Meningococcal disease - Symptoms, Causes, Images, and Treatment Options

Diseases

Highlights & Basics

Key Highlights

Meningococcal disease is an acute contagious illness, characterized by fever, petechial or purpuric rash, and signs of sepsis and/or meningitis.
May progress rapidly to septic shock, with hypotension, acidosis, and disseminated intravascular coagulation.
Highest rates of invasive infection are in children under 5 years of age, especially under 1 year of age, with a second peak occurring in 11- to 24-year-olds and third peak in people >65 years of age.
Diagnosis confirmed by isolation of Neisseria meningitidis from a normally sterile body site.
Confirmed meningococcal infection is treated with a third-generation cephalosporin. Where a cephalosporin is not appropriate, the choice of agent is based on the individual patient circumstances, antibiotic susceptibilities, and local availability.

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Definition

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Citations

Key Articles

Centers for Disease Control and Prevention. Meningococcal disease. Feb 2022 [internet publication].[Full Text]
Mbaeyi SA, Bozio CH, Duffy J, et al; Centers for Disease Control and Prevention. Meningococcal vaccination: recommendations of the Advisory Committee on Immunization Practices, United States, 2020. MMWR Recomm Rep. 2020 Sep 25;69(9):1-41.[Abstract][Full Text]
Centers for Disease Control and Prevention. Child and adolescent immunization schedule by age: recommendations for ages 18 years or younger, United States, 2024. Nov 2023 [internet publication].[Full Text]
Centers for Disease Control and Prevention. Adult immunization schedule by age: recommendations for ages 19 years or older, United States, 2024. Nov 2023 [internet publication].[Full Text]

Other Online Resources

CDC: adult immunization schedule - recommendations for ages 19 years or older
CDC: child and adolescent immunization schedule - recommendations for ages 18 years or younger

