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 (ABCs).
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.

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
• Guidelines for Vaccinating Pregnant Women
• Contraindications
• Standing Orders
• ACIP – Vaccines for Children (VFC) Resolution
• Prevention and Control of Meningococcal Disease: Recommendations of the Advisory Committee on Immunization Practices (ACIP)
• More...