May 22, 2024
Authored by: Larry K. Kociolek, M.D., MSCI FSHEA, FPIDS, Doneen West, MBA, PharmD, and Danielle Zerr, MD, MPH
The Centers for Disease Control and Prevention (CDC) issued a Health Alert Network on March 28, 2024 warning providers of an increase in invasive meningococcal disease, primarily attributed to Neisseria meningitidis serogroup Y.
Meningococcal disease is rare, but is associated with high case fatality rates of 10- 15% even when treated with appropriate antibiotics. Although current increases in disease are disproportionately affecting people ages 30–60 years, Black or African American people, and people with HIV, every pediatric and adult demographic is at risk for meningococcal disease.
In pediatric patients, risk of exposure increases in those with secondhand smoke exposure and those living in crowded households or in congregate settings, such as college dormitories. Those living with someone with meningococcal disease has up to an 800-fold increased risk of developing meningococcal disease themselves.
Photo Credit: Centers for Disease Control and Prevention
The Call to Action from the CDC
Healthcare providers should:
- Have a heightened suspicion for meningococcal disease, particularly among populations disproportionately affected by the current increase (see above)
- Be aware that patients may present without symptoms typical of meningitis (see below)
- Ensure that all people recommended for meningococcal vaccination, including people with HIV, are up to date for meningococcal vaccines
Clinical Symptoms:
Meningococcal disease most often presents as meningitis, with symptoms that may include:
- fever
- headache
- stiff neck
- nausea
- vomiting
- photophobia
- altered mental status
Meningococcal disease may also present with bloodstream infection, with symptoms that may include fever and chills, fatigue, vomiting, cold hands and feet, severe aches and pains, rapid breathing, diarrhea, or, in later stages, a dark purple rash. Bloodstream infection can rapidly progress to sudden septic shock and may become life-threatening within hours.
Transmission:
N. meningitidis only infects humans, and transmission occurs via direct contact with respiratory droplets from an infected person. Carriage is highest in adolescents and young adults, mostly due to their lifestyle involving smoking, kissing, visits to bars, and nightclubs, and living in close quarters (Microorganisms, 2020). Transmission to healthcare workers may occur from mucous membrane contact with infectious secretions from close, face-to-face contact during activities such as mouth-to-mouth resuscitation, endotracheal tube placement or management, or open airway suctioning while not wearing or correctly using recommended personal protective equipment.
Prevention:
Meningococcal disease is preventable with vaccination, including for serogroup Y. CDC has published meningococcal vaccine recommendations for young adults and also for certain high-risk groups of infants and younger children.
MenACWY should be given to all 11- to 12-year-olds as part of routine preventive care. A booster dose is recommended at 16 years of age. During an outbreak or tot anyone at increased risk of meningococcal disease, the CDC also recommends a booster dose if 5 or more years have passed since receiving MenACWY.
In certain groups of infants and younger children, CDC recommends MenACWY. Those who remain at increased risk will also require regular boosters for protection.
Serogroup B meningococcal vaccine may be administered to all adolescents and young adults ages 16 through 23 years of age and should be given to adolescents and young adults with certain high-risk conditions.
Treatment:
Due to the high morbidity and mortality of meningococcal disease, effective antibiotics should be administered promptly to any patient suspected of having meningococcal disease. Effective empiric therapy includes extended spectrum cephalosporins, such as cefotaxime or ceftriaxone.
References:
Pizza M, Bekkat-Berkani R, Rappuoli R. Vaccines against Meningococcal Diseases. Microorganisms. 2020 Oct 3;8(10):1521. doi: 10.3390/microorganisms8101521. PMID: 33022961; PMCID: PMC760137