Meningococcal Disease: What everyone should know

Meningococcal disease is a sudden, life-threatening infection caused by the bacterium, Neisseria meningitidis (also known as 'meningococcus'). It is best known as a cause of meningitis (an infection of the protective membranes covering the brain and spinal cord), but widespread blood infection with the organism (meningococcemia) is even more damaging and dangerous.

Meningococcal disease is among the most dreaded of illnesses by parents because of its predilection for children, its often challenging diagnosis, and grisly clinical course. It can be difficult to identify in its early stages, progresses rapidly, and can lead to death within 24 hours of the first symptoms.

Survivors may experience debilitating sequelae, including hearing or visual loss, learning disabilities or mental retardation, hydrocephalus, seizures, and amputation of limbs.

Neisseria meningitidis is a major cause of bacterial meningitis and other invasive bacterial infections worldwide. Meningococcus is the most common cause of bacterial meningitis in children and a leading cause of bacterial meningitis in adults. The infection occurs more often in winter or spring. It may cause local epidemics at boarding schools, college dormitories, or military bases.

How Common Is Meningococcal Disease?

A remarkable characteristic of meningococcal epidemiology is that it is highly fluid, with major fluctuations in the incidence of endemic disease and the occurrence of outbreaks and epidemics.

There are 13 "serogroups" of meningococci, distinguished by differences in the surface polysaccharides of their outer membrane capsules. Globally, most meningococcal disease is caused by serogroups A, B, C, W135 and Y.5 By far the highest incidence of meningococcal disease occurs in the "meningitis belt" of sub-Saharan Africa. Serogroup A has been the most important serogroup in this region. In the Americas, the reported incidence of disease is much lower than in the meningitis belt. In addition, in some countries such as Australia, the incidence is at a historical low. 

The majority of meningococcal disease in European countries is caused by serogroup B strains, particularly in countries that have introduced serogroup C meningococcal conjugate vaccines. Serogroup B has also been predominant in Australia and New Zealand. It has been predominant in Australia because of the suppression of serogroup C disease through vaccination and in New Zealand because of a serogroup B epidemic. The meningococcal C conjugate vaccine was introduced into the Australian routine immunisation schedule in 2003 with a single dose at 12 months of age, along with a catch-up for individuals less than 20 years of age. This resulted in a 75% reduction in nationally notified laboratory-confirmed cases from 213 in 2002 to 50 in 2005.

How Is Meningococcal Disease Transmitted?

The bacteria are transmitted from person-to-person through droplets of respiratory or throat secretions. Close and prolonged contact – such as kissing, sneezing or coughing on someone, or living in close quarters (such as a dormitory, sharing eating or drinking utensils) with an infected person (a "carrier") – facilitates the spread of the disease. 

People can “carry” meningococcus bacteria without getting meningococcal disease. Being a carrier means that the bacteria live in the nose and throat, but do not invade the body and cause illness. Carriers do not have any symptoms of meningococcal disease. Adults carry the bacteria that cause meningococcal disease in their nose and throat, but that number increases in closed populations (e.g., military recruits in camps). The carrier state usually lasts weeks.

Signs and Symptoms of Meningococcal Disease

Meningitis and meningococcemia are the most common infectious manifestations of meningococcal disease.

Other clinical presentations include pneumonia, septic arthritis, conjunctivitis, sinusitis, tracheobronchitis, pharyngitis and myocarditis.

Meningococcal meningitis

In children older than one year and in adults, meningococcal meningitis is characterised by acute onset of intense headache, fever, nausea, vomiting, sensitivity to light, irritability, confusion, and stiff neck. Many patients have a history of a recent mild respiratory illness. Infants present with poor feeding, increased irritability, fever, somnolence, inconsolable crying, seizures, and a bulging fontanelle (soft spot on the top of the head). Meningococcal meningitis is the most common presentation of meningococcal disease.

Meningococcemia

Another common outcome of meningococcal infection is bloodstream infection referred to as "septicemia" or "meningococcemia." This is the more dangerous and deadly illness caused by Neisseria meningitidis bacteria. In 50% to 75% of patients, meningococcemia is characterised by a rash of pinpoint red spots ("petechiae") or purple "bruise-like" areas ("purpura") that do not disappear when pressure is applied to the skin. The rash is most often found on the trunk or extremities, but may progress to involve any part of the body. Other signs and symptoms include fever and chills, headache, neck stiffness, nausea and vomiting, confusion or unconsciousness, seizures, unstable vital signs (e.g. very low blood pressure, low urine output, rapid breathing, and rapid heart rate), and collapse due to shock.

How Is Meningococcal Disease Diagnosed?

If meningococcal disease is suspected, samples of blood or cerebrospinal fluid (fluid near the spinal cord) are collected. The spinal fluid is obtained by performing a spinal tap (lumbar puncture) where a needle is inserted into the lower back. Any bacteria found in the blood or spinal fluid is grown in a medical laboratory and identified. The polymerase chain reaction (PCR) test may be used to complement standard laboratory procedures for the diagnosis of meningococcal meningitis. It is a rapid and sensitive test for confirmation of the diagnosis; its sensitivity is not affected by prior antibiotic treatment. Punch biopsy or needle aspiration specimens of any of the small rash spots can also confirm the presence of Neisseria meningitidis.

How Is Meningococcal Disease Treated?

Meningococcal disease can be treated with a number of effective antibiotics. It is important that treatment be started as soon as possible. If meningococcal disease is suspected, antibiotics are given right away. Antibiotic treatment should reduce the risk of mortality, but sometimes the infection has caused too much damage to the body for antibiotics to prevent death or serious long-term problems. Even with antibiotic treatment, people die in about 10-15% of cases. About 11-19% of survivors will have long-term disabilities, such as loss of limb(s), deafness, nervous system problems, or brain damage.

Patients with presumed meningococcal infections are isolated in private rooms and treatment begun promptly to any patient suspected of having a meningococcal infection.

At presentation, meningitis due to N. meningitidis may be impossible to differentiate from other types of meningitis. Thus, empirical treatment with an antibiotic that penetrates into the central nervous system should be started as soon as possible.

Primary Preventive Measures 

In 2013, the Australian Therapeutic Goods Administration added Bexsero,® a multi-component meningococcal B vaccine to the Australian Register of Therapeutic Goods for use in individuals from two months of age and older. Bexsero is the first and only broad coverage vaccine to help protect all age groups against meningococcal B disease, including infants who are at the greatest risk of infection.

For up-to-date information on vaccinations available contact the Australian Government Department of Health

Secondary Preventive Measures 

Person-to-person transmission can be interrupted by chemoprophylaxis, which eradicates the asymptomatic nasopharyngeal carrier state. Close contacts of patients with meningococcal infections should receive chemoprophylaxis as soon as feasible, ideally within 24 hours of identification of the index case. Close contacts include household members, people with other close social contact, air travelers seated directly next to patients on flights of over 8 hours' duration, and healthcare providers having unprotected contact with the patients' respiratory secretions.

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