Meningococcal disease is a serious bacterial disease which is a leading cause of bacterial meningitis in children. It is caused by the bacteria Neisseria Meningitidis also known as meningococcus. Some people may be carrier of the bacteria which is found in the back of their nose and mouth but they will not have any symptoms.
Neisseria meningitidis bacteria can spread from person to person via respiratory droplets (coughing) , throat secretions in saliva and spit ( sharing food, kissing) and through prolonged contact with infected person i.e. in household/hostel/prison.
Meningococcus can cause meningitis which is the inflammation of the lining of the brain and spinal cord which can be lethal. It can also cause bacteremia and septicemia which is the spread of the bacteria in blood to all organ systems.
About 10-15% of those with meningococcal disease has been associated with fatality. Those who survive, 20% may have remnant neurological deficits like deafness, loss of function, brain damage and other nervous system deficits. Early diagnosis and treatment with appropriate antibiotics will reduce the morbidity.
It is more prevalent among children below 1 year old and also in college students among 16-21 years old.Those with asplenia (previously spleen removed ) are also at risk of meningococcal disease.
Meningitis is the infection of the membrane lining of the brain and spinal cord. Symptoms of meningococcal meningitis typically occur 3-7 days post exposure. They include
- nausea and vomiting
- altered mental state (confusion)
- high fever, headache and stiff neck
- Photophobia (sensitive to light )
- Seizures at a later stage
Newborns and infants may not have the typical symptoms of fever, headache and stiff neck. Instead they may present with irritability, vomiting and poor feeding.
Meningococcal Septicemia / Bacteremia
Meningococcal septicemia is a more dangerous deadly form of infection caused by the bacteria neisseria Meningitidis. This occur when the bacteria enters the bloodstream and disseminate throughout the body. The bacteria can destroy blood vessel walls and cause bleeding into the skin and organs.
The symptoms of Meningococcal septicemia include :
- Fever and chills
- Vomiting and diarrhea
- Cold peripherals
- Severe muscle ache and joint aches
- Tachypnoea ( rapid breathing )
- A classic dark purple rash caused by bleeding int the skin (petechiae and puerperal rash) in the later stage.
There are two vaccines available, they can prevent 4 types of meningococcal disease including the common serogroups B,C and Y.
- Meningococcal conjugate vaccine (MCV4) is the preferred vaccine for people less than 55 years of age
- Meningococcal polysaccharide vaccine (MPSV4) has been available since the 1970s. It is the only meningococcal vaccine licensed for those older than 55 years old.
Children between 2 months- 10 years : Meningococcal conjugate vaccine (MenACWY or Hib-MenCY-TT) is recommended for those who are at increased risk for meningococcal disease. Booster doses may be recommended if your child remains at increased risk.
Teenagers between 11-18 years old: Two doses of MCV4 are recommended with the first dose at 11 or 12 years of age, with a booster dose at age 16.If the first dose is given between 13 and 15 years of age, the booster should be given between 16 and 18. If the first dose is given after the 16th birthday, a booster is not needed.
Adults who are at risk should get vaccinated and a booster is recommended if risk still persist. Risk factors include:
- Laboratory staff who always in contact with meningococcal bacteria
- Military recruits
- College freshmen living hostels
- Patients who previously had spleen removed (Asplenia)
- Travelers traveling to places where meningococcal disease is common such as certain parts of Africa
- Contact exposure with patient with meningococcal disease
- Immune-compromised patients.
Contraindications to vaccination
1. Patient who develop anaphylactic reaction to the vaccine before should not take the vaccination.
2. People who are ill and febrile at that time should delay vaccination until they are better.
3. The older vaccine MPSV4 can be given safely to pregnant women. But the newer vaccine MCV4 is not as well studied hence should be avoided.
Side effects of vaccine
Minor side effects such as swelling and redness at site of injection may occur but will resolve within 1-2 days. Very small percentage of people may get low grade fever post vaccine.
Serious allergic reaction to vaccine is very rare and need to be hospitalized.