive antibiotics. Anyone with questions about whether they should receive treatment should talk to their own health care provider.

Persons who have had close contact with patients who have meningococcal disease are at greatly increased risk for contracting the disease. The primary means of preventing the spread of meningococcal disease is antimicrobial chemoprophylaxis. Secondary cases are rare as a result of effective chemoprophylaxis for household members, contacts at child care centers, and anyone else directly exposed to an infected patient’s oral secretions (e.g., kissing, mouth-to-mouth resuscitation).

Risk of secondary disease among close contacts is highest during the first few days after the onset of disease, which requires that chemoprophylaxis be administered as soon as possible. If given more than 14 days after the onset of disease, chemoprophylaxis is probably of limited or no benefit.

There are three different meningococcal vaccines available to help protect those at risk for meningococcal disease from the most common serogroups of meningococcal disease seen in the U.S. (serogroups B, C and Y), but they will not prevent all cases. Two of the vaccines protect again subgroups ACWY, while a different meningococcal vaccine protects against only subgroup B. Research is underway to develop a meningococcal vaccine that protects against all five subgroups, but it isn’t likely to be available soon.

CDC has made general and risk/disease specific recommendations for meningococcal vaccines.

Meningococcal: Who Needs to Be Vaccinated?

Meningococcal Vaccination for Preteens and Teens: Questions and Answers

In Vermont, MenACWY vaccines are required for residential students in grades 7-12 and first year college students living in dormitories who are 21 years or younger.

• Discuss meningococcal immunization with your healthcare provider. Make sure those in your family who are at risk get the vaccine on schedule. 
• Know the risks
• Know the symptoms of meningococcal infection and seek medical intervention promptly should you recognize symptoms in yourself or others.
• Educate persons, especially young people, to refrain from smoking, and to avoid smoky environments, e.g., bars and nightclubs where smoking and alcohol are prevalent.  Tobacco use (active or passive) and binge-drinking have been associated with disease in outbreak situations.
• Crowded living conditions can facilitate respiratory droplet transmission of meningococci. College freshman residing in dormitories are at greater risk of acquiring meningococcal disease. Check with your healthcare provider to receive the vaccine before heading off to the dorm.
• Similarly, new military recruits living in new congregate settings should take the vaccine.
• Those who have had close contact with people with meningococcal disease, such as household members, are at a substantially increased risk for acquiring carriage and disease. If you are identified as a close contact of a case, take the antibiotic regimen recommended by your healthcare provider.