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Meningococcal meningitis, meningococcal disease, meningococcemia

WISCONSIN DIVISION OF PUBLIC HEALTH Department of Health and Family Services Meningococcal Disease
(meningococcal meningitis, meningococcemia)

What is meningococcal disease?
Meningococcal disease includes meningococcal meningitis and meningococcemia.
Meningococcal meningitis is a severe form of meningitis (inflammation of the meninges,
the tissues that cover the brain and spinal cord) caused by the bacterium Neisseria
. Meningococcemia is an infection of the blood with Neisseria meningitidis.
A person may have either meningococcal meningitis or meningococcemia, or both at
the same time.

What are the symptoms?
The signs and symptoms of meningococcal disease can vary widely, but include sudden
onset of high fever, headache, vomiting, stiff neck and a rash. Sensitivity to light,
sleepiness and confusion may also occur. Symptoms may be difficult to detect in infants
and the infant may only appear lethargic, irritable, have vomiting, or be feeding poorly.
As the disease progresses, patients of any age may have seizures. Meningococcal
disease is fatal in 8-15% of cases.

How soon do the symptoms appear?
The symptoms may develop rapidly, sometimes in a matter of hours, but usually over
the course of 1-2 days. In some cases, death may occur within hours of the onset of
symptoms. The symptoms may appear anytime between 2 and 10 days after exposure,
but usually within 3 to 4 days.

Who gets meningococcal disease?
N. meningitidis bacteria are commonly found in the nose and throat without ever
causing disease. Nationally, it is estimated that 5-10% of the population is carrying the
bacterium at any given time. Most people exposed to N. meningitidis do not become ill.
It is not well understood why only a few people develop invasive illness, but may be
influenced by genetic, immune (e.g., preceding viral illness, immune compromised),
societal (e.g., overcrowding, smoke exposure) or physical factors making them more
susceptible to disease.
Anyone can get meningococcal disease, but it is most common in children under 5.
Compared to other persons their age, college freshmen, especially those that live in
dormitories, are at a slightly increased risk for meningococcal disease.

How are the bacteria that cause meningococcal disease spread?
The meningococcus bacteria are spread by direct contact with respiratory and oral
secretions (saliva, sputum or nasal mucus) of an infected person.
When and for how long is an infected person able to spread the disease?
A person with meningococcal disease may transmit the disease beginning several days
before he/she becomes ill, until the bacteria are no longer present in discharges from
the nose and throat. Patients should be excluded from school, daycare or the work
place until at least 24 hours after therapy was begun and the illness has subsided.
What is the treatment for meningococcal disease?
Meningococcal disease can be treated with a number of effective antibiotics. Persons
who have been in close, direct contact with a patient with meningococcal disease may
need to take antibiotics such as rifampin, ciprofloxacin or ceftriaxone as a preventive
measure to eliminate the bacteria that they may be carrying in their throat.

Should people who have been in contact with a person with a diagnosed case of
meningococcal disease be treated?
Only people who have been in close, direct contact need to be considered for
preventive treatment. Close contacts include household members, intimate contacts,
persons performing mouth to mouth resuscitation or endotracheal intubation, day care
center classmates, or anyone directly exposed to the patient’s oral or nasal secretions
(e.g., kissing, sharing eating utensils or beverage containers). Direct contacts are
usually advised to take preventive antibiotics. Close contacts should be alerted to
watch for early signs of illness, especially fever, and seek treatment promptly.
Casual contact that might occur in a classroom, office or work setting is not usually
significant enough to warrant antibiotic treatment.

Is there a vaccine to prevent meningococcal disease?
There are two vaccines (Menomune®, Menactra™) that will protect against four of the
types of meningococcus, including 2 of the 3 types most common in the U.S. (serogroup
C, Y, and W-135) and a type that causes epidemics in Africa (serogroup A).
Meningococcal vaccines cannot prevent all types of the disease (neither protect against
type B). The vaccine is recommended in some outbreak situations or for travelers to
areas of the world where high rates of the disease are known to occur. College
freshman living in dormitories should consider receiving the vaccine due to their slightly
elevated risk of acquiring the disease.
In 2005, the Advisory Committee on Immunization Practices (ACIP) recommended that
children receive the new meningococcal vaccine (Menactra™) at their routine 11-12
year old doctor’s visit and that for the next two to three years, teens entering high school
should also be vaccinated.


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