Meningococcal Invasive Disease

Although N. meningitidis is a very severe pathogen, it is not as contagious as viruses that cause the common cold or the flu. The bacteria are not spread by casual contact or by simply breathing the air where a person with meningitis has been. 

N. meningitidis spreads from person to person either by:

• Direct contact with respiratory and throat secretions (e.g. kissing)
• Indirect contact (e.g. sharing of eating utensils, toothbrushes), or
• Aerosol droplets (e.g. coughing and sneezing).

Symptoms of invasive meningococcal disease can be different depending on the type of infection the bacteria have caused. The most common symptoms are high fever, chills, drowsiness, and a rash. 

• Symptoms of meningococcal meningitis may include headache, fever, and stiffness of the neck, sometimes accompanied by nausea, vomiting, visual sensitivity to light, or mental confusion.
• In newborns and small infants, the classic symptoms of fever, headache, and neck stiffness may be absent or difficult to notice. The infant may appear slow or inactive, have vomiting, be irritable, or be feeding poorly.
• The symptoms of meningococcemia (infection in the bloodstream) may include a sudden onset of fever and a rash of small purplish spots. In addition to meningitis and septicemia, pneumonia, arthritis, pericarditis, endocarditis, and other clinical presentations also may be observed.

Complications of meningococcal invasive disease can result in permanent hearing loss, brain damage, loss of limbs, and death.

Groups at increased risk for meningococcal invasive disease:

• People with a damaged or missing spleen 
• People with an immune system disorder (including complement component deficiency)
• People exposed to tobacco smoke either directly or second hand
• Infants and young children
• International travelers to places where meningococcal disease is common
• Household contacts of people who are sick with meningococcal disease
• People who live in close quarters with others including military recruits and college students who live in dormitories
• Microbiologists who work with isolates of N. meningitidis
• People who sit directly next to someone with meningococcal disease for 8 or more hours (e.g., airline flight)
• Healthcare personnel with direct, unprotected exposure to the patient’s oral secretions (e.g., unprotected mouth-to-mouth resuscitation, endotracheal intubation)

The incubation period is usually 3-4 days, but it can range from 1-10 days.

A person can pass the infection to others for as long as the bacteria are present in discharges from the nose and mouth. A person is no longer infectious after 24 hours of appropriate antimicrobial treatment. (Antimicrobial treatment should be continued for the full duration that it is prescribed.)

There are 3 types of meningococcal vaccines available in the United States. Meningococcal vaccines also vary by the number of serogroups they provide protection against.

Routine hand washing and practicing respiratory etiquette (i.e., covering mouth and nose while sneezing or coughing) are essential to prevent the spread of bacteria. Avoiding close contact with people who are sick, and not sharing food, eating utensils, and other personal belongings can also help stop the spread of the bacteria.

For more information about the meningococcal vaccines call the Immunization Division at 800-252-9152.

CDC Pink Book Meningococcal Vaccine

• Center for Disease Control and Prevention’s (CDC) Meningococcal Vaccine Chapter within the Pink Book

For Healthcare Professionals

• Meningococcal Vaccine information for healthcare professionals on the CDC website

For the Public

• Meningococcal Vaccine information for the public FAQs on the CDC website

ACIP Recommendations

• Most recent articles and recommendations for meningococcal vaccination from the Advisory Committee on Immunization Practices.

Children with meningococcal infections (meningitis or bloodstream infections caused by N. meningitidis) should be kept out of school or childcare until they have been treated appropriately with antibiotics, have written permission from a healthcare provider, and are fever free for 24 hours without the use of fever-suppressing medications. Rules for exclusion of sick children from school and childcare are outlined in the Texas Administrative Code, specifically  Rule 97.7 for schools and  Rule 746.3603 for childcare.

The number of invasive meningococcal disease cases reached a high of 203 (1.0 cases per 100,000 population) in 2001. Overall, the number of invasive meningococcal disease cases have remained under 40 cases for the last nine years with a record low number of cases (17 cases) reported in 2017. In Texas, the age-specific incidence rate for invasive meningococcal disease is highest in older adults.

• VPD Resources Page
• VPD Homepage

Meningitis, often referred to as spinal meningitis by the general public, is an infection of the layers of tissue which cover the brain and spinal cord and causes swelling. It may be caused by many different germs including the bacteria Neisseria meningitidis. It is generally a very serious illness which can result in blindness, deafness, amputations, permanent brain damage, or even death. However, with proper treatment, many people recover fully.

