Meningococcal disease

What is meningococcal disease?

Meningococcal disease is an infection caused by a type of bacterium known as the meningococcus bacterium, or Neisseria meningitides.

The main forms of invasive meningococcal disease include:

  • meningitis, where the infection involves the meninges — the covering of the brain and spinal cord;
  • meningococcal septicaemia, where the bacteria invade the bloodstream causing blood poisoning; and
  • a combination of meningitis and septicaemia.

People can also carry meningococcus in the nose or throat and yet remain well — these people are known as carriers. Carriers can spread the bacteria to other people (usually through fine droplets spread by coughing or sneezing), some of whom will become very unwell with invasive meningococcal disease.

Symptoms and signs

Anyone can develop meningococcal disease, though it is more common in the under-fives and adolescents/young adults.

People with meningococcal disease are usually very unwell. Symptoms and signs of meningococcal septicaemia may include:

  • high fever;
  • lethargy, drowsiness, irritability or confusion;
  • vomiting and/or diarrhoea;
  • cold hands and feet;
  • pain in the joints or muscles; and
  • a rash, which may start as very small red or purple spots then enlarge to look like bruises.

People with meningococcal meningitis may have the following symptoms:

  • fever;
  • severe headache;
  • dislike of bright lights (photophobia);
  • neck stiffness;
  • cold hands and feet;
  • lethargy, drowsiness, irritability or confusion;
  • vomiting;
  • seizures; and
  • pain in the joints and muscles.

In young babies the signs of meningococcal disease may differ from those in older children and adults, and may include:

  • fever;
  • drowsiness;
  • floppiness;
  • irritability;
  • dislike of being handled;
  • a high-pitched moaning cry;
  • disinterest in or refusing to feed;
  • vomiting and/or diarrhoea;
  • a rash of red-purple spots or bruises;
  • pale, blotchy skin; and
  • a bulging fontanelle (soft spot on top of the head).

It is important to remember that most of the time not all of these symptoms are present.

Infection with meningococcal disease can develop very quickly, and can be fatal. Anyone with symptoms or signs suggestive of the disease requires medical attention immediately.

Diagnosis and tests

Tests that are usually performed when meningococcal disease is suspected include the following.

  • Blood cultures, to test for the presence of Neisseria meningitides in the blood.
  • Lumbar puncture, where a sample of cerebrospinal fluid (CSF) — the fluid that surrounds the brain and spinal cord — is taken and tested for evidence of meningococcal infection.
  • Head CT or MRI to check for evidence of swelling or inflammation around the brain.

Treatment for meningococcal disease

Treatment includes:

  • intravenous antibiotics – antibiotics that are given into a vein via a drip; and
  • corticosteroid medicine (dexamethasone or hydrocortisone), which is also usually given intravenously and can reduce the risk of complications.

With early diagnosis and treatment, most people make a full recovery. Some people will suffer long-term complications, such as deafness, following a meningococcal infection.

Preventing meningococcal disease

Vaccination

There are many different strains (serogroups) of meningococcal disease — those that most commonly cause disease globally are groups A, B, C, W and Y. There are vaccines available against several strains of meningococcal disease, including the most common disease-causing strains in Australia — groups B and C.

Since 2003, vaccination against group C meningococcus has been part of the National Immunisation Program Schedule for all children aged 12 months.

A meningococcal B vaccine is available through purchase on the private market and can be given from the age of 2 months. This vaccine is not currently part of the National Immunisation Program Schedule. Meningococcal B vaccine is recommended for:

  • infants and young children;
  • adolescents aged 15 to 19 years; and
  • people with medical conditions that put them at high risk of meningococcal disease.

A quadrivalent meningococcal vaccine is available that offers protection against 4 strains of meningococci — A, C, W135 and Y. This vaccine is only recommended for use in certain situations, including overseas travel to at-risk areas and for people with medical conditions that put them at increased risk of meningococcal disease.

No vaccine is able to offer 100 per cent protection against meningococcal disease, so even if you or your child have been immunised, it is important to seek immediate medical attention if any symptoms of meningococcal disease are present.

Meningococcal vaccination side effects

Possible adverse effects associated with meningococcal vaccination include:

  • redness and soreness at the injection site;
  • fever;
  • irritability or drowsiness in young children;
  • decreased appetite; and
  • headaches.

Fever is a common side effect associated with meningococcal B vaccine, especially when used in children aged 2 to 12 months. It is recommended that paracetamol is given with meningococcal B vaccine to prevent or reduce fever.

Antibiotics

Those who have been in close contact with someone with meningococcal disease, such as members of the same household, are given antibiotics in case they are a carrier who could spread the disease to others. It is important to be aware that even if contacts have had antibiotics, they could still develop the infection — so immediate medical help is needed if they develop any symptoms.

References

1. Australian Government Department of Health and Ageing. The Australian Immunisation Handbook, 10th Edition 2013. 4.10 Meningococcal disease (updated 17 Jan 2014). http://www.immunise.health.gov.au/internet/immunise/publishing.nsf/Content/handbook10-4-10 (accessed Jul 2014).
2. Australian Government Department of Health. National Immunisation Program Schedule (from July 2013). http://www.immunise.health.gov.au/internet/immunise/publishing.nsf/Content/nips-ctn (accessed Jul 2014).
3. Immunise Australia Program. Meningococcal disease (updated 4 Mar 2014). http://www.immunise.health.gov.au/internet/immunise/publishing.nsf/Content/immunise-meningococcal (accessed Jul 2014).
4. Chemoprophylaxis for meningitis (revised June 2010). In: eTG complete. Melbourne: Therapeutic Guidelines Limited; 2014 Mar. http://online.tg.org.au/complete/ (accessed Jul 2014).
5. MayoClinic.com. Meningitis (updated 19 Mar 2013). http://www.mayoclinic.org/diseases-conditions/meningitis/basics/definition/con-20019713 (accessed Jul 2014).
6. Children’s Hospital Westmead; Sydney Children’s Hospital, Kaleidoscope Hunter Children’s Network. Fact sheet – meningococcal infection (updated 6 Apr 2010). http://kidshealth.schn.health.nsw.gov.au/sites/kidshealth.schn.health.nsw.gov.au/files/fact-sheets/pdf/meningococcal-infection.pdf (accessed Aug 2014).
myDr