Meningococcal and Vacination

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Meningitis is an inflammation of the membranes that cover the brain and spinal cord. People sometimes refer to it as spinal meningitis. Meningitis is usually caused by a viral or bacterial infection. Knowing whether meningitis is caused by a virus or bacterium is important because the severity of illness and the treatment differ depending on the cause. Viral meningitis is generally less severe and clears up without specific treatment. But bacterial meningitis can be quite severe and may result in brain damage, hearing loss, or learning disabilities. For bacterial meningitis, it is also important to know which type of bacteria is causing the meningitis because antibiotics can prevent some types from spreading and infecting other people. Before the 1990s, Haemophilus influenzae type b (Hib) was the leading cause of bacterial meningitis. Hib vaccine is now given to all children as part of their routine immunizations. This vaccine has reduced the number of cases of Hib infection and the number of related meningitis cases. Today, Streptococcus pneumoniae and Neisseria meningitidis are the leading causes of bacterial meningitis.


Contents

What are the signs and symptoms of meningitis?

High fever, headache, and stiff neck are common symptoms of meningitis in anyone over the age of 2 years. These symptoms can develop over several hours, or they may take 1 to 2 days. Other symptoms may include nausea, vomiting, discomfort looking into bright lights, confusion, and sleepiness. In newborns and small infants, the classic symptoms of fever, headache, and neck stiffness may be absent or difficult to detect. Infants with meningitis may appear slow or inactive, have vomiting, be irritable, or be feeding poorly. As the disease progresses, patients of any age may have seizures.

Bacterial Meningitis

How is bacterial meningitis diagnosed?

Early diagnosis and treatment are very important. If symptoms occur, the patient should see a doctor immediately. The diagnosis is usually made by growing bacteria from a sample of spinal fluid. The spinal fluid is obtained by performing a spinal tap, in which a needle is inserted into an area in the lower back where fluid in the spinal canal can be collected. Identification of the type of bacteria responsible is important for selection of correct antibiotics.

Can bacterial meningitis be treated?

Bacterial meningitis can be treated with a number of effective antibiotics. It is important, however, that treatment be started early in the course of the disease. Appropriate antibiotic treatment of most common types of bacterial meningitis should reduce the risk of dying from meningitis to below 15%, although the risk is higher among the elderly.

Is bacterial meningitis contagious?

Yes, some forms of bacterial meningitis are contagious. The bacteria can mainly be spread from person to person through the exchange of respiratory and throat secretions. This can occur through coughing, kissing, and sneezing. Fortunately, none of the bacteria that cause meningitis are as contagious as things like the common cold or the flu. Also, the bacteria are not spread by casual contact or by simply breathing the air where a person with meningitis has been.

However, sometimes the bacteria that cause meningitis have spread to other people who have had close or prolonged contact with a patient with meningitis caused by Neisseria meningitidis (also called meningococcal meningitis) or Hib. People in the same household or daycare center, or anyone with direct contact with a patient's oral secretions (such as a boyfriend or girlfriend) would be considered at increased risk of getting the infection. People who qualify as close contacts of a person with meningitis caused by N. meningitidis should receive antibiotics to prevent them from getting the disease. This is known as prophylaxis. Prophylaxis for household contacts of someone with Hib disease is only recommended if there is 1 household contact younger than 48 months who has not been fully immunized against Hib or an immunocompromised child (a child with a weakened immune system) of any age is in the household. The entire household, regardless of age, should receive prophylaxis in these cases.

Are there vaccines against bacterial meningitis?

Yes, there are vaccines against Hib, against some serogroups of N. meningitidis and many types of Streptococcus pneumoniae. The vaccines are safe and highly effective.

The Advisory Committee on Immunization Practices (ACIP) recommends routine vaccination of all persons aged 11-18 years of age with 1 dose of MCV4, the meningococcal conjugate vaccine known as Menactra®, at the earliest opportunity. Pre-teens who are 11-12 years old should be routinely vaccinated at the 11-12 year old check-up as recommended by ACIP. This visit is the best time for adolescents to receive MCV4. Also, since the occurrence of meningococcal disease increases during adolescence, health-care providers should vaccinate previously unvaccinated pre-teens and teens aged 11-18 years with MCV4 at the earliest possible health-care visit.

College freshmen living in dormitories are at increased risk for meningococcal disease and should be vaccinated with MCV4 before college entry if they have not previously been vaccinated. The risk for meningococcal disease among nonfreshmen college students is similar to that for the general population of similar age (age 18-24 years). However, since the vaccines are safe and produce immunity, they can be provided to nonfreshmen college students who want to reduce their risk for meningococcal disease.

