Meningococcal Disease

What is Meningococcal Disease

Meningococcal disease is a potentially life-threatening
bacterial infection.
Expressed as either
Meningococcal meningitis, or
Meningococcemia
Meningococcal disease was first described in 1805
when an outbreak swept through Geneva, Switzerland.
The causative agent, Neisseria meningitidis
(meningococcus), was identified in 1887.

WHO

Public Health Significance?

Leading cause of bacterial meningitis in children
and young adults in the U.S
2,400 to 3,000 cases each year in U.S.
5% to 10% of patients die, typically within 24-48
hours of onset of symptoms.
10 to 20% of survivors of bacterial meningitis may
result in brain damage, permanent hearing loss,
learning disability or other serious sequelae.
Meningococcal septicemia - rapid circulatory
collapse.
sequelae:

WHO

Meningococcal Disease
Etiologic Agent:
Neisseria meningitidis (Gram-negative diplococcus
bacterium) with multiple serogroups ( A, B, C, D,
29E, H, I, K, L, W-135, X, Y, and Z).
Strains belonging to groups A, B, C, Y and W-135
are implicated most frequently in invasive disease.
Implicate:

Clinical Presentation
> 2 Years :
High fever, headache, and stiff neck.
Other symptoms include nausea, vomiting, discomfort looking
into bright lights, confusion, and sleepiness.

Newborns and small infants:

Classic symptoms may be absent or difficult to detect.
In babies under one year of age, the soft spot on the top of the
head (fontanel) may bulge upward.
Infant may only appear slow or inactive, or be irritable, have
vomiting, or be feeding poorly.
Bulge:

Upward:

Irritable:

Meningococcal Disease
Incubation Period:
The incubation period is variable, 2-10 days,
but usually 3-4 days

Infectious Period:
An infected person is infectious as long as
meningococci are present in nasal and oral
secretions or until 24 hours after initiation of
effective antibiotic treatment.

Case Definition
Clinical Description:
Meningococcal disease manifests most commonly as
meningitis and/or meningococcemia that may progress
rapidly to purpura fulminans, shock, and death. However,
other manifestations might be observed.

Laboratory criteria for diagnosis:

Isolation of Neisseria meningitidis from a normally sterile site
(e.g., blood or cerebrospinal fluid (CSF) or, less commonly,
joint, pleural, or pericardial fluid)
Manifest:

Case Definition
Case Classification
Probable: a case with a positive antigen test in
cerebrospinal fluid or clinical purpura fulminans
in the absence of a positive blood culture.

Confirmed: a clinically compatible case that is

laboratory confirmed.

Epidemiology
Reservoir:
Humans are the only known reservoir of Neisseria
Meningitidis.

Mode of Transmission:
Person to person through droplets of respiratory
or throat secretions.
Close and prolonged contact e.g.,
(kissing, sneezing and coughing on someone,
living in close quarters or dormitories (military recruits,
students), sharing eating or drinking utensils, etc.)

MMWR Morb Mortal Wkly Rep. 2000;49(RR-7):13-20

Public Health Actions

Education:
Public
Providers
Laboratories

Public Health Actions

Upon receiving a report of invasive meningococcal
disease:
1. Determine if reported case is probable or
confirmed.
2. Assure that isolates are forwarded to the Office
of Laboratory Services for serogrouping.
3. Determine if contacts need prophylaxis.
4. Recommend prophylaxis if indicated.
5. Complete appropriate report form(s).
6. Send completed forms to IDEP

Comparison of incidence of meningococcal

meningitis in Maryland college students to
similar age group in the general population.
The average annual incidence among students
enrolled in four-year schools = 1.74 per 100,000
The average annual incidence in the general
population of the same age =
1.44 per 100,000
Incidence in students who were on-campus
residents = 3.24 per 100,000
Incidence in students in students living
off-campus = .96 per 100,000
Harrison LH, Dwyer DM, Maples CT, Billmann L: Risk of Meningococcal Infection in College Students.
JAMA. 1999;281(20) 1906-1910

QUESTIONS