Meningococcal Disease
Basics
Description
- Meningococcemia is a blood-borne infection caused by Neisseria meningitidis.
- Bacteremia without meningitis: Patient is acutely ill and may have skin manifestations (rashes, petechiae, and ecchymosis) and hypotension. Bacteremia with meningitis: sudden onset of fever, nausea, vomiting, headache, decreased ability to concentrate, and myalgias
- Disease progresses rapidly (within hours).
- Skin findings and hypotension may be present.
- A petechial rash appears as discrete lesions 1 to 2 mm in diameter; most frequently on the trunk and lower portions of the body; seen in >50% of the patients on presentation
- Purpura fulminans is a severe complication of meningococcal disease and occurs in up to 25% of cases. It is characterized by acute onset of cutaneous hemorrhage and necrosis due to vascular thrombosis and disseminated intravascular coagulopathy.
Epidemiology
Incidence
- The mortality rate is ~13%.
- 11–19% of survivors suffer serious sequelae, including deafness, neurologic deficits, or limb loss.
- Disease is seasonal and peaks in December/January.
- Atypical clinical presentations include abdominal symptoms, septic arthritis, and bacteremic pneumonia.
- Peak incidence occurs in the 1st year of life; 35–40% of cases occur in children aged <5 years. A second peak occurs in adolescence.
- In 2017 (most recent CDC data), there were <350 cases of reported meningococcal disease (incidence rate of 0.18 cases per 100,000 persons) (1); most common in adolescents and young adults, followed by infants aged <1 year
Etiology and Pathophysiology
- N. meningitidis is a fastidious, aerobic, gram-negative diplococcus with at least 13 serotypes.
- N. meningitidis has an outer coat that produces disease-causing endotoxin. Virulence factors promote invasive disease.
- Humans are the only known reservoir for N. meningitidis.
- Major serogroups in the United States are B, C, Y, and W-135.
- Serogroup B is the predominant cause of meningococcemia in children aged <1 year.
- Serogroup C is the most common cause of meningococcal disease in the United States.
- Serogroup Y is the predominant cause of meningococcemia in the elderly (2).
- Major serogroups worldwide are A, B, C, Y, and W-135.
- W-135 is the major cause of disease in the “meningitis belt” of sub-Saharan Africa.
Genetics
Late complement component deficiency has an autosomal recessive inheritance.
Risk Factors
General Prevention
- Two vaccines are currently licensed for use in the United States. Each contains antigens to serogroups A, C, Y, and W-135. Neither provides immunity against serotype B, which is responsible for 1/3 of U.S. cases.
- Meningococcal polysaccharide vaccine (MPSV-4): recommended for patients aged ≥55 years at elevated risk (1)
- Short duration of protection: 1 to 3 years for patients aged <5 years; 3 to 5 years for adolescents and adults
- Often used when traveling to endemic areas, college freshmen, community outbreaks
- Meningococcal conjugate vaccine (MCV-4; MenACWY) (1):
- Routine immunization is recommended for all children aged 11 to 18 years.
- Immunization is recommended for those aged 2 to 55 years with increased risk for meningococcal disease.
- Guillain-Barré syndrome has been associated with the MCV-4 vaccine.
- Meningococcal polysaccharide vaccine (MPSV-4): recommended for patients aged ≥55 years at elevated risk (1)
- The FDA has licensed two serogroup B meningococcal (MenB) vaccines. The first (MenB-FHbp) is a 3-dose series. The second (MenB-4C) is a 2-dose series. Both vaccines were approved for use in persons aged 10 to 25 years. Individuals aged ≥10 years who are at increased risk for meningococcal disease due to persistent complement component deficiencies, anatomic or functional asplenia, should receive MenB vaccine.
- Protective levels of antibody are achieved ~7 to 10 days after primary immunization (2).
- CDC international travel advisory: Vaccine is required for Hajj pilgrims >2 years of age; given to travelers to sub-Saharan Africa (“meningitis belt”)
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Citation
Domino, Frank J., et al., editors. "Meningococcal Disease." 5-Minute Clinical Consult, 27th ed., Wolters Kluwer, 2020. Medicine Central, im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/1688703/all/Meningococcal_Disease.
Meningococcal Disease. In: Domino FJF, Baldor RAR, Golding JJ, et al, eds. 5-Minute Clinical Consult. Wolters Kluwer; 2020. https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/1688703/all/Meningococcal_Disease. Accessed December 9, 2023.
Meningococcal Disease. (2020). In Domino, F. J., Baldor, R. A., Golding, J., & Stephens, M. B. (Eds.), 5-Minute Clinical Consult (27th ed.). Wolters Kluwer. https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/1688703/all/Meningococcal_Disease
Meningococcal Disease [Internet]. In: Domino FJF, Baldor RAR, Golding JJ, Stephens MBM, editors. 5-Minute Clinical Consult. Wolters Kluwer; 2020. [cited 2023 December 09]. Available from: https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/1688703/all/Meningococcal_Disease.
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