Routine vaccination also is recommended for certain persons who have increased risk for meningococcal disease. Use of MCV4 is preferred among people aged 2-55 years; however, use of MPSV4, the meningococcal polysaccharide vaccine known as Menomune®, is recommended among adults over 55 years of age.

There are also vaccines to prevent meningitis due to S. pneumoniae (also called pneumococcal meningitis), which can also prevent other forms of infection due to S. pneumoniae. The pneumococcal polysaccharide vaccine (PPV23) is recommended for all persons over 65 years of age and younger persons at least 2 years old with certain chronic medical problems. There is a vaccine (pneumococcal conjugate vaccine, or PCV7) that is effective in infants for the prevention of pneumococcal infections and is routinely recommended for all children younger than 2 years of age.

Viral Meningitis

What is viral meningitis?

Meningitis is an inflammation of the membranes ("meninges") that cover the brain and spinal cord. Viral infections are the most common cause of meningitis; bacterial infections are the second most common cause. Other, rarer causes of meningitis include fungi, parasites, and non-infectious causes, including those that are related to drugs.

Meningitis caused by viral infections is sometimes called "aseptic meningitis."

Is viral meningitis a serious disease?

Viral ("aseptic") meningitis is serious but rarely fatal in people with normal immune systems. Usually, the symptoms last from 7 to 10 days and the patient recovers completely. Bacterial meningitis, on the other hand, can be very serious and result in disability or death if not treated promptly. Often, the symptoms of viral meningitis and bacterial meningitis are the same. For this reason, if you think you or your child has meningitis, see your doctor as soon as possible.

What causes viral meningitis?

Different viral infections can lead to viral meningitis. But most cases in the United States, particularly during the summer and fall months, are caused by enteroviruses (which include enteroviruses, coxsackieviruses, and echoviruses). Most people who are infected with enteroviruses either have no symptoms or only get a cold, rash, or mouth sores with low-grade fever. And, only a small number of people with enterovirus infections go on to develop meningitis.

Other viral infections that can lead to meningitis include mumps, herpesvirus (such as Epstein-Barr virus, herpes simplex viruses, and varicella-zoster virus—the cause of chickenpox and shingles), measles, and influenza.

Arboviruses, which mosquitoes and other insects spread, can also cause infections that can lead to viral meningitis. And lymphocytic choriomeningitis virus, which is spread by rodents, is a rare cause of viral meningitis.

What are the signs and symptoms of viral meningitis?

Symptoms can appear quickly or they can also take several days to appear, usually after a cold or runny nose, diarrhea, vomiting, or other signs of infection show up. Symptoms in adults may differ from those in children:

  • Common in infants
    • Fever
    • Irritability
    • Poor eating
    • Hard to awaken
  • Common in older children and adults
    • High Fever
    • Severe Headache
    • Stiff Neck
    • Sensitivity to bright light
    • Sleepiness or trouble waking up
    • Nausea, vomiting
    • Lack of appetite

How is viral meningitis diagnosed?

Viral meningitis is usually diagnosed by laboratory tests of a patient’s spinal. The test can reveal whether the patient is infected with a virus or a bacterium. The exact cause of viral meningitis can sometimes be found through tests that show which virus has infected a patient; however, identifying the exact virus causing meningitis may be difficult.

Because the symptoms of viral meningitis are similar to those of bacterial meningitis, which is usually more severe and can be fatal, it is important for people suspected of having meningitis to seek medical care and have their spinal fluid tested. A hospital stay may be necessary in more severe cases or for people with weak immune systems.

How is viral meningitis treated?

There is no specific treatment for viral meningitis. Most patients completely recover on their own within 2 weeks. Antibiotics do not help viral infections, so they are not useful in the treatment of viral meningitis. Doctors often will recommend bed rest, plenty of fluids, and medicine to relieve fever and headache.

A hospital stay may be necessary in more severe cases or for people with weak immune systems.

How is the virus spread?

Different viruses that cause viral meningitis are spread in different ways. Enteroviruses, the most common cause of viral meningitis, are most often spread through direct contact with an infected person’s stool. The virus is spread through this route mainly among small children who are not yet toilet trained. It can also be spread this way to adults changing the diapers of an infected infant.

Enteroviruses and other viruses (such as mumps and varicella-zoster virus) can also be spread through direct or indirect contact with respiratory secretions (saliva, sputum, or nasal mucus) of an infected person. This usually happens through kissing or shaking hands with an infected person or by touching something they have handled and then rubbing your own nose or mouth. The viruses can also stay on surfaces for days and can be transferred from objects. Viruses also can spread directly when infected people cough or sneeze and send droplets containing the virus into the air we breathe.