Meningococcal meningitis is a particularly severe form of meningitis caused by the bacteria Neisseria meningitidis. Even when treated with the right antibiotics, about 10-20% of people with this illness die, often within hours of the onset of the first signs of illness. 

Yes. However, it is not as contagious as the common cold or the flu. People do not catch them through casual contact or by breathing air where someone with meningococcal disease has been.

It is spread by direct contact, as in coughing, sneezing, kissing, and immediate sharing of unwashed eating utensils. 

For adults, symptoms of meningitis may include:

• Fever 
• Severe headache 
• Stiffness of the neck
• Nausea and maybe vomiting
• A skin rash that looks like small, purplish red spots

Any infant with a fever of 101^oF or greater and who is not easily wakened should be seen by a doctor.

Persons with meningitis may also be confused or very drowsy; sometimes they may even go into a coma from which they cannot be awakened. Getting early medical advice when a person has fever, stiff neck and headache, especially when meningitis has been reported in the community, can be lifesaving. 

Do not wait. Seek immediate medical attention for the sick person. Remember to ask the doctor about care of household members. 

Persons with meningococcal meningitis must be hospitalized, almost always in intensive care. They are treated with intravenous antibiotics and other medications and monitored closely. 

Up to 15-20% of normal healthy people can have the meningococcal germs in their nose and throat and remain well. Why some people suddenly become ill with this germ is not understood and happens unpredictably. 
Two groups of people are known to have a higher chance of getting sick, as a result of direct and close contact to the infected case: 

• The first group is people who live together under the same roof where there is a case of meningitis in the house.
• The second group is preschool age children in day care centers where there is a case of meningitis.

Generally, children in the same school have no increased risk of getting sick and should just be observed. The same is also true of adults who work together. 

In a hospital setting, the only people who may have an increased chance of getting meningococcal meningitis are those who have direct face-to-face contact with a case, such as may occur during artificial breathing. 

Those who are close contacts (household members, day-care classmates and teachers, and "best friends") will usually be advised to take a two-day course of antibiotics to reduce their risk of meningitis. Depending on the antibiotic used, this may be a single dose or up to two days of medication. Medications used are ciprofloxacin (Cipro) or rifampin given orally, or ceftriaxone (Rocephin) given as an injection. 

IIn most situations, there is little chance that an individual who is exposed to a case of meningococcal meningitis will also get sick. However, anybody who has been around a case of meningitis should be alert to the possibility of disease in themselves and seek medical care if they develop symptoms of meningitis. If you are going to become ill, the symptoms will show up in just a few days. Most people will get sick in two to ten days; the average is three to four days. 

Yes. Vaccination with available meningococcal vaccines offers longer-term protection and is routinely recommended for adolescents and others at increased risk. 

There are two types of vaccinations for meningococcal disease available in the US. Meningococcal conjugate vaccines (Menactra® and Menveo®) available in the US provide protection against 4 of the 5 most common serogroups of N. meningitidis (serogroups A, C, W, and Y). Serogroup B vaccines (Trumenba® and Bexsero®) provides protection for the other most common serogroup, serogroup B. Meningococcal vaccinations are generally recommended for those beginning at 11-12 years of age with a booster between 16-18 years of age; however, for those persons at an increased risk for meningococcal disease the age recommended is different.

Depending on the brand and your age you may receive different number of doses. Approximately 2 weeks are required following vaccination for the development of protective antibody levels.

The health department investigates every proven or suspected case of meningococcal meningitis that is reported. 

First of all, the health department makes sure that close contacts are treated with preventive antibiotics, and that casual contacts are alerted to the signs and symptoms of disease. The health department also collects information on the particular type of Neisseria meningitidis that causes each illness. If the same particular type is seen in several cases, the health department sometimes recommends immunization of some or all persons in the community. Although there is not strong scientific evidence that mass immunization can stop a community epidemic of meningitis, it is probably worthwhile when a high rate of disease occurs in a community. 

The Texas Department of State Health Services and the Centers for Disease Control and Prevention do not recommend restricting travel, school or church attendance, or group events such as sporting or cultural events when meningitis occurs in the community. The risk is very small in those settings since transmission of the bacteria requires rather close exposure. 

Personal hygiene is very important. This includes: 

• Covering your nose and mouth when sneezing or coughing
• Frequent handwashing 
• Not allowing people to kiss your baby on the mouth 
• Not sharing common eating utensils
• Avoiding overcrowded conditions