Clinical Information for Healthcare Professionals

Disease Information

Causes of Bacterial Meningitis

• Neisseria meningitidis
• Streptococcus pneumoniae
• Haemophilus influenzae serotype b (Hib)
• Group B streptococcus (GBS)

Causes of 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: Clinical Overview

Clinical Features

Fever, headache and stiff neck in meningococcal meningitis cases, and sepsis and rash in meningococcemia.

Etiologic Agent

Multiple serogroups of Neisseria meningitidis. Serogroups B, C, and Y cause the majority of disease in the United States.  Serogroup W-135 causes a small portion of disease, and serogroup A causes disease in developing countries and the Meningitis Belt of subSaharan Africa.

Burden of disease

About 1000 cases annually in the United States during 2005-2010. Higher rates of disease in other countries. Largest burden in subSaharan Africa, where epidemics during the dry season can cause disease in up to 2% of a population, resulting in thousands of cases and deaths during large epidemics.

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. Asymptomatic carriers who are not a close contact of a patient with meningococcal disease do not require prophylaxis.

Risk Groups

Risk groups include household contacts of case patients, military recruits, college freshmen who live in dormitories, microbiologists who work with isolates of N. meningitidis, persons traveling to a country where meningococcal disease is epidemic or highly endemic, and patients without spleens or with terminal complement component deficiencies.  Infants less than one year of age and adolescents ages 16 through 21 years have higher rates of disease than other age groups, but cases occur in all age groups including the elderly.

Surveillance

Meningococcal disease is a reportable condition in all US states.  The local health department will conduct an investigation to ensure all close contacts are provided prophylaxis.

Most Requested Vaccine Resources

Meningococcal references and resources, provider education tools, and materials for patients

• Clinical Factsheet
• Proper handling of MCV4 and MPSV4 vaccine
• Recommendations for prevention and control
  ACIP recommendations, standing orders, contraindications...
• Vaccine References & Resources
• Provider Education
• Materials for Patients
• Healthcare Personnel Vaccination Recommendations(66 KB, 1 page)
• Guidelines for Vaccinating Pregnant Women
• Contraindications
• Standing Orders
• ACIP – Vaccines for Children (VFC) Resolution
• More...

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