Meningitis is an inflammation of the linings of the brain and spinal cord caused by either viruses or bacteria.
Viral meningitis is more common than bacterial meningitis and usually occurs in late spring and summer. Signs and symptoms of viral meningitis may include stiff neck, headache, nausea, vomiting, and rash. Most cases of viral meningitis run a short, uneventful course. Since the causative agent is a virus, antibiotics are not effective. Persons who have had contact with an individual with viral meningitis do not require any treatment.
Bacterial meningitis occurs rarely and sporadically throughout the year, although outbreaks tend to occur in late winter and early spring. Bacterial meningitis in college age students is most likely caused by Neisseria meningitidis or Streptococcus pneumoniae. Because meningococcal meningitis can cause grave illness and rapidly progress to death, it requires early diagnosis and treatment. In contrast to viral meningitis, persons who have had intimate contact with a case require prophylactic therapy. Untreated meningococcal disease can be fatal.
How does meningococcal disease occur?
Approximately 10% of the general population carry meningococcal bacteria in the nose and throat in a harmless state. This carrier state may last for days or months before spontaneously disappearing, and it seems to give persons who harbor the bacteria in their upper respiratory tracts some protection from developing meningococcal disease.
During meningococcal disease outbreaks, the percentage of people carrying the bacterium may approach 95%, yet the percentage of people who develop the meningococcal disease is less than 1%. This low occurrence of disease following exposure suggests that a person’s own immune system, in addition to bacterial factors, plays a key role. Meningococcal bacteria cannot usually live for more than a few minutes outside the body. As a result, they are not easily transmitted in water supplies, swimming pools, or by routine contact with an infected person in a classroom, dining room, bar, rest room, etc. Roommates, friends, spouses, and children who have had intimate contact with the oral secretions of a person diagnosed with meningococcal disease are at risk for contracting the disease and should receive prophylactic medication immediately. Examples of such contact include kissing, sharing eating utensils, and being exposed to droplet contamination from the nose or throat.
How many cases of meningococcal disease occur each year?
The annual incidence of meningococcal disease in the
United States is about 1 case per 100,000 population. During the 1998 -99 academic year, 83 cases of meningococcal disease were identified among college students. Six patients died. Cases were reported from 32 states. Among the 60 students for which serogroup information was available, 47% were serogroup C, 27% serogroup B and 19% serogroup Y. 1
Can meningococcal disease be mistaken for other illnesses?
Meningococcal disease is potentially dangerous because it is relatively rare and can be mistaken for other conditions. The possibility of having meningitis may not be considered by someone who feels ill, and early signs and symptoms may be ignored. A person may have symptoms suggestive of a minor cold or flu for a few days before experiencing a rapid progression to severe meningococcal disease.
What are the signs and symptoms of meningococcal disease?
Understanding the characteristic signs and symptoms of meningococcal disease is critical and possibly lifesaving.
Common early symptoms of meningococcal meningitis include fever, severe sudden headache accompanied by mental changes (e.g. malaise,lethargy), and neck stiffness.
A rash may begin as a flat, red eruption, mainly on the arms and legs. It may then evolve into a rash of small dots that do not change with pressure (petechiae). New petechiae can form rapidly, even while the patient is being examined.
What is the treatment for meningococcal disease exposure?
Treatment of infected persons
Meningococcal disease can be rapidly progressive. With early diagnosis and treatment, however, the likelihood of recovery is increased. Early recognition, performance of a lumbar puncture (spinal tap), and a prompt initiation of antimicrobial therapy are crucial.
The use of prophylactic antibiotics such as ciprofloxacin or rifampin is recommended for those who may have been exposed to a person diagnosed with meningococcal disease. Anyone who suspects possible exposure should consult a health care provider immediately. Prophylactic antibiotics may also be prescribed for asymptomatic meningococcus carriers. A bacterial culture from the nose is required for confirmation of carrier status.
As an adjunct to appropriate antibiotic chemoprophylaxis, immunization against the meningococcus bacterium may be recommended when an outbreak has occurred. It is important to note that meningococcal vaccine should not be used in place of chemoprophylaxis for those exposed to an infected person. The protection from the vaccine is to slow in this situation.
Meningococcal Meningitis Vaccine
Immunization against N. meningitidis may be recommended for members of a population that is experiencing an outbreak of meningococcal disease, (e.g. college students where an outbreak has occurred).
Since 1998, the Bates College Health Center has recommended, but not required, the Meningococcal vaccine to all students entering Bates College. The vaccine is available to all Bates students at the Health Center at cost.
The Meningococcal vaccine is effective against serogroups A, C, and Y. This vaccine is not effective in preventing serogroup B. (27% of cases in college students last year).
Numerous studies have demonstrated the immunogenicity and clinical efficacy of meningococcal vaccine. Although protection probably lasts for at least 3 years, the exact timing for a booster has not been determined.
Adverse reactions to the vaccine are mild and infrequent, consisting primarily of redness and pain at the injection site that may last 1-2 days. Rarely, fever of short duration may occur.
New Serogroup B Vaccines
The CDC currently recommends routine vaccination of adolescents at age 11-12 and again at age 16 to protect against four of five major serogroups of the disease (A,C,W and Y). Two new vaccines (Trumenba and Bexsero) were recently approved in the U.S. to protect against the fifth major serogroup, serogroup B meningococcal disease, in individuals ages 10-25 for restricted high risk use. In June 2015, the recommendations will probably be expanded to protect all adolescents against serogroup B meningococcal disease. Both of these new vaccines require more than one dose and should be discussed and initiated with your primary care provider before coming to campus. Students who begin the series at home can complete the vaccine schedule at the Health Center. The student’s account will be billed the cost of the vaccine. It is the student’s responsibility to let the Health Center know when they will need the next dose and provide documentation of previous doses.
Call or visit Bates College Health Center at 31 Campus Ave. (207) 786-6199
“Managing Meningococcal Disease In College Populations-Crisis Kit” Sponsored by the American College Health Association and Connaught Labs., 1994.
1 Maine Epi-Gram, “Meningococcal Vaccine Recommendations for College Students” August 1999.