Meningococcal Disease and Meningococcal Vaccine

It is estimated that every year in the United States approximately 1000 – 1,200 people are infected each year. Treatment typically consists of a regimen of strong antibiotics. However, administering special antibiotics does not guarantee that the person will survive or recover fully from meningitis. Ten to 15% will die from the disease, while 11% – 19% of those who survive often lose their legs or arms, experience loss of cognitive abilities or suffer other serious neuropathy.

What is meningococcal disease?

Meningococcal disease is a contagious bacterial disease caused by the meningococcus (the Neisseria meningitidis bacteria). Although roughly 10% of people currently host the bacteria in their throat and nasal passages, the bacteria does not produce life-threatening symptoms because these people are “carriers” of the disease. Sometimes, when the immune system is compromised due to chronic illness, the Neisseria meningitidis bacteria will infiltrate the body and attack the brain, spinal cord or bloodstream. The most common type of meningococcal disease is meningitis, a bacterial infection targeting the spinal cord (specifically the cerebrospinal fluid) and outer membranes of the brain called meninges. Meningococcal disease may also come in the form of blood infection (septicemia or bacteremia). Meningococcal disease is more common among infants and children.

Where does meningococcal disease come from?

Neisseria meningitidis are more likely to live in people asymptomatically than cause illness. Since pathogens that kill their hosts can no longer spread within a population, many bacteria have learned to adapt to host physiology without causing disease. Scientists postulate that early in the evolution of Neisseria meningitidis, an unknown selection pressure forced the bacteria to make some hosts seriously ill while leaving others unaffected. Possible cases of meningococcal disease may have been described as far back as the 16th century. However, the disease was first clearly reported in 1805 when over 30 people died from meningitis in Switzerland. Eighty years later, two Italian pathologists, Angelo Celli and Ettore Marchiafava, found intracellular micrococci in cerebral spinal fluid, which led to Anton Weichselbaum discovering the bacteria that caused meningococcal disease in 1887. It was not until 1978 that the first meningococcal vaccinations were provided to the public.

How is meningococcal disease transmitted?

Respiratory secretions and saliva are the primary modes of transmission. Anyone harboring the bacteria who sneezes or coughs droplets into the air may infect another person if that person inhales these droplets. Kissing or drinking after someone harboring the bacteria may also spread it through exchange of saliva. However, these bacteria are not as contagious as germs that cause the common cold or the flu. They are not spread by casual contact or by simply breathing the air where a person with meningococcal disease has been. People living in close contact with someone who has meningococcal disease and would be considered at increased risk of getting the infection should consider getting antibiotics to prevent them from getting the disease. A person remains contagious as long as the bacteria remain in their nose and throat.

What are meningococcal disease symptoms?

Symptoms of meningococcal meningitis typically emerge within three to 7 days, including sudden headache, fever and chills, nausea and vomiting, neck stiffness, sensitivity to light, and confusion. Late stage meningococcal symptoms involve seizures and even coma. Meningitis is very serious and can be fatal. In fatal cases, deaths can occur in as little as a few hours, whereas in non-fatal cases, permanent disabilities can include hearing loss and brain damage. Symptoms of the serious meningococcal bloodstream infection septicemia may include fatigue, vomiting, cold hands and feet, chills, severe pain in the muscles, chest or abdomen, diarrhea and rapid breathing. In later stages, patients diagnosed with septicemia may also develop meningococcemia which is a recognizable petechial rash developed under the skin due to blood leakage. Meningococcal septicemia is very serious and can be fatal. In fatal cases, deaths can occur in as little as a few hours, while in non-fatal cases, permanent disabilities can include amputation of toes, fingers, or limbs or severe scarring as a result of skin grafts.

What is the meningococcal vaccine?

The first vaccine for the prevention of meningococcal disease was developed in 1912, and the first polysaccharide vaccines were created in the 1960s. Nowadays,

two kinds of meningococcal vaccines are available in the United States: Menactra and Menveo (meningococcal conjugate vaccine or MCV4) and Menomune (meningococcal polysaccharide vaccine or MPSV4). The conjugate vaccine (intramuscular injection) is recommended for people under 55, while the polysaccharide vaccine (subcutaneous injection) is the only meningococcal vaccine meant for those over 55. The conjugate vaccine is recommended for 11-12 year olds, with a booster given at 15 years old, or for 13-15 year olds, with a booster given at ages 16 through 18. Adolescents who receive their first dose of meningococcal vaccine at or after age 16 years do not need a booster dose. Both of these vaccines protect against 4 types of meningococcal disease. However, there are other types of meningococcal diseases against which these vaccine do not protect. The meningococcal vaccine cannot cause meningococcal disease.

What are the meningococcal vaccine side effects?

While most people experience minimal to no side effects from the meningococcal vaccine, some may suffer brief dizziness, fainting spells and jerky movements that result in falling and injury. However, these side effects are primarily seen in adolescents who receive the vaccination. Falling can be prevented if the person who is feeling dizzy sits or lies down following inoculation. More than 50% of those getting the vaccine report pain and redness at the site of the injection. A much smaller percentage report mild fever that subsides within 48 hours of receiving the vaccine. People suffering an allergic reaction to the vaccine will present symptoms immediately or within a few hours of being injected. Allergic reactions are rare but potentially fatal due to swelling of the throat tissues, tachycardia, difficulty breathing, extreme weakness and spiking fever.

Who should not get the meningococcal vaccine?

People should delay or forego a meningococcal vaccine if they have suffered previous severe allergic reactions to the meningococcal vaccine or other vaccines, they are ill from a moderate or severe illness (influenza, pneumonia, etc), they are pregnant women, they are children without a functioning spleen or have been formally diagnosed with sickle cell disease.

Sources:

http://www.cdc.gov/meningococcal/about/index.html

http://www.ijmm.org/article.asp?issn=0255-0857;year=2006;volume=24;issue=1;spage=7;epage=19;aulast=Manchanda

http://www.cdc.gov/vaccines/vpd-vac/mening/default.htm

http://www.cdc.gov/vaccines/hcp/vis/vis-statements/mening.html

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