Meningococcal disease

Last updated: 17 January 2008

What is meningococcal disease?

• Meningococcal disease is a serious illness that usually causes meningitis (inflammation of the lining of the brain and spinal cord) and/or septicaemia (blood poisoning). Rare forms of the disease include septic arthritis (joint infection), pneumonia (lung infection) and conjunctivitis (infection of the outer lining of the eye and eyelid).
• People with meningococcal disease can become extremely unwell very quickly. Five to ten per cent of patients with meningococcal disease die, even despite rapid treatment.
• The disease has become less common in recent years and about 100 to 130 cases are now seen in NSW each year. Winter and spring are the peak seasons for meningococcal disease.
• Meningococcal disease is caused by infection with meningococcus bacteria of which there are several serogroups. In NSW, the most common form is serogroup B. There is no vaccine that is effective against serogroup B in NSW. Compared with serogroup B, disease caused by serogroup C is rare in NSW, especially since the introduction of the meningococcal C vaccine.
• Between 5 and 25 per cent of people carry meningococcal bacteria at the back of the nose and throat without showing any illness or symptoms.

What are the symptoms?

• Symptoms of meningococcal disease are non-specific but may include sudden onset of fever, headache, neck stiffness, joint pain, a rash of red-purple spots or bruises, dislike of bright lights nausea and vomiting.
• Not all of the symptoms may be present at once.
• Young children may have less specific symptoms. These may include irritability, difficulty waking, high-pitched crying, and refusal to eat.
• The typical meningococcal rash doesn't disappear with gentle pressure on the skin. Not all people with meningococcal disease get a rash or the rash may occur late in the disease.
• Sometimes the classic symptoms may follow less specific symptoms including leg pain, cold hands and abnormal skin colour.
• Meningococcal disease can sometimes follow on from other respiratory infections.
• People who have symptoms of meningococcal disease should see a doctor urgently, especially if there is persistent fever, irritability, drowsiness or lethargy, or a child is not feeding normally.

How is it spread?

• Meningococcal bacteria are not easily spread from person to person and the bacteria do not survive well outside the human body.
• The bacteria are passed between people in the secretions from the back of the nose and throat. This generally requires close and prolonged contact with a person carrying the bacteria who is usually completely well. An example of 'close and prolonged contact' is living in the same household or intimate (deep) kissing.
• Meningococcal bacteria are not easily spread by sharing drinks, food or cigarettes.

Who is at risk?

While the disease can affect anyone, those at higher risk include:

• household contacts of patients with meningococcal disease
• infants, small children, adolescents and young adults
• people who are exposed to cigarette smoke and people who are exposed to smokers
• people who practice intimate (deep mouth) kissing with more than one partner
• people who have recently had a viral upper respiratory tract illness
• travellers to countries with high rates of meningococcal disease
• people with no working spleen or who have certain other rare medical conditions.

How is it prevented?

Quitting smoking helps to reduce the risk of spreading the bacteria. Keep cars and homes smoke-free.

Two types of vaccine are available.
• Meningococcal C conjugate vaccine protects against meningococcal group C disease. It is recommended for all children at one year of age (as part of free routine immunisation) and for people who have had meningococcal disease.
• Meningococcal polysaccharide vaccine protects against groups A, C, Y and W135. It is recommended for travellers to countries where there are epidemics of meningococcal disease (eg. sub-Saharan Africa and people travelling to the Hajj in Saudi Arabia).

Both vaccines should be given to laboratory workers dealing with meningococci and to people without a working spleen and with certain other medical problems.

Because vaccines do not protect against the more common meningococcal group B disease, vaccinated people must still be alert for the symptoms and signs of meningococcal disease.

How is it diagnosed?

Diagnosis is based on the patient's history and examination. This is sometimes difficult in the early stages of the disease. Confirmation of the diagnosis involves testing samples from the patient, including blood, cerebrospinal fluid or skin samples. The time taken to get a test result can vary from case to case and depends on the tests performed.

How is it treated?

Patients with meningococcal disease need urgent treatment with antibiotics and treatment is usually started before the diagnosis is confirmed by tests.

What is the public health response?

Hospitals and laboratories notify cases of meningococcal disease to the local Public Health Unit. PHU staff will work with the doctor, the patient or the patient's family to identify the people who have been close to the ill person (depending on the duration and the nature of their exposure, these people are called contacts). Contacts are given information about meningococcal disease. A smaller group of close contacts are carefully identified and are given clearance antibiotics because they are the people most likely to be carrying the bacteria. These antibiotics eliminate the bacteria from the throat and prevent the bacteria from being transmitted to others. Clearance antibiotics are different to the antibiotics used to treat the infection and people who receive clearance antibiotics are still at some risk of developing the disease. All contacts should therefore be aware of the symptoms of meningococcal disease and should see a doctor urgently if these occur.