Referenced Articles

1. Centers for Disease Control and Prevention. Chapter 8: meningococcal disease. In: Manual for the surveillance of vaccine-preventable diseases. Jan 2022 [internet publication].[Full Text]
2. Pollard AJ. Global epidemiology of meningococcal disease and vaccine efficacy. Pediatr Infect Dis J. 2004 Dec;23(suppl 12):S274-9.[Abstract]
3. Rodgers E, Bentley SD, Borrow R, et al. The global meningitis genome partnership. J Infect. 2020 Oct;81(4):510-20.[Abstract][Full Text]
4. Centers for Disease Control and Prevention. Epidemiology and prevention of vaccine-preventable diseases: the pink book. 14th ed. Chapter 14: meningococcal disease. Aug 2021 [internet publication].[Full Text]
5. Klein JO. Management of the febrile child without a focus of infection in the era of universal pneumococcal immunization. Pediatr Infect Dis J. 2002 Jun;21(6):584-8;discussion 613-4.[Abstract]
6. Lefèvre B, Poinsignon Y, Piau C, et al; Groupe d'Epidémiologie et Recherche en Infectiologie Clinique du Centre et de l'Ouest (GERICCO). Chronic meningococcemia: a report of 26 cases and literature review. Infection. 2019 Apr;47(2):285-8.[Abstract]
7. Centers for Disease Control and Prevention. Meningococcal disease. Feb 2022 [internet publication].[Full Text]
8. MacNeil JR, Blain AE, Wang X, et al. Current epidemiology and trends in meningococcal disease - United States, 1996-2015. Clin Infect Dis. 2018 Apr 3;66(8):1276-81.[Abstract][Full Text]
9. Centers for Disease Control and Prevention. Meningococcal disease in other countries. Feb 2022 [internet publication].[Full Text]
10. Moore AE, MacNeil JR, Wang X, et al. Emergence of localized serogroup W meningococcal disease in the United States - Georgia, 2006-2016. MMWR Morb Mortal Wkly Rep. 2018 Aug 17;67(32):894-7.[Abstract][Full Text]
11. European Centre for Disease Prevention and Control. Invasive meningococcal disease - annual epidemiological report for 2018. Jun 2022 [internet publication].[Full Text]
12. Rosenstein NE, Perkins BA, Stephens DS, et al. Meningococcal disease. N Engl J Med. 2001 May 3;344(18):1378-88.[Abstract]
13. Musher DM. How contagious are common respiratory tract infections? N Engl J Med. 2003 Mar 27;348(13):1256-66.[Abstract]
14. Caugant DA, Tzanakaki G, Kriz P. Lessons from meningococcal carriage studies. FEMS Microbiol Rev. 2007 Jan;31(1):52-63.[Abstract][Full Text]
15. Christensen H, May M, Bowen L, et al. Meningococcal carriage by age: a systematic review and meta-analysis. Lancet Infect Dis. 2010 Dec;10(12):853-61.[Abstract]
16. Maiden MC, Bygraves JA, Feil E, et al. Multilocus sequence typing: a portable approach to the identification of clones within populations of pathogenic microorganisms. Proc Natl Acad Sci U S A. 1998 Mar 17;95(6):3140-5.[Abstract][Full Text]
17. Tzeng YL, Stephens DS. Epidemiology and pathogenesis of Neisseria meningitidis. Microbes Infect. 2000 May;2(6):687-700.[Abstract]
18. Waage A, Brandtzaeg P, Halstensen A, et al. The complex pattern of cytokines in serum from patients with meningococcal septic shock: association between interleukin 6, interleukin 1, and fatal outcome. J Exp Med. 1989 Jan 1;169(1):333-8.[Abstract][Full Text]
19. Brandtzaeg P, Kierulf P, Gaustad P, et al. Plasma endotoxin as a predictor of multiple organ failure and death in systemic meningococcal disease. J Infect Dis. 1989 Feb;159(2):195-204.[Abstract]
20. Mbaeyi SA, Bozio CH, Duffy J, et al; Centers for Disease Control and Prevention. Meningococcal vaccination: recommendations of the Advisory Committee on Immunization Practices, United States, 2020. MMWR Recomm Rep. 2020 Sep 25;69(9):1-41.[Abstract][Full Text]
21. Neal KR, Nguyen-Van-Tam JS, Jeffrey N, et al. Changing carriage rate of Neisseria meningitidis among university students during the first week of term: cross sectional study. BMJ. 2000 Mar 25;320(7238):846-9.[Abstract][Full Text]
