Meningococcal Infections

What are meningococcal infections?

Meningococcal infections are caused by a 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 meningococcemia (blood stream infections). Meningococcal infections are uncommon, but can be fatal. These infections occur most often during the late winter and early spring months. Children are more commonly affected, but the illness also occurs in adolescents and adults. College freshman living in dorms are also at risk.

How are meningococcal infections transmitted?

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

What are the symptoms of meningococcal infections?

While, each child may experience symptoms differently, these are the most common:

  • Meningococcal meningitis

    • In children older than 1 year, symptoms may include:

      • Fever

      • Neck and/or back pain

      • Headache

      • Nausea and vomiting

      • Neck stiffness

      • A purple-red, splotchy rash or skin discoloration may appear as the disease progresses

    • In infants, symptoms are difficult to pinpoint and may include:

      • Irritability

      • Listlessness and sleeping all the time

      • Refusing a bottle

      • Crying when picked up or being held

      • Can't be comforted while crying

      • Bulging fontanel (soft spot on an infant's head)

      • Behavior changes

  • Meningococcemia. Meningococcemia is a potentially life-threatening illness. Symptoms may occur suddenly and get worse quickly. Immediate treatment is necessary.

    While each child may experience symptoms differently, the following are the most common symptoms:

    • Fever

    • Chills

    • Sore throat

    • Headache, especially when flexing the neck by moving the chin toward the chest

    • Sensitivity to light

    • Aching muscles and joints

    • Malaise (not feeling well)

    • Exhaustion and weariness

    • Rash, which may appear as follows:

      • Small, red, flat or raised spots

      • Progression of rash to larger red patches or purple lesions (similar in appearance to large bruises)

    As the illness worsens quickly, symptoms may include:

    • Low blood pressure

    • Very low urine output

    • Bleeding

    • Shock, 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 look like other conditions or medical problems. Always consult your child's doctor for a diagnosis.

How are meningococcal meningitis and meningococcemia diagnosed?

In addition to a complete medical history and physical exam, other tests 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. A small amount of cerebral spinal fluid (CSF) can be removed and sent for testing to determine if there is an infection. CSF is the fluid that bathes your child's brain and spinal cord.

  • Blood culture

  • Culture of skin lesions or rash (not common)

  • Other blood tests

What is the treatment for meningococcal infections?

Your child's doctor will consider your child's age, overall health, and other factors when advising treatment. Prompt treatment is needed with meningococcal infections. Antibiotics (for example, 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 will usually require IV antibiotics and 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 be put on a ventilator to assist with breathing.

How can meningococcal infections be prevented?

The meningococcal vaccine, meningococcal conjugate vaccine (MCV4), is recommended by the Centers for Disease Control and Prevention (CDC) for all children 11 to 18 years old. Dosages of MCV4 are recommended for children between 11 and 12 years of age and again at 16 to18 years of age. If the vaccine was not given at age 11 to 12, it should be given when beginning high school, with a booster dose a few years later. High-risk infants and young children can receive meningococcal vaccines beginning at age 2 months. Other high-risk children and adolescents who require immunization with MCV4 include the following:

  • People who have damaged spleens or who do not have spleens

  • College students not already immunized in high school (immunization of college students is recommended by the American College Health Association)

  • Military recruits

  • People who are traveling to countries where the meningococcal infections are common

  • Family members or those in close contact with people with meningitis

  • People with a weak immune system

A hospitalized child will require isolation for 24 hours after antibiotics have been started. Family members or people who 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 doctor. 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 body fluids through kissing or sharing toothbrushes or eating utensils

  • People who frequently sleep in the same area as the infected child

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

Learn more about meningococcus and the meningococcal vaccine at CHOP's Vaccine Education Center.

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