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 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 (DIC).
Epidemiology
Incidence
- The mortality rate is ~13%.
- 11–19% of survivors suffer serious sequelae, including deafness, neurologic deficits, or limb loss.
- Disease is seasonal, peaks in December/January.
- Atypical clinical presentations include abdominal symptoms, septic arthritis, and bacteremic pneumonia.
- Peak incidence occurs in the first year of life; 35–40% of cases occur in children aged <5 years. A second peak occurs in adolescence.
- In 2021 (most recent CDC data), there were 210 cases of reported meningococcal disease (incidence rate of ~0.2 cases per 100,000 persons) (1); most common in adolescents and young adults, followed by infants <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
- Meningococcal ACWY Vaccines (MenACWY):
- Infants and children: routine vaccination for high-risk children aged 2 months and older
- Adolescents: first dose typically at age 11 or 12 years, with a booster at age 16 years. Teens and young adults (16 through 23 years old) may also receive a serogroup B meningococcal vaccine.
- At-Risk adults: Adults with certain risk factors or who are in an area with an outbreak should also be vaccinated.
- Meningococcal B vaccines (MenB):
- Infants and children: not routinely recommended for all children but may be given to those at increased risk
- Adolescents and young adults: may be administered to individuals aged 16 to 23 years (preferred age is 16 to 18 years) who are not at increased risk, based on shared clinical decision-making
- At-risk individuals: recommended for individuals 10 years and older who are at increased risk
- Special populations: Individuals with certain medical conditions, laboratory workers, or travelers to areas where meningococcal disease is common might also need vaccination.
- Protective levels of antibody are achieved ~7 to 10 days after primary immunization (2).
- CDC international travel advisory: vaccine required for Hajji 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, 33rd ed., Wolters Kluwer, 2025. 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; 2025. https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/1688703/all/Meningococcal_Disease. Accessed December 3, 2024.
Meningococcal Disease. (2025). In Domino, F. J., Baldor, R. A., Golding, J., & Stephens, M. B. (Eds.), 5-Minute Clinical Consult (33rd 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; 2025. [cited 2024 December 03]. Available from: https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/1688703/all/Meningococcal_Disease.
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