Meningococcal Disease

Find out more about the disease spread by kissing


Meningococcal Meningitis hits out of the blue. It's rare, but it's often mistaken for just the flu at first. A healthy college student feeling a bit under the weather; hours later the same student can be desperately ill. There's a way to avoid this.There's a vaccine. The problem is a) not everyone gets it b) the vaccine might not protect against every strain present.

There are different strains of Meningococcus.

Different vaccines have been developed to cover these strains, but one strain in particular was not included in many vaccine regimens. This became a problem for students at Princeton University and University of California at Santa Barbara  (UCSB) in 2013. An outbreak of Meningoccal disease resulted in 13 cases and one death on the campuses in 2013. 

What happens?

Meningococcal meningitis starts with a abrupt fever and headache. It can feel like the flu. Patients develop neck stiffness that progresses over hours. Symptoms may include nausea, vomiting, confusion, drowsiness, light sensitivity (pain looking at lights). There may be a rash on the abdomen, chest, arms, legs made of small dots (petechiae) or purple spots that look like bruising (purpura). If one presses against the rash, it does not disappear.

The disease leads to death in 10-15% infected. It is important anyone with symptoms seeks immediate medical attention.

What to look for

Among the many important signs and symptoms:

  • Light may hurt
  • They feel like they can't move their neck. Their neck is too stiff to nod their head.
  • They may have a rash, little red dots, that don't disappear when pressing a glass against the rash
  • They may become very sleepy or disoriented

It can spread in college dorms

It's a sudden but small, risk faced by those in dorms who may have close contact, sharing drinks or kissing.


It's rare: less than 1000 become sick in the US each year

Meningococcal disease causes about 600-1000 cases annually in the US; 10-20% of survivors may have permanent injury - hearing loss, brain damage, loss of fingers, toes, or limbs. Worse outcomes are seen when bacteria spread to the blood (meningococcemia). 

It's caught through close contact

Meningococcal disease is caused by a bacteria, Neisseria meningitidis, that spreads through saliva or respiratory droplets (especially from coughing or sneezing, but not necessarily). This can spread 3 feet from the infected person. Close contact and close living quarters hasten spread. 

Disease incubation is 3-4 days (2-10 days).

Most cases are sporadic. Some people carry a small amount of meningococcal bacteria in their noses and throats without being sick. They can pass it to someone else unknowingly. This "carriage" can be as high as 10% and is highest in older teenagers and patient contacts. Rates may be as high as 1 in 5 in older teens (in Europe) or household contacts (in New Zealand).

Different people face different risks

Infants are at highest risk, followed by teens and young adults. Those who have no spleen or who have certain genetic factors (complement deficiency) face more risk.

Risk depends on socializing. Sharing drinks or utensils or children playing in daycare can spread the infection. First-year college students in dorms have a higher risk. New military recruits are at risk - but are universally vaccinated in the US.

Gay men have faced outbreaks of meningococcal disease, unrelated to other infections like HIV. New York City saw sudden cases in 2012-2014, as did Los Angeles in 2014. British Columbia saw an outbreak in 2004.

The Hajj pilgrimage to Mecca, which is the largest mass gathering worldwide, has seen W-135 strain outbreaks in the past (2000-2001). Attendees are now required to show proof of vaccination.

In Africa, the Meningitis Belt stretches from Senegal to Ethiopia with over 20,000 cases and 2,000 deaths a year. During each dry season from December through June, meningitis epidemics occur. Most cases and deaths occur in 3 countries: Burkina Faso, Nigeria, Chad.

Other areas of the world see outbreaks. Chile has had continued spread of W-135

There are different types of Meningococcal Meningitis

In the US, there are 3 main serogroups: B,C, Y. Worldwide, there are also A and W-135. US vaccines cover A, C, W-135, Y -- but not B. The meningococcal polysaccharide vaccine (Menomune®) only works for children aged 2 and over (but infants at highest risk). The other vaccines, Menactra® and Menveo® (and MenHibrix®), are meningococcal conjugate vaccines and so can create immune responses in children as young as 9 and 2 months, respectively. Vaccines are recommended in the US at age 11-12 and boosted at 16 (and for all in college).

Serotype B vaccine was formulated separately.

Meningococcus B is a different strain 

About 1 in 3 cases are due to serotype B in the US.  Most infant cases are. Of those over 11 years old, fewer than 1 in 4 are. Rates are higher in Europe. After serotype B outbreaks, Cuba and then Norway developed a special serotype B vaccines (using outer membrane vesicles (OMV)). This was modified for New Zealand and elsewhere. This special vaccine was permitted by the FDA at Princeton and UCSB; both faced serotype B outbreaks with no vaccine in the US. Another US college outbreak in 2010 was also attributed to serotype B.

The meningococcus B vaccine is increasingly being made available around the world. Babies in the UK are now eligible for the MenB vaccine as of September 2015.

How to protect yourself with prophylaxis

Prophylactic antibiotics can be given to prevent disease in close contacts of infected patients. However, only 3-4% of affected households have secondary cases.

Seek treatment immediately

For those who are ill, immediate medical attention is required. Antibiotics are needed; intensive care may be required. Patients should have droplet precautions to avoid transmission.

The infection can spread throughout the body. Some may lose fingers, toes, or limbs from the infection that ensues.

Continue Reading