22. Fijen CA, Kuijper EJ, te Bulte MT, et al. Assessment of complement deficiency in patients with meningococcal disease in the Netherlands. Clin Infect Dis. 1999 Jan;28(1):98-105.[Abstract][Full Text]
23. McNamara LA, Topaz N, Wang X, et al. High risk for invasive meningococcal disease among patients receiving eculizumab (Soliris) despite receipt of meningococcal vaccine. MMWR Morb Mortal Wkly Rep. 2017 Jul 14;66(27):734-7.[Abstract][Full Text]
24. Centers for Disease Control and Prevention. Meningococcal disease: certain medical conditions as a risk factor. Feb 2022 [internet publication].[Full Text]
25. Miller L, Arakaki L, Ramautar A, et al. Elevated risk for invasive meningococcal disease among persons with HIV. Ann Intern Med. 2014 Jan 7;160(1):30-7.[Abstract]
26. Folaranmi TA, Kretz CB, Kamiya H, et al. Increased risk for meningococcal disease among men who have sex with men in the United States, 2012-2015. Clin Infect Dis. 2017 Sep 1;65(5):756-63.[Abstract][Full Text]
27. Dubey H, Oster P, Fazeli MS, et al. Risk factors for contracting invasive meningococcal disease and related mortality: a systematic literature review and meta-analysis. Int J Infect Dis. 2022 Jun;119:1-9.[Abstract][Full Text]
28. Centers for Disease Control and Prevention. Child and adolescent immunization schedule by age: recommendations for ages 18 years or younger, United States, 2024. Nov 2023 [internet publication].[Full Text]
29. Centers for Disease Control and Prevention. Adult immunization schedule by age: recommendations for ages 19 years or older, United States, 2024. Nov 2023 [internet publication].[Full Text]
30. Lee GM. Preventing infections in children and adults with asplenia. Hematology Am Soc Hematol Educ Program. 2020 Dec 4;2020(1):328-35.[Abstract][Full Text]
31. Mbaeyi SA, Joseph SJ, Blain A, et al. Meningococcal disease among college-aged young adults: 2014-2016. Pediatrics. 2019 Jan;143(1):e20182130. [Erratum in: Pediatrics. 2019 May;143(5):e20190342.][Abstract][Full Text]
32. Mandal S, Campbell H, Ribeiro S, et al. Risk of invasive meningococcal disease in university students in England and optimal strategies for protection using MenACWY vaccine. Vaccine. 2017 Oct 13;35(43):5814-8.[Abstract]
33. Bruce MG, Rosenstein NE, Capparella JM, et al. Risk factors for meningococcal disease in college students. JAMA. 2001 Aug 8;286(6):688-93.[Abstract][Full Text]
34. Public Health England. Guidance for public health management of meningococcal disease in the UK. Aug 2019 [internet publication].[Full Text]
35. Martín-Sánchez M, Fairley CK, Bradshaw CS, et al. Meningococcal vaccine uptake among men who have sex with men in response to an invasive meningococcal C disease outbreak in Melbourne, Australia. Sex Transm Infect. 2020 Jun;96(4):246-50.[Abstract][Full Text]
36. Centers for Disease Control and Prevention: CDC Newsroom. CDC assists with meningococcal disease outbreak investigation in Florida. Jun 2022 [internet publication].[Full Text]
37. Centers for Disease Control and Prevention. Vaccine recommendations and guidelines of the ACIP: meningococcal ACIP vaccine recommendations, 2020. Sep 2020 [internet publication].[Full Text]
38. Ghia CJ, Rambhad GS. Meningococcal disease burden in India: a systematic review and meta-analysis. Microbiol Insights. 2021 Nov 29;14:11786361211053344.[Abstract][Full Text]
39. Sejvar JJ, Johnson D, Popovic T, et al. Assessing the risk of laboratory-acquired meningococcal disease. J Clin Microbiol. 2005 Sep;43(9):4811-4.[Abstract][Full Text]
40. Fischer M, Hedberg K, Cardosi P, et al. Tobacco smoke as a risk factor for meningococcal disease. Pediatr Infect Dis J. 1997 Oct;16(10):979-83.[Abstract]
41. Moore PS, Hierholzer J, DeWitt W, et al. Respiratory viruses and mycoplasma as cofactors for epidemic group A meningococcal meningitis. JAMA. 1990 Sep 12;264(10):1271-5.[Abstract]
