Meningococcal Disease

Meningococcal Disease

Symptoms and Causative Agent

Neisseria meningitidis bacteria, also called meningococcus [meningococci (plural)], are an important cause of bacterial meningitis and sepsis (bloodstream infection) in the United States. Meningococci can also cause pneumonia, otitis media (ear infection), arthritis, and other infections, although these are less common. Collectively, the different illnesses caused by N. meningitidis are referred to as meningococcal disease.

Meningococcal meningitis symptoms include fever, headache, confusion and stiff neck, which may also be accompanied by nausea, vomiting, and sensitivity to light. Meningococcal bacteremia (or meningococcemia – bloodstream infection) symptoms include sudden fever onset and rash. Other forms of meningococcal disease have symptoms related to the organ affected: otitis media has ear pain; arthritis has joint pain and swelling.

Invasive meningococcal disease can be fatal; survivors may have permanent injury, including brain damage, hearing loss, or loss of a limb.

Transmission

As many as 10-20% of adolescents and adults are colonized by N. meningitidis without becoming ill. These individuals may carry the bacteria for weeks or months. The bacteria can be spread to others via direct contact such as kissing, or by respiratory secretions as a result of coughing or sneezing.

Individuals with abnormal spleen function are at an increased risk for developing severe meningococcal disease. HIV infection and some genetic factors are also likely to increase the risk for meningococcal disease, as is cigarette smoking. Family members of an infected person also have an increased risk.

Although meningococcal epidemics do not occur on a national level in developed countries, there is a risk to travelers who visit parts of the world where epidemics occur regularly. The highest risk region for epidemic meningococcal disease is sub-Saharan Africa.

Treatment and Care

Antibiotics are used to treat meningococcal disease. Because the symptoms of meningococcal meningitis are similar to forms of meningitis caused by other bacteria, the antibiotics initially used in treatment may provide broad coverage until it can be confirmed that N. meningitidis is the cause of the infection. After this has been confirmed, penicillin or another appropriate single agent can be administered to complete the course of treatment.

Complications and Mortality

Invasive meningococcal disease can be extremely serious. Meningococcal meningitis, the most common presentation of meningococcal disease, “should always be viewed as a medical emergency” and requires admission to a hospital, according to the World Health Organization.

In the United States, between 1,400 and 2,800 cases of meningococcal disease occur each year. Invasive meningococcal disease can be fatal: even with antibiotic treatment, the case fatality rate is between 9-12%. Up to 20% of survivors of invasive meningococcal disease have permanent injury, including brain damage, hearing loss, or loss of a limb.

Available Vaccines and Vaccination Campaigns

Five serogroups—groups of bacteria that contain a common antigen able to generate an immune response—are collectively responsible for nearly all invasive meningococcal disease: groups A, B, C, Y, and W-135. Four of these (all but serogroup B) are covered by quadrivalent meningococcal vaccines used in the United States. 

There are two main types of meningococcal vaccines. A meningococcal polysaccharide vaccine has been available since the 1970s. However, similar to the polysaccharide vaccine against pneumococcal disease, it is most effective in adults and does not consistently generate immunity in young children.

The first conjugate meningococcal vaccine in the United States, MCV4 (Menactra), was licensed in 2005, with a second, MenACWY-CRM (Menveo), licensed in 2010. These are the preferred vaccines for individuals between two years and 55 years of age; Menactra is approved for ages two to 55, and Menveo for ages 11 to 55. (See our article, Different Types of Vaccines, for more on how these vaccines are made.)

Vaccines for group B meningococcal disease were licensed in the United States in 2014 and 2015. MenB-FHbp (Trumenba, Wyeth Pharmaceuticals, Inc.} is a three-dose vaccine, and MenB-4C (Bexsero, Novartis Vaccines) is a two-dose vaccine.

U.S. Vaccination Recommendations

Quadrivalent meningococcal vaccine was added to the recommended immunization schedule in 2005. One dose of the quadrivalent vaccine is recommended for children and adolescents around age 11 or 12. A booster dose is recommended about 5 years after the first dose, around age 16. A two-dose primary series is also recommended for certain children and adults at high risk of meningococcal disease.

In October 2015, the CDC adopted the position of the Advisory Committee on Immunization Practices that group B meningococcal vaccine be recommended to individuals ages 16-23 who are at risk of disease during outbreaks. The ACIP, however, did not recommend that the group B meningococcal vaccine join the quadrivalent meningococcal vaccine as a vaccine recommended universally for all adolescents. 

Your doctor can provide more information about group B meningococcal disease and about the vaccine.

Sources

Centers for Disease Control and Prevention. Epidemiology and Prevention of Vaccine-Preventable Diseases. Atkinson W, Wolfe S, Hamborsky J, McIntyre L, eds. 13th ed. Washington DC: Public Health Foundation, 2015. http://www.cdc.gov/vaccines/pubs/pinkbook/downloads/mening.pdf. (493 KB). Accessed 2/5/2016.