The time from when a person is infected until they develop symtoms (incubation period) is usually between 3 and 7 days for enteroviruses. An infected person is usually contagious from the time they develop symptoms until the symptoms go away. Young children and people with low immune systems may spread the infection even after symptoms have resolved.

Can I get viral meningitis if I’m around someone who has it?

If you are around someone with viral meningitis, you may be at risk of becoming infected with the virus that made them sick. But you have only a small chance of developing meningitis as a complication of the illness.

How can I reduce my chances of becoming infected with viruses that can lead to viral meningitis?

Viral meningitis most commonly results from infection with enteroviruses. But there are other causes, such as measles, mumps, and chickenpox. Viral meningitis can also be caused by viruses that are spread by mosquitoes and other insects that bite people.

The specific measures for preventing or reducing your risk for viral meningitis depend on the cause.

  • Following good hygiene practices can reduce the spread of viruses, such as enteroviruses, herpesviruses, and measles and mumps viruses. Preventing the spread of virus can be difficult, especially since sometimes people are infected with a virus (like an enterovirus) but do not appear sick. In such cases, infected people can still spread the virus to others. Thus, it is important to always practice good hygiene to help reduce your chances of becoming infected with a virus or of passing one on to someone else:
    • Wash your hands thoroughly and often. This is especially important after changing diapers, using the toilet, or coughing or blowing your nose in a tissue.
    • leaning contaminated surfaces, such as handles and doorknobs or the TV remote control, with soap and water and then disinfecting them with a dilute solution of chlorine-containing bleach also may decrease the spread of viruses. This solution can be made by mixing ¼ cup of bleach with 1 gallon (16 cups) of water.
    • Cover your cough. The viruses that cause viral meningitis can be spread by direct and indirect contact with respiratory secretions, so it is important to cover your cough with a tissue or, if you do not have a tissue, to cough into your upper arm. After using a tissue, place it in the trash and wash your hands.
    • Avoid kissing or sharing a drinking glass, eating utensil, lipstick, or other such items with sick people or with others when you are sick.
  • Receiving vaccinations included in the childhood vaccination schedule can protect children against some diseases that can lead to viral meningitis. These include vaccines against measles and mumps (the MMR vaccine) and chickenpox (the varicella-zoster vaccine).
  • Avoiding bites from mosquitoes and other insects that carry diseases that can infect humans may help reduce your risk for viral meningitis
  • If you have a rodent infestation in and around your home, follow the cleaning and control precautions listed on CDC’s Web site about lymphocytic choriomeningitis.

Risk Factors of Meningitis

The most effective way to protect you and your child against certain types of meningitis is to complete the childhood vaccine schedule. The risk of meningitis increases by not following the recommended vaccine schedule. Other factors that can increase your risk of meningitis include:

  • Age
    • Viral meningitis occurs mostly in children younger than age 5.
    • Before the availability of effective vaccines, bacterial meningitis was most commonly diagnosed in young children. Now, as a result of the protection offered by current childhood vaccines, bacterial meningitis is more commonly diagnosed among pre-teens and young adults.
  • Community Setting
    • Infectious diseases tend to spread quickly wherever larger groups of people gather together. As a result, college students living in dormitories, military personnel and children in childcare facilities are at an increased risk.
  • Pregnancy.
    • Pregnant women are at an increased risk of catching listeriosis. The bacteria that cause listeriosis, listeria bacteria, can also cause meningitis. The unborn baby of a pregnant woman with listeriosis is also at risk.
  • Working with animals
    • Dairy farmers, ranchers, and other people who work with domestic animals are at an increased risk of contracting listeriosis. The bacteria that cause listeriosis, listeria bacteria, can also cause meningitis.
  • Weakened immune system.
    • There are certain diseases, medications and surgical procedures that may weaken the immune system and increase risk of meningitis.

Causes

Meningitis is mostly caused by microorganisms like bacteria, viruses, parasites, and fungi. These microorganisms infect blood and the cerebrospinal fluid (CSF). Meningitis can also develop from non-infectious causes, including certain diseases like AIDS, cancer, diabetes, physical injury, or certain drugs that weaken the body’s immune system.

Bacterial Meningitis

Bacterial meningitis is usually more severe than viral meningitis. Bacterial meningitis can have serious after-effects, such as brain damage, hearing loss, limb amputation, or learning disabilities.

One of the leading causes of bacterial meningitis in children and young adults in the United States is the bacterium Neisseria meningitidis. Meningitis caused by this bacterium is known as meningococcal disease. Causes of bacterial meningitis also vary by age group:

Age Group Causes
Newborn Group B Streptococci, Escherichia coli, Listeria monocytogenes
Infants Neisseria meningitidis, Haemophilus influenzae, Streptococcus pneumoniae
Children N. meningitidis, S. pneumoniae
Adult S. pneumoniae, N. meningitidis, Mycobacteria, Cryptococci


Viral Meningitis

Viral meningitis is generally less severe and resolves without specific treatment.

