Meningococcal disease is a rare (about 1000-2600 cases are reported in the United States each year),⁶ but potentially fatal bacterial infection that can cause meningitis—an infection of the tissues surrounding the brain and spinal cord, or meningococcemia (also called sepsis)—a serious blood infection. Meningococcal disease is caused by a bacterium called Neisseria meningitidis.⁶

Viral Meningitis:
Meningitis can also be caused by viruses. Viral meningitis can be serious, but not usually life threatening. Most patients with viral meningitis get better on their own in 7 to 10 days.²⁰

Even people who are usually healthy can get meningitis. Data from the Centers for Disease Control and Prevention (CDC) have shown that following an increased incidence in early infancy, the risk of getting meningococcal disease increases again in early adolescence and peaks between 15-24 years of age.^10,11

Meningococcal disease is spread through the respiratory route, including respiratory droplets and direct contact with respiratory secretions. The disease can be transmitted through close personal contact with a person who is sick with meningococcal disease. There are also carriers who can have the bacteria in their nose and throat but never become sick. Contact with these carriers can also cause someone to contract meningococcal disease.²¹

Experts believe that some behaviors may put people at greater risk for getting meningococcal disease. These behaviors include^6,12,21,22:

• Living in close quarters, such as college dormitories
• Being in crowded situations for prolonged periods of time
• Sharing drinking glasses, water bottles, or eating utensils
• Kissing
• Smoking or being exposed to smoke
• Activities that make people run-down and may weaken the immune system, such as staying out late and having irregular sleeping patterns

Meningococcal disease can manifest itself very quickly, with initial symptoms often being indistinguishable from many other, less-serious illnesses. Early symptoms of meningococcal disease may include:

• Fever
• Malaise
• Myalgia
• Headache

Vomiting and diarrhea can also occur. At later stages patients experience delirium, confusion, a declining level of consciousness, or coma. A rash occurs in a majority of cases as petechiae (small red lesions). These may worsen into larger hemorrhagic lesions, referred to as purpura. In fulminant cases, massive system failure may occur resulting in death within 24 hours of onset of infection.^18,21

Remember: Time is critical when it comes to treating meningococcal disease. PATIENTS MUST BE TREATED IMMEDIATELY if they exhibit fever and other symptoms of meningococcal disease.

The pathogenesis of N meningitidis begins on the nasopharyngeal surface. The airway epithelial surface is covered with a mucus layer that the organism must penetrate. The meningococcus uses bacterial surface factors to adhere to nonciliated cells on the airway surface. Pili enhance attachment but are not necessary for attachment. They act as long-range attachment organelles.

The hydrophilic, highly charged nature of the capsular polysaccharide prevent interactions with the epithelial cell surface. Only unencapsulated meningococci enter epithelial cells, and capsular biosynthesis has been shown to stop as the meningococcus enters the epithelial cell.

On contact with epithelial and endothelial cells, the meningococcus initiates cytoskeletal changes within these cell types. The bacteria are incorporated into vacuoles and are transported to the basolateral surface of the cell.
Once transported to the basolateral surface of the cell they are able to enter the interstitial space and gain entry into the blood stream. Subsequent pilus-mediated attachment may be important in crossing of the blood-brain barrier.²³

As immune response cells continue to attack meningococcal bacteria, dead and dying neutrophils and bacteria cells collect in the infected meninges. The combination of inflamed meninges and increased pressure from dead cells and fluid produce the symptoms of meningitis. Meningitis may lead to death or permanent brain damage. Brain damage may manifest itself as deafness, mental retardation, or other effects.²¹

Meningococcal disease is very dangerous because it often begins with symptoms that look like common viral illnesses such as the flu. Unlike more common and less serious infections, however, meningococcal disease can get worse very rapidly. And even with the best treatment, it can kill an otherwise healthy young person in 24 hours or less.^14,21

In fact, death rates from meningococcal disease are up to 5 times higher among adolescents and young adults (15-24 years of age) compared with younger populations.^6,13

Of those who survive, 1 in 5 will suffer from permanent disabilities as a result of the severe swelling in the brain and spinal cord, and sepsis. These permanent sequelae can include^6,11,15,16:

• Amputation of limbs, fingers, or toes
• Severe scarring
• Brain damage
• Hearing loss
• Kidney damage
• Emotional, psychological problems: anxiety, depression, difficulty working, and more

Rapid diagnosis of invasive meningococcal disease is important in order to begin early antibiotic therapy. A presumptive diagnosis is often made because of the seriousness of the meningococcal infection. In addition, laboratory confirmation of meningococcal disease is important for regional and national surveillance, and in identification and management of outbreaks.

Laboratory confirmation of a clinical diagnosis can be made by culturing blood specimens, cerebrospinal fluid (CSF), skin lesions, and other sites of infection. The CSF is obtained by lumbar puncture and is generally cloudy in the positive case. A Gram stain is usually performed on any of the cultured specimens and is a very useful diagnostic tool. N meningitidis stains as a Gram-negative diplococcus. Treatment must not be delayed because of laboratory testing. Treating with antibiotic therapy on suspicion of meningococcal disease is warranted.²⁴

A patient with meningococcal disease must be treated immediately with an appropriate intravenously - administered antibiotic.^6,21

The risk of getting meningococcal disease can be reduced by avoiding risky behaviors. It can also be prevented via immunization.

Menactra vaccine is indicated for active immunization to prevent invasive meningococcal disease caused by N meningitidis serogroups A, C, Y and
W-135. Menactra vaccine is approved for use in individuals 9 months through 55 years of age. Menactra vaccine does not prevent N meningitidis serogroup B disease.¹

Meningococcal disease is serious and potentially life-threatening. The majority of cases in adolescents and young adults are potentially vaccine preventable.²⁴