42. Thompson MJ, Ninis N, Perera R, et al. Clinical recognition of meningococcal disease in children and adolescents. Lancet. 2006 Feb 4;367(9508):397-403.[Abstract]
43. MacLennan J, Kafatos G, Neal K, et al; United Kingdom Meningococcal Carriage Group. Social behavior and meningococcal carriage in British teenagers. Emerg Infect Dis. 2006 Jun;12(6):950-7.[Abstract][Full Text]
44. Mbaeyi S, Pondo T, Blain A, et al. Incidence of meningococcal disease before and after implementation of quadrivalent meningococcal conjugate vaccine in the United States. JAMA Pediatr. 2020 Sep 1;174(9):843-51.[Abstract][Full Text]
45. World Health Organization. WHO recommendations for routine immunization - summary tables. Nov 2021 [internet publication].[Full Text]
46. Folaranmi T, Rubin L, Martin SW, et al. Use of serogroup B meningococcal vaccines in persons aged ≥10 years at increased risk for serogroup B meningococcal disease: recommendations of the Advisory Committee on Immunization Practices, 2015. MMWR Morb Mortal Wkly Rep. 2015 Jun 12;64(22):608-12.[Abstract][Full Text]
47. Collins JP, Crowe SJ, Ortega-Sanchez IR, et al. Use of the Pfizer pentavalent meningococcal vaccine among persons aged ≥10 years: recommendations of the Advisory Committee on Immunization Practices - United States, 2023. MMWR Morb Mortal Wkly Rep. 2024 Apr 18;73(15):345-50.[Abstract][Full Text]
48. Curtis S, Stobart K, Vandermeer B, et al. Clinical features suggestive of meningitis in children: a systematic review of prospective data. Pediatrics. 2010 Nov;126(5):952-60.[Abstract]
49. National Institute for Health and Care Excellence. Meningitis (bacterial) and meningococcal disease: recognition, diagnosis and management. Mar 2024 [internet publication].[Full Text]
50. McGill F, Heyderman RS, Michael BD, et al. The UK joint specialist societies guideline on the diagnosis and management of acute meningitis and meningococcal sepsis in immunocompetent adults. J Infect. 2016 Apr;72(4):405-38.[Abstract][Full Text]
51. Heckenberg SGB, de Gans J, Brouwer MC, et al. Clinical features, outcome, and meningococcal genotype in 258 adults with meningococcal meningitis: a prospective cohort study. Medicine (Baltimore). 2008 Jul;87(4):185-92.[Abstract][Full Text]
52. American Academy of Pediatrics. Meningococcal infections. In: Kimberlin DW, Barnett ED, Lynfield R, et al, eds. Red Book: 2021-2024 report of the Committee on Infectious Diseases. 32nd ed. Itasca, IL: American Academy of Pediatrics; 2021:519-32.
53. Nadel S, Kroll JS. Diagnosis and management of meningococcal disease: the need for centralized care. FEMS Microbiol Rev. 2007 Jan;31(1):71-83.[Abstract][Full Text]
54. van de Beek D, de Gans J, Spanjaard L, et al. Clinical features and prognostic factors in adults with bacterial meningitis. N Engl J Med. 2004 Oct 28;351(18):1849-59.[Abstract][Full Text]
55. Brouwer MC, Tunkel AR, van de Beek D. Epidemiology, diagnosis, and antimicrobial treatment of acute bacterial meningitis. Clin Microbiol Rev. 2010 July;23(3):467-92.[Abstract][Full Text]
56. van de Beek D, Cabellos C, Dzupova O, et al. ESCMID guideline: diagnosis and treatment of acute bacterial meningitis. Clin Microbiol Infect. 2016 May;22 Suppl 3:S37-62.[Abstract][Full Text]
57. Bryant PA, Li HY, Zaia A, et al. Prospective study of a real-time PCR that is highly sensitive, specific, and clinically useful for diagnosis of meningococcal disease in children. J Clin Microbiol. 2004 Jul;42(7):2919-25.[Abstract][Full Text]
58. Schuurman T, de Boer RF, Kooistra-Smid AM, et al. Prospective study of use of PCR amplification and sequencing of 16S ribosomal DNA from cerebrospinal fluid for diagnosis of bacterial meningitis in a clinical setting. J Clin Microbiol. 2004 Feb;42(2):734-40.[Abstract][Full Text]
59. Straus SE, Thorpe KE, Holroyd-Leduc J. How do I perform a lumbar puncture and analyze the results to diagnose bacterial meningitis? JAMA. 2006 Oct 25;296(16):2012-22.[Abstract][Full Text]