Most viral meningitis cases in the United States, especially during the summer months, are caused by enteroviruses; however, only a small number of people with enterovirus infections actually develop meningitis.

Other viral infections that can lead to meningitis include

  • Mumps
  • Herpesvirus, including Epstein-Barr virus, herpes simplex viruses, varicella-zoster virus (which also causes chicken pox and shingles), measles, and influenza
  • Viruses spread through mosquitoes and other insects (arboviruses)
  • In rare cases LCMV (lymphocytic choriomeningitis virus), which is spread by rodents, can cause viral meningitis

Non-infectious Meningitis

Non–infectious meningitis causes include

  • Cancers
  • Systemic lupus erythematosus (lupus)
  • Certain drugs
  • Head injury
  • Brain surgery

Transmission

Bacterial Meningitis

Bacterial meningitis is contagious. The bacteria are spread through the exchange of respiratory and throat secretions (i.e., coughing, kissing). Fortunately, none of the bacteria that cause meningitis are as contagious as things like the common cold or the flu. Also, the bacteria are not spread by casual contact or by simply breathing the air where a person with meningitis has been.

Sometimes the bacteria that cause meningitis have spread to other people who have had close or prolonged contact with a patient with meningitis caused by N. meningitidis (also called meningococcal meningitis) or H. influenzae serotype b (also called Hib meningitis)

People in the same household or daycare center or anyone with direct contact with a patient's oral secretions (such as a boyfriend or girlfriend) would be considered at increased risk of getting the infection. People who qualify as close contacts of a person with meningitis caused by N. meningitidis should receive antibiotics to prevent them from getting the disease.

Viral Meningitis

Enteroviruses, the most common cause of viral meningitis, are most often spread from person to person through fecal contamination (which can occur when changing a diaper or using the toilet and not properly washing hands afterwards). Enteroviruses can also be spread through respiratory secretions (saliva, sputum, or nasal mucus) of an infected person. Other viruses, such as mumps and varicella-zoster virus, may also be spread through direct or indirect contact with saliva, sputum, or mucus of an infected person. Contact with an infected person may increase your chance of becoming infected with the virus that made them sick; however you will have a small chance of developing meningitis as a complication of the illness.

Non-infectious Meningitis

This type of meningitis is not spread from person to person. Non-infectious meningitis can be caused by cancers, systemic lupus erythematosus (lupus), certain drugs, head injury, and brain surgery.

Signs & Symptoms

Meningitis infection is characterized by a sudden onset of fever, headache, and stiff neck. It is often accompanied by other symptoms, such as

  • Nausea
  • Vomiting
  • Photophobia (sensitivity to light)
  • Altered mental status

Bacterial Meningitis

The symptoms of bacterial meningitis can appear quickly or over several days. Typically they develop within 3-7 days after exposure.

Infants younger than one month old are at a higher risk for severe infection. In newborns and infants, the classic symptoms of fever, headache, and neck stiffness may be absent or difficult to notice. The infant may appear to be slow or inactive, irritable, vomiting or feeding poorly. In young children, doctors may also look at the child’s reflexes, which can also be a sign of meningitis.

Although the early symptoms of viral meningitis and bacterial meningitis may be similar, later symptoms of bacterial meningitis can be very severe (e.g., seizures, coma). For this reason, if you think you or someone else may have meningitis, see a physician as soon as possible.

Viral Meningitis

Viral meningitis is an infection of the meninges (the covering of the brain and spinal cord) that is caused by a virus. Enteroviruses, the most common cause of viral meningitis, appear most often during the summer and fall in temperate climates.

Viral meningitis can affect babies, children, and adults. It is usually less severe than bacterial meningitis and normally clears up without specific treatment. The symptoms of viral meningitis are similar to those for bacterial meningitis, which can be fatal. Because of this, it is important to see a healthcare provider right away if you think you or your child might have meningitis.

Symptoms of viral meningitis in adults may differ from those in children:

  • Common symptoms in infants
    • Fever
    • Irritability
    • Poor eating
    • Hard to awaken
  • Common symptoms in adults
    • High fever
    • Sever headache
    • Stiff neck
    • Sensitivity to bright light
    • Sleepiness or trouble waking up
    • Nausea, vomiting
    • Lack of appetite

The symptoms of viral meningitis usually last from 7 to 10 days, and people with normal immune systems usually recover completely.

