About Meningococcal Disease
First of all, what are the most important things we can do related to meningococcal disease?
1. Get vaccinated.
2. Know the symptoms.
3. Take good care of yourself to keep your immune system strong.
What is meningococcal disease?
Meningococcal disease can refer to any illness that is caused by the bacteria Neisseria meningitidis, also known as meningococcus. It can affect the lining of the brain and spinal cord (bacterial meningitis), or it can cause infection in the bloodstream (meningococcemia), or both. While it is a rare disease (approximately 600 – 1,000 cases in the U.S. per year)1, college-aged adults are at higher risk.What is the relationship between meningococcal disease and bacterial meningitis?2
The terms “meningococcal disease,” “bacterial meningitis” and “meningitis” are often used interchangeably. However, there are medical differences between these terms:
- Meningococcal disease is caused by Neisseria meningitidis and can manifest as either bacterial meningitis or meningococcemia.
- “Meningitis” is an inflammation of the protective membranes that cover the brain and spinal cord. Although it is usually caused by bacteria or viruses, it can also be caused by injury, cancer or certain drugs. When it is caused by bacteria, including Neisseria meningitidis, it is bacterial meningitis.
The disease is transmitted through respiratory droplets (e.g., coughing, sneezing) or direct contact with an infected person.3 It occurs most often in late winter and early spring, but can happen at any time.4What are the symptoms?
Meningococcal disease is often misdiagnosed as something less serious because early symptoms may be similar to the flu. Symptoms may include: fever, vomiting, severe headache, pain in joints, stiff neck, confusion, sensitivity to light, exhaustion, and/or a rash. However, symptoms of meningococcal disease vary.
The rash usually associated with meningococcemia is called purpura, a purple rash that does not disappear with applied pressure. It is possible that a person may have meningococcal disease even if they do not present with this rash. In Emily’s case, and with several other bacterial meningitis cases we are aware of, a different rash appeared on the torso, arms, legs, etc. This rash looked more like hives.
Immediate recognition and treatment of meningococcal disease is critical. It can progress rapidly and can lead, often within hours of the first symptoms, to death or serious complications including hearing loss, brain damage, limb amputations, and loss of kidney function. For this reason, anyone who thinks they may have meningococcal disease should seek medical care immediately.Who is at risk for contracting the disease?
Anyone can contract meningococcal disease, but adolescents and young adults have an increased risk. Nearly 20 percent of all U.S. cases annually occur in preteens, teens and young adults ages 11-24.5 However, the majority of cases among adolescents are potentially vaccine-preventable.
Certain lifestyle patterns, common among adolescents and young adults increase their risk, including:
- Irregular sleep patterns
- Crowded living situations, such as sleep-away camps, dormitories and other student-style housing arrangements
- Active and passive smoking
- Social situations where there is crowding
Adolescents and young adults can reduce their risk by being immunized against meningococcal disease. Immunization is the best method of prevention. However, maintaining a healthy lifestyle – like getting plenty of rest and not coming into close contact with people who are sick – can also help.6What does it mean to be a disease carrier?
Meningococcal disease is caused by a type of bacteria called meningococcus, or Neisseria meningitidis. About 10% of people “carry” the bacteria without getting meningococcal disease.4 A “carrier” is someone who has the bacteria living in their nose and throat, but it does not invade the body and make them sick. Carriers do not have any symptoms of meningococcal disease but can unknowingly transmit the bacteria to others. Since the bacteria are most often spread by people who carry it, most cases of meningococcal disease appear to be random and aren't linked to other cases.1
Although further data are needed on the impact of current vaccines on carriage, the limited studies that have been conducted among adolescents in the United Kingdom demonstrated that the vaccines do reduce carriage.7,8 Further studies need to be conducted in the U.S. where meningococcal disease epidemiology is different.What vaccines are available to protect against meningococcal disease?
The following vaccines provide protection against meningococcal disease
- Conjugate vaccines:
- Menactra® protects against serogroups A, C, W and Y and is available for use in people age 9 months through 55 years of age.
- MenHibrix® protects against serogroups C and Y and Haemophilus influenza type b (Hib) and is available for use in children 6 weeks of age through 18 months of age.
- Menveo® protects against serogroups A, C, W and Y and is available for use in people 2 months to 55 years of age.
- Polysaccharide vaccine:
- Menomune®, a polysaccharide vaccine that protects against serogroups A, C, W and Y, is available for use in people age 2 years and older.91 This vaccine is primarily used by those who fall outside of the approved age for the above conjugate vaccines.
- Serogroup B vaccines (serogroup B is responsible for about one third of U.S. cases):
- Bexsero®, which is currently under priority review by the U.S. Food and Drug Administration (FDA) for approval., was administered at Princeton University and the University of California, Santa Barbara (UCSB) in 2013 in response to outbreaks of serogroup B meningococcal disease on those campuses. It is currently approved in Europe, Australia and Canada.
- Trumenba®, the first vaccine approved in the U.S. to provide protection against serogroup B meningococcal disease, is now available for use in people ages 10 to 25 years. The FDA licensed this vaccine on October 29, 2014.
The CDC recommends vaccination with the conjugate vaccine (for serogroups A, C, W and Y) at 11 to 12 years old, with a booster dose at age 16. For those who receive the first dose at 13 through 15 years of age, a booster is recommended at 16 through 18.10 The CDC suggests that adolescents receive the vaccine less than five years before starting college.
The CDC has not yet issued a recommendation for serogroup B meningococcal vaccination, but now is a good time to start a conversation with a healthcare provider about it.
- CDC. Factsheet. Help Protect Your Teen Against Meningococcal Disease. Available at: http://www.cdc.gov/features/meningococcal/
- National Meningitis Association. Fact Sheet: Disease and Prevention Information. Available at: http://www.nmaus.org/disease-prevention-information/
- CDC. Factsheet. Meningococcal Disease: Causes & Transmissions. Available at: http://www.cdc.gov/meningococcal/about/causes-transmission.html
- CDC’s Manual for Surveillance of VPD. Chapter 8: Meningococcal Disease. Available at: http://www.cdc.gov/vaccines/Pubs/surv-manual/chpt08-mening.html#f5
- CDC MMWR: Prevention and Control of Meningococcal Disease: Recommendations of the Advisory Committee on Immunization Practices (ACIP). Available at: http://www.cdc.gov/mmwr/preview/mmwrhtml/rr6202a1.htm#Tab2
- CDC. Factsheet. Meningococcal Disease: Prevention. Available at: http://www.cdc.gov/meningococcal/about/prevention.html
- Read, et al. Lancet, 2014. Published online August 19, 2014: http://www.thelancet.com/journals/lancet/article/PIIS0140-6736%2814%2960842-4/fulltext
- Maiden, et. al. JID., 2008. Published online March 1, 2008: http://jid.oxfordjournals.org/content/197/5/737.abstract
- FDA. Menomune. Available at: http://www.fda.gov/BiologicsBloodVaccines/Vaccines/ApprovedProducts/ucm179991.htm
- CDC. Recommended Immunization Schedule for Persons Age 0 Through 18 Years. Available at: http://www.cdc.gov/vaccines/schedules/hcp/imz/child-adolescent-shell.html#f13