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- 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.
- The mortality rate is ~13%.
- 11–19% of survivors suffer serious sequelae, including deafness, neurologic deficits, or limb loss due to peripheral ischemia.
- Disease is seasonal, peaks in December/January.
- In 2016, there were 375 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 <1 year
Etiology and Pathophysiology
- N. meningitidis is a gram-negative diplococcus with at least 13 serotypes.
- N. meningitidis has an outer coat that produces disease-causing endotoxin.
- Major serogroups in the United States are B, C, Y, and W-135.
- Serogroup B is the predominant cause of meningococcemia in children <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.
Late complement component deficiency has an autosomal recessive inheritance.
- 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 (3).
- Meningococcal polysaccharide vaccine (MPSV-4): recommended for patients ≥55 years at elevated risk (1)
- Meningococcal conjugate vaccine (MCV-4): recommended for patients 2 to 55 years of age (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 (3).
- Protective levels of antibody are achieved ~7 to 10 days after primary immunization (2).
- Vaccine is recommended for everyone aged 11 to 18 years and individuals 19 to 55 years who are at increased risk for meningococcal disease.
- Guillain-Barré syndrome has been associated with the MCV-4 vaccine; therefore, a personal history of Guillain-Barré is a relative contraindication for this vaccine.
- CDC international travel advisory
- Vaccine is required by the government of Saudi Arabia for Hajj pilgrims >2 years of age.
- The vaccine should be given to travelers to sub-Saharan Africa (“meningitis belt”).