Diagnosis

Early diagnosis and treatment are very important.Classic signs of meningitis include sudden onset of fever, headache and stiff neck. These signs are often accompanied by other symptoms, such as nausea, vomiting, sensitivity to light (photophobia), and altered mental status. Older children and adults may experience a skin rash. In young children, the signs may be more subtle and my include inactivity, irritability, vomiting, or poor feeding. If meningitis is suspected, samples of blood or cerebrospinal fluid are collected and sent to the laboratory for testing. It is important to know the specific cause of meningitis because the severity of illness and the treatment will differ depending on the cause. In the case of bacterial meningitis, for example, antibiotics can help prevent severe illness and reduce the spread of infection from person to person.

Bacterial

If bacteria are present, they can be grown (cultured). Growing the bacteria in the laboratory is important for confirming the presence of bacteria and for identifying the specific type of bacteria that is causing the infection.

Viral

The specific causes of meningitis may be determined by tests used to identify the virus in samples collected from the patient.

Treatment

Bacterial Meningitis

Bacterial meningitis can be treated with a number of effective antibiotics. It is important that treatment be started early in the course of the disease. If bacterial meningitis is suspected, initial treatment with ceftriaxone and vancomycin is recommended. Appropriate antibiotic treatment of the most common types of bacterial meningitis should reduce the risk of dying from meningitis to below 15%, although the risk is higher among the elderly.

Viral Meningitis

There is no specific treatment for viral meningitis. Antibiotics do not help viral infections, so they are not useful in the treatment of viral meningitis. Most patients completely recover on their own within 7 to 10 days. A hospital stay may be necessary in more severe cases or for people with weak immune systems.

Prevention

Keeping up to date with recommended immunizations is the best defense. Good hygiene is also an important way to prevent most infections. Avoid sharing drinking glasses, water bottles, eating utensils, tissues, and lip-gloss/lipsticks. Wash hands often with soap. If you are pregnant, you can reduce your risk of listeriosis (an infection caused by listeria bacteria) by cooking meats thoroughly and by avoiding cheeses made from unpasteurized milk.

Bacterial Meningitis

Routine immunizations can be very effective in preventing meningitis. There are vaccines against Haemophilus influenzae serotype b (Hib), measles, meningococcus, mumps, pneumococcus, and polio that can protect against meningitis caused by these organisms.

There are vaccines for the three main causes of bacterial meningitis: Streptococcus pneumoniae, Haemophilus influenzae serotype b (Hib), and Neisseria meningitidis:

Meningococcal vaccines (Neisseria meningitidis)

There are two vaccines against N. meningitidis available in the U.S. Meningococcal polysaccharide vaccine (MPSV4 or Menomune®) has been approved by the Food and Drug Administration (FDA) and available since 1981. Meningococcal conjugate vaccine (MCV4 or Menactra®) was licensed in 2005. Each vaccine can prevent 4 serotypes of meningococcal disease, including 2 of the 3 types most common in the U.S. (serogroups C, Y, and W-135) and a type that causes epidemics in Africa (serogroup A). Meningococcal vaccines cannot prevent all types of the disease, but they do protect many people who might become sick if they didn't get the vaccine.

Pneumococcal vaccines (Streptococcus pneumoniae)

There are two types of pneumococcal vaccine currently available: a polysaccharide vaccine and a conjugate vaccine. The pneumococcal conjugate vaccine, PCV7 or Prevnar®, licensed in late 2000, is the first pneumococcal vaccine that can be used in children under the age of 2 years. However, pneumococcal vaccines for the prevention of disease among children and adults who are 2 years and older have been in use since 1977. Pneumovax® and Pnu-Immune® are 23-valent polysaccharide vaccines (PPV23) that are currently recommended for use in all adults who are older than 65 years of age and for persons who are 2 years and older and at high risk for disease (e.g., sickle cell disease, HIV infection, or other immunocompromising condition.) For information on pneumococcal vaccines, visit the vaccine site.

Hib vaccine (Haemophilus influenzae serotype b)

The Haemophilus influenzae serotype b (Hib) vaccine is highly effective against bacterial meningitis caused by a type of bacteria called Haemophilus influenzae type b. But is not effective against non-type b Haemophilus influenzae. However, non-type b disease is rare in comparison to pre-vaccine Haemophilus influenzae type b disease. Hib vaccine can also prevent pneumonia (lung infection), epiglottitis (a severe throat infection), and other serious infections caused by Hib. It is recommended for all children under 5 years old in the U.S., and it is usually given to infants starting at two months old. Hib vaccine can be combined with other vaccines. In the U.S., Hib vaccine is available also combined with either DTaP or Hep B vaccine.

