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Meningococcal Infections

What are meningococcal infections?

Meningococcal infections are caused by a species of bacteria called Neisseria meningitidis. The most common forms of meningococcal infections include meningitis (infection of the membranes that surround the brain and spinal cord) and blood stream infections. Meningococcal infections are uncommon, but potentially fatal.

  • The National Foundation of Infectious Diseases estimates 2,800 cases of invasive meningococcal disease in the U.S. each year.

  • Meningococcal infections occur most frequently during the late winter and early spring months.

  • Meningococcal infections are most prevalent in children, but also occur in adolescents--particularly college freshman living in dormitories--and adults.

How are meningococcal infections transmitted?

The Neisseria meningitidis bacteria are spread through close contact with infected individuals. Droplets in the air from a sneeze or close conversation can be inhaled and may cause infection. Many individuals who acquire and carry the bacteria in their nose and throat never develop symptoms. In rare cases, the bacteria proliferate rapidly, causing serious illness in both children and adults.

What are the symptoms of meningococcal infections?

The following are the most common symptoms of meningococcal infections. However, each child may experience symptoms differently. Symptoms may include:

  • Meningococcal meningitis. An infection of the membranes that surround the brain and spinal cord.

    • In children older than 1 year, symptoms may include:

      • Fever

      • Neck and/or back pain

      • Headache

      • Nausea and vomiting

      • Neck stiffness

      • A purple-red, splotchy rash or skin discoloration may appear as the disease progresses

    • In infants, symptoms are difficult to pinpoint and may include:

      • Irritability

      • Sleeping all the time

      • Refusing a bottle

      • Crying when picked up or being held

      • inconsolable crying

      • Bulging fontanelle (soft spot on an infant's head)

      • Behavior changes

  • Meningococcemia (blood stream infection). Meningococcemia is a potentially life-threatening illness. Symptoms may occur abruptly and progress rapidly. Immediate intervention and treatment are usually necessary.

    While each child may experience symptoms differently, the following are the most common symptoms of meningococcemia:

    • Fever

    • Chills

    • Sore throat

    • Headache

    • Sensitivity to light

    • Aching muscles and joints

    • Malaise (not feeling well)

    • Exhaustion and weariness

    • Rash, which may appear as follows:

      • Small, red, flat or raised spots

      • Progression of rash to larger red patches or purple lesions (similar in appearance to large bruises)

    With rapid progression of the meningococcemia infection, symptoms may include:

    • Low blood pressure.

    • Very low urine output.

    • Impaired blood clotting that can lead to internal and external bleeding.

    • Infectious shock, a serious state marked by decreased blood pressure and decreased blood flow to important organs such as the kidneys, liver, and brain.

The symptoms of meningococcal meningitis and meningococcemia may resemble other conditions or medical problems. Always consult your child's doctor for a diagnosis.

How are meningococcal meningitis and meningococcemia diagnosed?

In addition to a complete medical history and physical examination, diagnostic studies for meningococcal meningitis and meningococcemia may include:

  • Lumbar puncture (spinal tap). A special needle is placed into the lower back, into the spinal canal. This is the area around the spinal cord. The pressure in the spinal canal and brain can then be measured. A small amount of cerebral spinal fluid (CSF) can be removed and sent for testing to determine if there is an infection or other problems. CSF is the fluid that bathes your child's brain and spinal cord.

  • Blood cultures.

  • Culture of skin lesions or rash.

  • Additional blood work. These tests are done to evaluate bleeding times and cell counts.

What is the treatment for meningococcal infections?

Specific treatment for meningococcal infections will be determined by your child's doctor based on:

  • Your child's age, overall health, and medical history

  • Extent of the disease

  • Your child's tolerance for specific medications, procedures, or therapies

  • Expectations for the course of the disease

  • Your opinion or preference

Prompt treatment is imperative with meningococcal infections. Antibiotics (for example, penicillin) are most commonly used. If a child has severe allergies to penicillin, other antibiotics may be used to treat the infection. Five to seven days of antibiotic therapy is usually effective. A child with meningococcal meningitis or meningococcemia will usually require close observation in a hospital or intensive care unit (ICU).

Other treatment for meningococcal infections is supportive (aimed at treating the symptoms present). A child with severe infection may require supplemental oxygen or mechanical ventilation to assist with breathing. If a child develops severe bleeding, he or she may require blood transfusions.

How can meningococcal infections be prevented?

The meningococcal vaccine, meningococcal conjugate vaccine (MCV4), is recommended by the Centers for Disease Control and Prevention (CDC) for all children 11 to 18 years old and for high-risk children ages 2 to 10. Dosages of MCV4 are recommended for children between 11 and 12 years of age and again at 16 to18 years of age. If the vaccine was not given at age 11 to 12, it should be given when beginning high school, with a booster dose a few years later. Other high-risk children who require immunization with MCV4 include the following:

  • Individuals who have a damaged spleen or children without a spleen

  • College students not already immunized in high school (immunization of college students is recommended by the American College Health Association)

  • Military recruits

  • Individuals who are traveling to countries where the incidence of meningococcal infections is higher (parts of Africa) or epidemic

  • Family members or those in close contact with individuals with meningitis

  • Individuals with a terminal complement deficiency (an autoimmune disorder)

A hospitalized child will require isolation for 24 hours after antibiotics have been administered. Family members or individuals who have been in close contact with a child with meningococcal disease may require antibiotics. If you have questions about exposure, please consult your child's doctor. The CDC recommends the following contacts be treated if exposed to the bacteria:

  • Household contacts, especially young children

  • Child care or nursery school contacts, during previous seven days

  • Direct exposure to the infected child's secretions through kissing or sharing toothbrushes or eating utensils

  • Individuals who frequently sleep in the same area as the infected child

Cases of meningococcal disease should be reported to your local public health department. Staff will provide education to you and your family, as well as to the public.

FYH

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