Meningococcal Infections

What are meningococcal infections?

Meningococcal infections are caused by a group of bacteria called Neisseria meningitidis. The most common forms of meningococcal infections include meningitis (infection of the membranes that surround the brain and spinal cord) and blood stream infections. Meningococcal infections are usually uncommon, but potentially fatal.

• The National Foundation of Infectious Diseases estimates 2,600 cases of invasive meningococcal disease in the US each year.
  
  
• Meningococcal infections occur most frequently during the late winter and early spring months.
  
  
• Meningococcal infections are most prevalent in children, but also occur in adolescents and adults.

How are meningococcal infections transmitted?

The Neisseria meningitidis bacteria are spread through close contact with infected individuals. Droplets in the air from a sneeze or close conversation can be inhaled and may cause infection. Many individuals who acquire the bacteria in their nose and throat never develop symptoms. In rare cases, the bacteria proliferate rapidly causing serious illness in both children and adults.

What are the symptoms of meningococcal infections?

The following are the most common symptoms of meningococcal infections. However, each child may experience symptoms differently. Symptoms may include:

• meningococcal meningitis - an infection of the membranes that surround the brain and spinal cord.
  
  
  • in children older than 1 one year, symptoms may include:
    
    
    • neck and/or back pain
    • headache
    • nausea and vomiting
    • neck stiffness
      
      
  • in infants, symptoms are difficult to pinpoint and may include:
    
    
    • irritability
    • sleeping all the time
    • refusing bottle
    • cries when picked up or being held
    • inconsolable crying
    • bulging fontanelle (soft spot on an infants head)
    • behavior changes
      
      
• meningococcemia (blood stream infection) - meningococcemia is a potentially life-threatening illness. Symptoms may occur abruptly and progress rapidly. Immediate intervention and treatment are usually necessary.
  While each child may experience symptoms differently, the following are the most common symptoms of meningococcemia:
  
  
  • fever
  • chills
  • sore throat
  • headache
  • aching muscles and joints
  • malaise (not feeling well)
  • exhaustion and weariness
  • rash, which may appear as follows:
    
    
    • small, red flat or raised, fine rash
      
      
    • progression of rash to larger red patches or purple lesions (similar in appearance to large bruises)
      
      
  With rapid progression of the meningococcemia infection, symptoms may include:
  
  
  • low blood pressure
    
    
  • very low urine output
    
    
  • impaired blood clotting that can lead to internal and external bleeding
    
    
  • infectious shock is a serious state marked by decreased blood pressure and decreased blood flow to important organs such as the kidneys, liver, and brain

The symptoms of meningococcal meningitis and meningococcemia may resemble other conditions or medical problems. Always consult your child's physician for a diagnosis.

How are meningococcal meningitis and meningococcemia diagnosed?

In addition to a complete medical history and physical examination, diagnostic studies for meningococcal meningitis and meningococcemia may include:

• lumbar puncture (spinal tap)- a special needle is placed into the lower back, into the spinal canal. This is the area around the spinal cord. The pressure in the spinal canal and brain can then be measured. A small amount of cerebral spinal fluid (CSF) can be removed and sent for testing to determine if there is an infection or other problems. CSF is the fluid that bathes your child's brain and spinal cord.
  
  
• blood cultures
  
  
• culture of skin lesions or rash
  
  
• additional blood work (to evaluate bleeding times and cell counts)

Treatment for meningococcal infections:

Specific treatment for meningococcal infections will be determined by your child's physician based on:

• your child's age, overall health, and medical history
• extent of the disease
• your child's tolerance for specific medications, procedures, or therapies
• expectations for the course of the disease
• your opinion or preference

Prompt treatment is imperative with meningococcal infections. Antibiotics (i.e., penicillin) are most commonly used. If a child has severe allergies to penicillin, other antibiotics may be used to treat the infection. Five to seven days of antibiotic therapy is usually effective. A child with meningococcal meningitis or meningococcemia may require close observation in a hospital or intensive care unit (ICU).
 
Other treatment for meningococcal infections is supportive (aimed at treating the symptoms present). A child with severe infection may require supplemental oxygen or mechanical ventilation to assist with breathing. If a child develops severe bleeding, he/she may require blood transfusions.

Prevention of meningococcal infections:

For Neisseria meningitides (the bacteria that causes meningococcal meningitis), two types of meningococcal vaccine are now available for children. Individuals who should be immunized include the following:

• asplenic children (children without a spleen)
  
  
• children with certain types of problems with their immune system
  
  
• college students not already immunized (immunization of college students is  recommended by the American College Health Association)
  
  
• children 11 years of age or older
  
  
• military recruits
  
  
• individuals who are traveling to countries where the incidence of meningococcal infection is higher (parts of Africa)

Your child’s physician can let you know whether you child needs meningococcal vaccine and which vaccine is recommended for your child. There have been recent shortages of vaccine. Your child’s physician can keep you updated on current recommendations.
 
A hospitalized child will require isolation for 24 hours after antibiotics have been administered. Family members or individuals that have been in close contact with a child with meningococcal disease may require antibiotics. If you have questions about exposure, please consult your child's physician. The CDC recommends the following contacts be treated if exposed to the bacteria:

• household contacts, especially young children
  
  
• child care or nursery school contacts, during previous seven days
  
  
• direct exposure to the infected child's secretions through kissing, sharing toothbrushes, or eating utensils
  
  
• individuals who frequently sleep in the same area as the infected child

Cases of meningococcal disease should be reported to your local public health department. They will provide education to you and your family, as well as to the public.

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