Viral Meningitis

Preventing the spread of viruses can be difficult, especially since sometimes people are infected with a virus (like enterovirus), but they do not appear sick. In such cases, people can still spread the virus to others. Following good hygiene practices can help lower your chances of becoming infected with viruses or of passing one on to someone else.

  • Wash your hands thoroughly and often, especially after changing diapers, using the toilet, or coughing or blowing your nose.
  • Clean contaminated surfaces, such as doorknobs or the TV remote control with soap and water and then disinfect them with a dilute solution of chlorine-containing bleach.
  • Avoid kissing or sharing a drinking glass, eating utensil, lipstick, or other such items with sick people or with others when you are sick.
  • Receiving vaccinations included in the childhood vaccination schedule can protect children against some diseases that can lead to viral meningitis. These include vaccines against measles and mumps (MMR vaccine) and chickenpox (varicella-zoster vaccine).
  • Avoiding bites from mosquitoes and other insects that carry diseases that can infect humans may help reduce your risk for viral meningitis.
  • If you have a rodent infestation in and/or around your home, follow the cleaning and control precautions listed on CDC’s website about LCMV (Lymphocytic choriomeningitis virus).

Meningococcal Vaccination

Meningococcal vaccines protect against most types of meningococcal disease, but they do not prevent all cases. There are two vaccines against Neisseria meningitidis available in the United States: meningococcal polysaccharide vaccine (MPSV4 or Menomune®) and meningococcal conjugate vaccine (MCV4 or Menactra®).

For Those Getting Vaccinated

Who does CDC recommend get the vaccine?

  • Children: MCV4 is recommended for certain high-risk children from ages 2 through 10.
  • Pre-teens/Adolescents: MCV4 is routinely recommended for all 11 through 18 year olds. If your child did not get this vaccine at the 11- or 12-year-old check-up, make an appointment for him or her to get it now.
  • Adults: Either MPSV4 vaccine or MCV4 vaccine is recommended for adults if you
    • Are a college freshman living in a dormitory
    • Are a military recruit
    • Have a damaged spleen or your spleen has been removed
    • Have terminal complement deficiency
    • Are a microbiologist who is routinely exposed to Neisseria meningitidis (the causal pathogen)
    • Are traveling to or residing in countries in which the disease is common

People Most at Risk

Bacterial meningitis caused by Neisseria meningitidis bacteria (meningococcal disease) can be fatal and should always be viewed as a medical emergency. About 10% of infected people die from the disease. In non-fatal cases, those affected experience long-term disabilities, such as brain damage, loss of limb, or deafness. Preventing the disease through the use of meningococcal vaccine is important.

Although anyone can get meningitis, pre-teens and adolescents, college freshmen who live in dormitories and travelers to countries where meningitis is always present are at an increased risk for meningococcal disease. Before the availability of effective vaccines, bacterial meningitis was most commonly diagnosed in young children. Now, as a result of the protection offered by current childhood vaccines, bacterial meningitis is more commonly diagnosed among pre-teens and young adults.

  • Pre–teens and Adolescents
    • As children reach their pre-teen and adolescent years, protection provided by some childhood vaccines can begin to wear off. As a result, pre-teens and adolescents are at a greater risk for catching certain diseases. Introducing vaccinations during the pre-teen years increases the level of protection during adolescence. For this reason, the Advisory Committee on Immunization Practices (ACIP) recommends routine vaccination of pre-teens and for those adolescents who have not yet received 1 dose of MCV4.Because the incidence of meningococcal disease increases during adolescence, the ACIP recommends routine vaccination of all persons aged 11-18 years. Children aged 11-12 years should visit their healthcare providers to receive 1 dose of MCV4 and other preventive services.
  • College Freshmen
    • College freshmen, especially those who live in dormitories, are at a slightly increased risk for bacterial meningitis caused by Neisseria meningitidis bacteria (meningococcal disease) compared with other persons of the same age. As of 2009, a total of 34 states have adopted legislation requiring colleges to provide information on risks of meningococcal disease to incoming students and/or students residing on campus, and 15 states have mandated vaccination for certain students, unless a vaccination waiver is provided. There are currently two vaccines licensed in the United States to protect against meningococcal meningitis. The Advisory Committee on Immunization Practices (ACIP) has issued the following recommendations regarding the use of vaccines for college students.
      • Providers of medical care to incoming and current college freshmen who plan to or already live in dormitories and residence halls should inform these students and their parents about meningococcal disease and the benefits of vaccination. ACIP does not recommend that the level of increased risk among freshmen warrants any specific changes in living situations for freshmen.
      • College freshmen who want to reduce their risk for meningococcal disease should either be administered vaccine (by a doctor's office or student health service) or directed to a site where vaccine is available.
      • The risk for meningococcal disease among non-freshmen college students is similar to that for the general population. However, the vaccine is safe and effective and therefore can be provided to non-freshmen students who want to reduce their risk for meningococcal disease.
      • Colleges should inform incoming and/or current freshmen who plan to live or already live in dormitories or residence halls about meningococcal disease and the availability of a safe and effective vaccine.
  • Travelers
    • The Advisory Committee on Immunization Practices (ACIP) recommends vaccination against bacterial meningitis caused by Neisseria meningitidis bacteria (meningococcal disease) to persons who travel to or reside in countries in which the bacterium Neisseria meningitidis is hyperendemic or epidemic, particularly if contact with the local population will be prolonged. The MCV4 vaccine is preferred for persons aged 2-55 years. MPSV4 is the recommended vaccine for persons over age 55; MPSV4 is also an acceptable alternative for persons aged 2-55 years. Vaccination against meningococcal disease is not a requirement for travel to any country except Saudi Arabia, where travelers to Mecca during the annual Hajj and Umrah pilgrimage must have proof of vaccination with quadrivalent vaccine in the last 3 years. Vaccination is recommended for persons traveling to the meningitis belt in Africa during the dry season, December through June. Advisories for travelers to other countries will be issued when epidemics of meningococcal disease caused by vaccine-preventable serogroups are recognized.