Centers for Disease Control and Prevention. Updated Recommendations for Use of Meningococcal Conjugate Vaccines --- Advisory Committee on Immunization Practices (ACIP), 2010. MMWR. 60:03;72-76.  http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6003a3.htm Accessed 2/5/2016.

Centers for Disease Control and Prevention. Epidemiology and Prevention of Vaccine-Preventable Diseases. Atkinson W, Wolfe S, Hamborsky J, McIntyre L, eds. 11th ed. Washington DC: Public Health Foundation, 2009. http://www.cdc.gov/vaccines/pubs/pinkbook/downloads/mening.pdf. (493 KB). Accessed 2/5/2016.

Centers for Disease Control and Prevention. Use of Serogroup B Meningococcal Vaccines in Adolescents and Young Adults: Recommendations of the Advisory Committee on Immunization Practices, 2015. MMWR. 64:41;1171-6. http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6441a3.htm Accessed 2/5/2016.

CIDRAP. ACIP endorses individual choice on meningitis B vaccine. June 24, 2015. http://www.cidrap.umn.edu/news-perspective/2015/06/acip-endorses-individual-choice-meningitis-b-vaccine Accessed 2/5/2016.

Meningococcal meningitis. World Health Organization. http://www.who.int/mediacentre/factsheets/fs141/en/index.html. Accessed 2/5/2016.

Vaccine Information Statement: Meningococcal Vaccines. Centers for Disease Control and Prevention. http://www.cdc.gov/vaccines/hcp/vis/vis-statements/mening.html Accessed 2/5/2016.

Approved Products > Menveo. 7/14/2010. US Food and Drug Administration. http://www.fda.gov/BiologicsBloodVaccines/Vaccines/ApprovedProducts/ucm201342.htm. Accessed 2/5/2016.

Approved Products > Menomune-A/C/Y/W-135. 10/22/2010. US Food and Drug Administration. .http://www.fda.gov/BiologicsBloodVaccines/Vaccines/ApprovedProducts/ucm179991.htm. Accessed 2/5/2016.

Approved Products > Menactra. 7/29/2010. US Food and Drug Administration. http://www.fda.gov/BiologicsBloodVaccines/Vaccines/ApprovedProducts/ucm176044.htm. Accessed 2/5/2016.

Ask the Experts: Meningococcal Disease. Immunization Action Coalition, August 2010.http://www.immunize.org/askexperts/experts_men.asp. Accessed 2/5/2016.

First Vaccine Approved by FDA to Prevent Serogroup B Meningococcal Disease. 10/29/2014. US Food and Drug Administration. Accessed 2/5/2016.

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Last update 5 February 2016

 

Timeline Entry: 2005

Meningococcal: New Recommendation

Sanofi’s quadrivalent meningococcal polysaccharide-protein conjugate vaccine was licensed in the United States in January 2005. In May of that year, the Advisory Committee on Immunization Practices recommended routine meningococcal vaccination for all adolescents aged 11-12 years, with additional recommendations for persons at increased risk of meningococcal disease. In June 2007 this recommendation would be expanded to include vaccination of all persons 11-18 years of age at the earliest opportunity.

Until 2004, 1,400-2,800 cases of meningococcal disease occurred in the United States each year. In 2007, 1,077 cases were reported. Although antibiotics are available and can be successful in treating the disease, the case-fatality ratio for meningococcal disease is 10%–14%. Moreover, between 11%–19% of meningococcal disease survivors suffer neurologic disability, limb loss, and hearing loss.

In 2010, ACIP would recommend a booster dose of the meningococcal vaccine at age 16 to help extend protection through the college years.

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Timeline Entry: 2010

Meningococcal Vaccine Rolled Out in Africa

A conjugate meningococcal group A vaccine began to be used in the African meningitis belt, where epidemics have historically led to thousands of deaths in epidemic years and much disability. This vaccine was developed in a unique collaboration among corporate, governmental, and non-governmental entities for a cost of development that was less than 10% of the $500 million typically required to create a new vaccine. The final cost per dose was only US $0.40. At the close of the 2011 epidemic season, monitoring indicated that there had not been a single case of group A meningitis among those who had received the vaccine. By 2014, meningococcal deaths were at their lowest level in 10 years. More than 220,000,00 people between the ages of 1 and 29 in 15 African countries had received the vaccine by the end of 2015. 

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Assessment Questions

Neisseriae meningitidis are __________.

  • bacteria
  • viruses
  • fungi
  • none of the above

True or false? Meningococcal disease can be fatal.

  • True
  • False

__________ with another person is needed to spread Neisseria meningitidis.

  • Direct contact
  • Sexual contact
  • Indirect contact
  • The fecal-oral route
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