Meningococcal Invasive Disease

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Invasive meningococcal infection is caused by a bacterium called Neisseria meningitidis (N. meningitidis).

Although N. meningitidis is a very severe pathogen, it is not as contagious as viruses that cause the common cold or the flu. The bacteria are not spread by casual contact or by simply breathing the air where a person with meningitis has been. 

N. meningitidis spreads from person to person either by:

  • Direct contact with respiratory and throat secretions (e.g. kissing)
  • Indirect contact (e.g. sharing of eating utensils, toothbrushes), or
  • Aerosol droplets (e.g. coughing and sneezing).

Symptoms of invasive meningococcal disease can be different depending on the type of infection the bacteria have caused. The most common symptoms are high fever, chills, drowsiness, and a rash. 

  • Symptoms of meningococcal meningitis may include headache, fever, and stiffness of the neck, sometimes accompanied by nausea, vomiting, visual sensitivity to light, or mental confusion.
  • In newborns and small infants, the classic symptoms of fever, headache, and neck stiffness may be absent or difficult to notice. The infant may appear slow or inactive, have vomiting, be irritable, or be feeding poorly.
  • The symptoms of meningococcemia (infection in the bloodstream) may include a sudden onset of fever and a rash of small purplish spots. In addition to meningitis and septicemia, pneumonia, arthritis, pericarditis, endocarditis, and other clinical presentations also may be observed.

Complications of meningococcal invasive disease can result in permanent hearing loss, brain damage, loss of limbs, and death.

Groups at increased risk for meningococcal invasive disease:

  • People with a damaged or missing spleen 
  • People with an immune system disorder (including complement component deficiency)
  • People exposed to tobacco smoke either directly or second hand
  • Infants and young children
  • International travelers to places where meningococcal disease is common
  • Household contacts of people who are sick with meningococcal disease
  • People who live in close quarters with others including military recruits and college students who live in dormitories
  • Microbiologists who work with isolates of N. meningitidis
  • People who sit directly next to someone with meningococcal disease for 8 or more hours (e.g., airline flight)
  • Healthcare personnel with direct, unprotected exposure to the patient’s oral secretions (e.g., unprotected mouth-to-mouth resuscitation, endotracheal intubation)

Incubation Period
The incubation period is usually 3-4 days, but it can range from 1-10 days.

A person can pass the infection to others for as long as the bacteria are present in discharges from the nose and mouth. A person is no longer infectious after 24 hours of appropriate antimicrobial treatment. (Antimicrobial treatment should be continued for the full duration that it is prescribed.)

Prevention and Vaccination
There are two vaccines that offer protection against the five most common serogroups of Neisseria meningitidis in the United States. 

Routine hand washing and practicing respiratory etiquette (i.e., covering mouth and nose while sneezing or coughing) are essential to prevent the spread of bacteria. Avoiding close contact with people who are sick, and not sharing food, eating utensils, and other personal belongings can also help stop the spread of the bacteria.

For more information about the meningococcal vaccines call the Immunization Division at 800-252-9152.

School Exclusion Policy
Children with meningococcal infections (meningitis or bloodstream infections caused by N. meningitidis) should be kept out of school or childcare until they have been treated appropriately with antibiotics, have written permission from a healthcare provider, and are fever free for 24 hours without the use of fever-suppressing medications. Rules for exclusion of sick children from school and childcare are outlined in the Texas Administrative Code, specifically  Rule 97.7 for schools and  Rule 746.3603 for childcare.

Texas Trends
The number of invasive meningococcal disease cases reached a high of 203 (1.0 cases per 100,000 population) in 2001. Overall, the number of invasive meningococcal disease cases have remained under 40 cases for the last nine years with a record low number of cases (17 cases) reported in 2017. In Texas, the age-specific incidence rate for invasive meningococcal disease is highest in older adults.
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