Like bacterial meningitis, viral meningitis can affect anyone. But infants younger than 1 month old and people whose immune systems are weak are at higher risk for severe infection. People who are around someone with viral meningitis have a chance of becoming infected with the virus that made that person sick, but they are not likely to develop meningitis as a complication of the illness.

Clinical Information for Healthcare Professionals

Disease Information

Causes

Bacterial Meningitis
  • Neisseria meningitidis
  • Streptococcus pneumoniae
  • Haemophilus influenzae serotype b (Hib)
  • Group B streptococcus (GBS)
Viral Meningitis
  • Enterovirus—In the United States (especially during the summer months) most viral meningitis cases are caused by enteroviruses. This is a group of viruses that includes enteroviruses, coxsackieviruses, and echoviruses. For more information, see
    • Non-Polio Enterovirus Infections
    • Hand, Foot, and Mouth Disease
  • Measles
  • Influenza
  • Mumps
  • Herpesvirus, such as
    • Epstein-Barr virus
    • Herpes simplex viruses
    • Varicella-zoster virus—the cause of chickenpox and shingles
  • Arboviruses—These viruses, which are spread by mosquitoes and other insects, can also cause infections that can lead to viral meningitis
  • Lymphocytic Choriomeningitis Virus—This virus, which is spread by rodents, is a rare cause of viral meningitis.

Meningococcal Disease (Bacterial Meningitis and Meningococcemia): Technical & Clinical Information Chart

Clinical Features Fever, headache and stiff neck in meningitis cases, and sepsis and rash in meningococcemia.
Etiologic Agent Multiple serogroups of Neisseria meningitidis.
Incidence 0.5-5/100,000 for endemic disease, worldwide in distribution. During 1996-1997, 213,658 cases with 21,830 deaths were reported in West African countries. Up to 2% in epidemics in Africa.
Sequelae 10%-14% of cases are fatal. Of patients who recover 11%-19% have permanent hearing loss, mental retardation, loss of limbs, or other serious sequelae.
Transmission N. meningitidis colonizes mucosal surfaces of nasopharynx and is transmitted through direct contact with large droplet respiratory secretions from the patients or asymptomatic carriers. Humans are the only host.
Risk Groups Risk groups include infants and young children (for endemic disease), refugees, household contacts of case patients, military recruits, college freshmen who live in dormitories, microbiologists who work with isolates of N. meningitidis, patients without spleens or with terminal complement component deficiencies, and people exposed to active and passive tobacco smoke.
Surveillance Surveillance is conducted worldwide through International Disease Notification and in the United States by NETSS, and CDC's Active Bacterial Core surveillance
Trends Devastating epidemics will continue to occur in countries throughout the meningitis belt of Africa; emergence of epidemics due to a newer serogroup (W-135) in Africa; in the United States, increased frequency of outbreaks and changes distribution of serogroups responsible for endemic disease (increase in cases due to serogroup Y) as well as increased disease among adolescents and young adults.
Challenges Establishing surveillance and early detection of epidemics in Africa, followed by emergency mass vaccination campaigns reaching high vaccine coverage; integration of meningitis surveillance with surveillance for other epidemic-prone diseases; and introduction of conjugate meningococcal vaccines into routine childhood immunization programs in the United States and Africa.
Opportunities Incorporation of meningococcal conjugate vaccine in U.S. routine vaccination programs. Routine vaccination of infants in selected African countries and mass vaccination of children and adults using newer conjugated meningococcal vaccines.

