Clinical Information

Clinical features

Clinical features include fever, headache, and stiff neck in meningococcal meningitis cases, and sepsis and rash in meningococcemia.

Etiologic agent

There are multiple serogroups of Neisseria meningitidis. Serogroups B, C, and Y cause the majority of disease in the United States. Serogroup W and nongroupable strains cause a small portion of disease.

Best practices for use of polymerase chain reaction (PCR) for diagnosing Haemophilus influenzae and Neisseria meningitidis disease and public health importance of identifying serotype/serogroup

Burden of disease

Rates of meningococcal disease have declined in the United States since the 1990s and remain low. In 2019, there were about 375 total cases of meningococcal disease reported (incidence rate of 0.11 cases per 100,000 persons). Anyone can get meningococcal disease, but rates of disease are highest in children younger than 1 year old, with a second peak in adolescence. Among adolescents and young adults, those 16 through 23 years old have the highest rates of meningococcal disease. Learn more about meningococcal disease trends.

Treatment

Because of the risks of severe morbidity and death, effective antibiotics should be administered promptly to patients suspected of having meningococcal disease.

Extended-spectrum cephalosporins used for empirical therapy

Empirical therapy for suspected meningococcal disease should include an extended-spectrum cephalosporin, such as cefotaxime or ceftriaxone.

Treatment with penicillin or ampicillin requires susceptibility testing

Once the microbiologic diagnosis is established, definitive treatment can be continued with an extended-spectrum cephalosporin (cefotaxime or ceftriaxone). Alternatively, if susceptibility of the meningococcal isolate to penicillin is confirmed, treatment can be switched to penicillin G or ampicillin.

Additional treatment may be needed to eradicate nasopharyngeal carriage

Ceftriaxone clears nasopharyngeal carriage effectively after 1 dose. If antimicrobial agents other than ceftriaxone or cefotaxime are used for treatment of meningococcal disease, eradication of nasopharyngeal carriage with rifampin (4 doses over 2 days) or single doses of ciprofloxacin or ceftriaxone are recommended prior to discharge from the hospital.

Sequelae

About 10 to 15 in 100 people with meningococcal disease will die. Up to 1 in 5 survivors will have long-term disabilities, such as

  • Loss of limb(s)
  • Deafness
  • Nervous system problems
  • Brain damage

Transmission

People spread meningococcal bacteria to others by exchanging respiratory and throat secretions during close or lengthy contact. People with meningococcal disease and those who carry the bacteria asymptomatically in the nasopharynx can spread the bacteria. Humans are the only host.

Risk groups

Household or close contacts of case patients are at the highest risk for developing meningococcal disease. Infants less than one year old, adolescents and young adults 16 through 23 years old, and adults over 85 years of age have higher rates of disease than other age groups. However, cases occur in all age groups.

In addition, people with certain medical conditions are at increased risk for meningococcal disease. These medical conditions include

  • Functional or anatomic asplenia
  • Persistent complement component deficiencies (e.g., C3, C5-9, properdin, factor H, factor D)
  • HIV infection

Clinicians should consider complement testing in patients with meningococcal disease. Meningococcal disease is often the first sign that a person has complement deficiency, which is a hereditary condition. In addition, recurrent disease may occur for patients with complement deficiency. Clinicians should offer vaccination to those patients found to have a complement deficiency.

People who receive complement inhibitors (e.g., eculizumab [Soliris®], ravulizumab [Ultomiris™]) are also at increased risk for meningococcal disease. Clinicians typically prescribe complement inhibitors for treatment of

  • Atypical hemolytic uremic syndrome (aHUS)
  • Paroxysmal nocturnal hemoglobinuria (PNH)
  • Generalized myasthenia gravis (MG)
  • Neuromyelitis optica spectrum disorder (NMOSD)

Recent data suggest that meningococcal vaccines likely provide incomplete protection against invasive meningococcal disease in patients receiving eculizumab. Experts believe this increased risk likely also applies to patients receiving ravulizumab. Learn more about managing patients who receive complement inhibitors.

The following groups of people also have an increased risk for meningococcal disease:

  • Microbiologists who are routinely exposed to isolates of Neisseria meningitidis
  • People identified as being at increased risk because of an outbreak of meningococcal disease
  • People traveling to a country where meningococcal disease is epidemic or highly endemic
  • First-year college students who live in residence halls
  • Military recruits

Prevention

CDC recommends meningococcal vaccination for all preteens and teens. CDC also recommends clinicians vaccinate children and adults who are at increased risk for meningococcal disease. See Meningococcal Vaccination: Information for Healthcare Professionals for information on all meningococcal vaccine recommendations by vaccine, age, and indication.

CDC also recommends chemoprophylaxis for close contacts of patients with meningococcal disease, regardless of immunization status. See the “Chemoprophylaxis” section of the meningococcal chapter of the Manual for the Surveillance of Vaccine-Preventable Diseases for additional guidance.

Due to recent reports of ciprofloxacin-resistant, β-lactamase-producing N. meningitidis serogroup Y cases in the United States, clinicians and public health staff should

  • Consider antimicrobial susceptibility testing on meningococcal isolates to inform prophylaxis decisions if their state has reported a case of meningococcal disease caused by ciprofloxacin-resistant strains within the past 2 years.
  • Update prophylaxis practices around N. meningitidis cases as needed based on detection of ciprofloxacin-resistance cases. View CDC guidance on changing prophylaxis antibiotics in areas with ciprofloxacin resistance.

Surveillance

Meningococcal disease is a reportable condition in all states. State and local health departments conduct investigations to ensure all close contacts get prophylaxis.

Cases of meningococcal disease in the United States have increased sharply since 2021 and now exceed pre-pandemic levels.

Learn more about recent trends, including antimicrobial resistance, and what healthcare providers should do: meningococcal disease surveillance.

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