60. Rennick G, Shann F, de Campo J. Cerebral herniation during bacterial meningitis in children. BMJ. 1993 Apr 10;306(6883):953-5.[Abstract][Full Text]
61. Viallon A, Botelho-Nevers E, Zeni F. Clinical decision rules for acute bacterial meningitis: current insights. Open Access Emerg Med. 2016 Apr 19;8:7-16.[Abstract][Full Text]
62. Le Saux N; Canadian Pediatric Society. Position statement: guidelines for the management of suspected and confirmed bacterial meningitis in Canadian children older than 2 months of age. Oct 2020 [internet publication].[Full Text]
63. De Gaudio M, Chiappini E, Galli L, et al. Therapeutic management of bacterial meningitis in children: a systematic review and comparison of published guidelines from a European perspective. J Chemother. 2010 Aug;22(4):226-37.[Abstract]
64. European Centre for Disease Prevention and Control (ECDC). Public health management of sporadic cases of invasive meningococcal disease and their contacts. Oct 2010 [internet publication].[Full Text]
65. Visintin C, Mugglestone MA, Fields EJ, et al. Management of bacterial meningitis and meningococcal septicaemia in children and young people: summary of NICE guidance. BMJ. 2010 Jun 28;340:c3209.[Abstract]
66. Brouwer MC, McIntyre P, Prasad K, et al. Corticosteroids for acute bacterial meningitis. Cochrane Database Syst Rev. 2015 Sep 12;(9):CD004405.[Abstract][Full Text]
67. van de Beek D, Farrar JJ, de Gans J, et al. Adjunctive dexamethasone in bacterial meningitis: a meta-analysis of individual patient data. Lancet Neurol. 2010 Mar;9(3):254-63.[Abstract]
68. Gilbert DN, Chambers HF, Saag MS, et al, eds. The Sanford guide to antimicrobial therapy 2022. 52nd ed. Sperryville, VA: Antimicrobial Therapy, Inc; 2022.
69. Evans L, Rhodes A, Alhazzani W, et al. Surviving Sepsis Campaign: international guidelines for management of sepsis and septic shock 2021. Crit Care Med. 2021 Nov 1;49(11):e1063-143.[Abstract][Full Text]
70. Potts CC, Rodriguez-Rivera LD, Retchless AC, et al. Antimicrobial susceptibility survey of invasive Neisseria meningitidis, United States 2012-2016. J Infect Dis. 2022 Jun 1;225(11):1871-5.[Abstract][Full Text]
71. Alderson MR, Arkwright PD, Bai X, et al; GMI Collaborators. Surveillance and control of meningococcal disease in the COVID-19 era: a Global Meningococcal Initiative review. J Infect. 2022 Mar;84(3):289-96.[Abstract][Full Text]
72. Public Health Agency of Canada. Canadian immunization guide. Aug 2022 [internet publication].[Full Text]
73. Brooks R, Woods CW, Benjamin DK Jr., et al. Increased case-fatality rate associated with outbreaks of Neisseria meningitidis infection, compared with sporadic meningococcal disease, in the United States, 1994-2002. Clin Infect Dis. 2006 Jul 1;43(1):49-54.[Abstract][Full Text]
74. Centers for Disease Control and Prevention. Infection control in healthcare personnel: epidemiology and control of selected infections transmitted among healthcare personnel and patients. Oct 2022 [internet publication]. [Full Text]
75. Zalmanovici Trestioreanu A, Fraser A, Gafter-Gvili A, et al. Antibiotics for preventing meningococcal infections. Cochrane Database Syst Rev. 2013 Oct 25;(10):CD004785.[Abstract][Full Text]
76. Public Health Agency of Canada. Canadian immunization guide part 4 - active vaccines: meningococcal vaccine. Sep 2021 [internet publication].[Full Text]
77. Goldstein EJC, Overturf GD. Indications for the immunological evaluation of patients with meningitis. Clin Infect Dis. 2003 Jan 15;36(2):189-94.[Abstract][Full Text]
78. Platonov AE, Vershinina IV, Kuijper EJ, et al. Long term effects of vaccination of patients deficient in a late complement component with a tetravalent meningococcal polysaccharide vaccine. Vaccine. 2003 Oct 1;21(27-30):4437-47.[Abstract]