Laboratory Information

he CDC Meningitis Laboratory provides laboratory support for U.S. active population based surveillance for an overall population base of more than 30 million people for Neisseria meningitidis and Haemophilus influenzae.

CDC's national meningococcal laboratory surveillance data play a critical role in continuing efforts to combat meningococcal pathogens. Laboratory data, together with Active Bacterial Core surveillance (ABCs) meningococcal isolates, serve as a valuable resource for outside researchers.

The laboratory serves health departments throughout the U.S. in the characterization of meningococcal isolates for outbreak support and other public health concerns, and is also very active internationally. The lab is a well-recognized reference center for identification and characterization of Neisseria meningitidis and Haemophilus influenzae.

In addition to surveillance and reference activities, the lab is actively involved with specialized meningococcal research projects that have direct public health relevance, with numerous collaborators in academia and industry.

Reference Lab

The Meningitis Laboratory can offer advice concerning laboratory procedures dealing with bacterial meningitis. If you feel that your bacterial meningitis isolates have novel features with potential public health impact, the lab is glad to discuss ways to assist in characterizing these isolates. Suspected outbreaks should be reported to state or local health departments.

Unfortunately, the lab does not have the resources to perform typing or other characterization for all requests sent to CDC's Meningitis Laboratory. Therefore, requestors are asked to discuss with the lab, in advance, the reason for the request so that the resources can be allocated to type those isolates that will answer the most pressing public health questions. An outbreak is one example of a situation in which rapid serotyping has immediate value. Vaccine failures and serotype replacement have been well documented in the literature, and useful population based data is generated through the Active Bacterial Core surveillance.

The lab will provide typing or other tests only upon prior communication with a contact in the Meningitis Laboratory (contact below) indicating the reason for this service.

Meningitis in Other Countries

Bacterial Meningitis in Other Countries

Many countries suffer from endemic meningococcal disease, primarily in children under the age of five, at an annual attack rate of around 1 to 3 per 100,000 of the population. Some of these countries, mostly in the developing world, suffer from repeated epidemics of meningitis.

In temperate regions the number of cases increases in winter and spring. Serogroups B and C together account for a large majority of cases in Europe and the Americas. Several local outbreaks due to N. meningitidis serogroup C have been reported in Canada and the U.S. (1992-93) and in Spain (1995-97). Major African epidemics are associated with N. meningitidis serogroup A, which is usually the cause of meningococcal disease in Asia.

There is increasing evidence of serogroup W-135 being associated with outbreaks of considerable size. In 2000 and 2001 several hundred pilgrims attending the Hajj in Saudi Arabia were infected with N. meningitidis W-135. Then in 2002, W-135 emerged in Burkina Faso, striking 13,000 people and killing 1,500.

Epidemics in Africa

Studies show that:

  • Epidemic meningitis has been present on the African continent for about 100 years
  • The disease prevails in the sub-Saharan meningitis belt
  • Epidemics there occur in the dry season (December to June), dying out during the intervening rainy season
  • Epidemics usually take place in irregular cycles every 5-12 years
  • Serogroup A meningococci account for about 80-85 percent of all cases
  • In 2002 there was a major outbreak of meningococcal meningitis in Burkina Faso with about 80 percent of cases due to serogroup W-135

The size of these epidemics can be enormous. In major African epidemics, the attack rate ranges from 100 to 800 per 100,000 population, but individual communities have reported rates as high as 1 per 100. In comparison, the average attack rate in industrialized nations is around 1 to 3 per 100,000 of the population.

Between 1988 and 1997, 704,000 cases and more than 100,000 deaths were reported in Africa, some 20,000 occurring in 1996, the largest epidemic year ever recorded. Between 1998 and 2002, African countries within the meningitis belt reported more than 224,000 new cases of meningococcal meningitis. However, the true disease burden is likely to be greater because routine reporting systems break down during epidemics. In addition, many people die before reaching a health center and thus remain unrecorded in official statistics.

While all the risk factors for meningococcal outbreaks in Africa are not understood, several conditions have been associated with the development of epidemics in the meningitis belt. They include:

  • Medical conditions: immunological susceptibility of the population
  • Demographic conditions: travel and large population displacements
  • Socioeconomic conditions: poor living conditions and overcrowded housing
  • Climatic conditions: drought and dust storms

Source: [1]

Related Videos

Have You Heard?

Pre-teens, adolescents, and college freshmen who live in dorms are at an increased risk for meningococcal disease. This podcast discusses routine vaccination recommendations for 11-18 year olds.

Video at YouTube



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