Clinical features include fever, headache, and stiff neck in meningococcal meningitis cases, and sepsis and rash in meningococcemia.
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.
Burden of Disease
Rates of meningococcal disease have been declining in the United States since the late 1990s (see graph at top right). In 2017, there were about 350 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 (see graph at bottom right). Among adolescents and young adults, those 16 through 23 years old have the highest rates of meningococcal disease.
Because of the risks of severe morbidity and death, effective antibiotics should be administered promptly to patients suspected of having meningococcal disease. Empirical therapy for suspected meningococcal disease should include an extended-spectrum cephalosporin, such as cefotaxime or ceftriaxone. Once the microbiologic diagnosis is established, definitive treatment with penicillin G, ampicillin, or an extended-spectrum cephalosporin (cefotaxime or ceftriaxone) is recommended.  However, due to recent reports of β-lactamase-producing N. meningitidis serogroup Y cases in the United States, healthcare providers should ascertain susceptibility of meningococcal isolates to penicillin before using penicillin or ampicillin for treatment.
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.
About 10 to 15 in 100 people infected with meningococcal disease will die. Up to 1 in 5 survivors will have long-term disabilities, such as
- Loss of limb(s)
- Nervous system problems
- Brain damage
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. People who are not a close contact of a patient with meningococcal disease do not require prophylaxis.
Household or close contacts of case patients are at the highest risk for developing meningococcal disease. Infants less than one year old and adolescents 16 through 23 years old have higher rates of disease than other age groups. However, cases occur in all age groups, including the elderly.
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 then offer vaccination to those patients found to have a complement deficiency.
People who take 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)
Recent data suggest that meningococcal vaccines likely provide incomplete protection against invasive meningococcal disease in eculizumab patients. Experts believe this increased risk likely also applies to ravulizumab patients. 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
Learn about CDC’s meningococcal vaccination recommendations, including those for groups at increased risk.
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.
Meningococcal disease is a reportable condition in all states. State and local health departments conduct investigations to ensure all close contacts get prophylaxis. Learn more about meningococcal disease surveillance.
- Meningococcal Vaccination: Information for Healthcare Professionals
- Meningitis Resources for Healthcare Professionals
- Health Advisory: Ciprofloxacin-resistant, β-lactamase-producing Neisseria meningitidis serogroup Y, United States, 2019–2020