Meningococcal Disease

Cause: Neisseria meningitidis mainly serogroups B, C, Y, and W135 in the United States, and additionally serogroup A, elsewhere. Invasive disease is reportable.

Illness and treatment: Invasive meningococcal disease is most commonly meningitis with symptoms of fever, headache, stiff neck, vomiting, light sensitivity and confusion. Bloodstream infection (meningococcemia) causes fever and often shock, as well as a rash or bruise-like skin lesions. A case may have both syndromes. Pneumonia and joint infections can occur. Even with appropriate antibiotic treatment and supportive care, case fatality rate is 9-12%.

Sources: Humans, including asymptomatic carriers, are the reservoir. Transmission is through respiratory droplets or direct contact with respiratory secretions. Secondary cases are rarely documented, though outbreaks can occur.

Additional risks: Rates are highest for infants under 12 months. An increasing proportion of cases are in adolescents and young adults. Crowded living conditions, low socioeconomic status, and tobacco smoke exposure may increase risk, as do certain immune deficiencies including asplenia.

Prevention: Universal immunization of all adolescents aged 11–18 years and persons aged 2–55 years who are considered at increased risk is recommended. Good respiratory hygiene can reduce the likelihood of transmission. Exposed persons should take prophylactic antibiotics.

Recent Washington trends: During the past decade, 26 to 76 cases have been reported annually, with 1 to 8 deaths each year.

Purpose of Reporting and Surveillance

To identify persons who have been significantly exposed to the index case, in order to recommend antibiotic prophylaxis (chemoprophylaxis) and to inform them about signs and symptoms of illness.
Under very rare circumstances, to recommend prophylactic immunization in a defined population or community.

Legal Reporting Requirements

Health care providers and Health care facilities: immediately notifiable to local health jurisdiction
Laboratories: immediately notifiable to local health jurisdiction; submission required – isolate from a normally sterile site, within 2 business days; submission on request – if no isolate available, specimen associated with positive result, within 2 business days.
Local health jurisdictions: notifiable to Washington State Department of Health (DOH) Communicable Disease Epidemiology (CDE) within 7 days of case investigation completion or summary information required within 21 days.