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Meningitis / Meningococcal Disease

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While meningitis vaccination is not required, studies have shown that college students are at increased risk of contracting this potentially life-threatening disease. For this reason, the Centers for Disease Control and Prevention and the American College Health Association strongly recommend that college students consider vaccination to reduce this risk. The State of Colorado requires all new students to sign a Meningococcal Information notice acknowledging that students or their parents/guardians are aware of the risks of meningitis. The form can be printed from the Required Health Forms page.

What is Meningococcal Disease?
Meningococcal disease is a potentially life-threatening bacterial infection. The disease most commonly is expressed as either meningococcal meningitis, an inflammation of the membranes surrounding the brain and spinal cord, or meningococcemia, a presence of bacteria in the blood. Meningococcal disease is caused by Neisseria meningitis, which has become the leading cause of bacterial meningitis in older children and young adults in the United States. Meningococcal disease strikes about 3,000 Americans each year, leading to death in approximately 10-15 percent of cases, which translates into 300 deaths annually. It is estimated that 100 to 125 cases of meningococcal disease occur annually on college campuses and five to 15 students die each year as a result. The disease can result in permanent brain damage, hearing loss, learning disability, amputation, kidney failure, or death.

There are five strains or serogroups of N. meningitis that cause meningococcal disease. These are A, B, C, Y, and W-135. Among the serogroups responsible for invasive meningococcal disease in the United States in 1997, serogroup C caused about 28 percent of cases, serogroup B about 30 percent, serogroup Y about 37 percent, and serogroups A and W-135 were extremely rare. Serogroup A is predominantly a cause of meningococcal disease in Africa and Asia.

In the United States, the incidence of meningitis outbreaks of serogroup C has risen sharply in the past 10 years, especially among young adults in school and community settings. There were 26 outbreaks between 1994 and 1996, four of these outbreaks at a college or university, compared with only 15 outbreaks occurring between 1989 to 1993, including two outbreaks at a college or university.

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What are the Symptoms of Meningococcal Disease?
Meningococcal disease usually peaks in late winter and early spring. The disease can easily be misdiagnosed as something less serious, because symptoms are similar to the flu. The most common symptoms include high fever, headaches, neck stiffness, confusion, nausea, vomiting, lethargy, and/or rashes. Anyone with similar symptoms should contact a physician immediately. If not treated the disease can progress rapidly and can lead to shock and death, often within hours of the onset of symptoms.

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Who is at Risk for Meningococcal Disease?
Meningococcal disease can affect people at any age. Certain groups seem to be at increased risk of contracting the disease including those in close contact with a known case, patients with compromised immunity, and persons traveling to specific endemic areas of Asia, Africa, or South America.

Since 1991, cases of meningococcal disease among 15-24 year olds have more than doubled. Recent evidence found students residing on campus in dormitories appear to be at higher risk for meningococcal disease. The highest risk appeared to be in freshmen living in dormitories, who seemed to have a six times higher risk than college students overall. Data also suggests that certain social behaviors such as exposure to passive and active smoking, bar patronage, and excessive alcohol consumption may increase students' risk for contracting the disease.

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Is there a Meningococcal Vaccine?
The meningococcal vaccine Menactra is highly effective in reducing the risk of meningococcal meningitis caused by several different types of meningococcal bacteria. The vaccine has been shown to create protective levels of antibodies against four of the five more common serogroups of N. meningitidus meningitis. As with any vaccine, meningococcal vaccination may not protect 100% of susceptible individuals. The new Menactra vaccine provides protection for about seven year. The Menomune vaccine lasts three to five years.

The Advisory Committee of Immunization Practices (ACIP) of the U.S. Centers for Disease Control and Prevention (CDC) recommends that college freshmen, particularly those who live in or plan to live in residence halls, should receive the vaccine. Other undergraduate students or graduate students wishing to reduce their risk for meningococcal disease can also choose to be vaccinated.

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Who should not get the Vaccine?
You should not receive the Menactra meningococcal vaccine if:

  • you are pregnant or suspect that you might be pregnant
  • you are allergic to thimerosal, a substance found in several vaccines and in several contact lens solution
  • you have an acute illness, with fever (101F or higher)
  • you have a history of GB Syndrome

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What are the Possible Side Effects of the Vaccine?
The vaccine is considered relatively free of side effects and is generally effective for about seven years. Minor reactions may include redness and swelling at the injection site that may last one to two days. About 2 percent of recipients may develop fever after vaccination. If you develop a high or persistent fever, consult a physician. Extremely rare allergic reactions have occurred, including those resulting in hives, asthma, and even anaphylaxis. As with any vaccine, vaccination with meningitis vaccine does not protect 100 percent of all susceptible individuals.

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How is Meningococcal Disease Transmitted?
Meningococcal bacteria are transmitted through the air via droplets of respiratory secretions and direct contact with persons infected with the disease. Oral contact with shared items such as cigarettes or drinking glasses or through intimate contact such as kissing could put a person at risk for acquiring the infection.

Approximately 10 percent of the general population may carry meningococcal bacteria in their 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 percent, yet the percentage of people who develop meningococcal disease is less than 1 percent. This low occurrence of disease following exposure suggests that a person's own immune system, in addition to bacterial factors, plays a key role in disease development.

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, restroom, 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.

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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 spinal tap, and prompt initiation of antibiotic therapy are crucial.

Treatment for exposed persons
The use of such prophylactic antibiotics as ciprofloxacin or rifampin is recommended for those who may have been exposed to a person diagnosed with meningococcal disease. Anyone who suspects exposure should consult a physician immediately. Prophylactic antibiotics may also be prescribed for asymptomatic meningococcus carriers.

Vaccination
As an adjunct to appropriate antibiotic chemoprophylaxis, immunization against the meningococcal bacterium may be recommended when an outbreak of meningococcal disease has occurred in a community. It is important to note that meningococcal vaccine should not be used in place of chemoprophylaxis for those exposed to an infected person; protection from immunization is too slowly generated in this situation.

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How can One Reduce the Risk of Contracting Meningococcal Disease?
Maximize your body's own immune system response. A lifestyle that includes a balanced diet, adequate sleep, appropriate exercise, and the avoidance of excessive stress is very important. Avoiding upper respiratory tract infections and inhalation of cigarette smoke may help to protect from invasive disease. Everyone should be sensitive to public health measures that decrease exposure to oral secretions, such as covering one's mouth when coughing or sneezing and washing hands after contact with oral secretions.

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Other Web Resources
Other sites with information on meningococcal disease:NOTE: THE LINKS BELOW ARE BROKEN.

NOTE: Wardenburg brochures and information on this web site are designed to give you general health information and education. They should NOT be relied upon for personal diagnosis or treatment. Only your health care provider is qualified to give you a medical opinion. Please talk to your doctor or nurse practitioner if you have any concerns about your health.

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