Invasive Meningococcal Disease (spinal meningitis, cerebrospinal fever, meningococcemia)

Page Contents

• • What is invasive meningococcal disease?
• • Who gets invasive meningococcal disease?
• • How is invasive meningococcal disease spread?
• • What are the symptoms of invasive meningococcal disease?
• • How soon after infection do symptoms appear?
• • When and for how long is an infected person able to spread the disease?
• • How is invasive meningococcal disease diagnosed?
• • What is the treatment for invasive meningococcal disease?
• • Should people who have been in contact with a diagnosed case of invasive meningococcal disease receive preventive treatment?
• • Is there a vaccine to prevent invasive meningococcal disease?
• • Is meningococcal vaccine required for school entry or for summer camp?

What is invasive meningococcal disease?

Invasive meningococcal disease is a severe infection caused by the bacteria Neisseria meningitidis (meningococcus) that includes both meningitis (infection of the meninges - a thin lining covering the brain and spinal cord) or meningococcemia (infection of the blood). The infection can also occur as pneumonia (an infection of the lungs) or in joints, such as the knees. In 2009, there were 17 cases of invasive meningococcal disease reported among New York City residents (rate of 0.21 cases per 100,000 persons).

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Who gets invasive meningococcal disease?

Anyone can get invasive meningococcal disease. Infants < 12 months of age have the highest rates of disease. Clusters of cases and outbreaks do occur but are rare in the United States.

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How is invasive meningococcal disease spread?

The meningococcus is spread by direct close contact with nose or throat discharges of an infected person. About eight percent of healthy people carry this particular bacterium in their nose and throat without any signs of illness. Why certain people become ill upon acquiring the organism is not fully understood. Close living quarters, such as in military barracks and dormitories, favor transmission of the organism.

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What are the symptoms of invasive meningococcal disease?

Although most people exposed to the meningococcus bacteria do not become seriously ill, some may develop fever, headache, vomiting, stiff neck and a rash. Sometimes the disease can be fatal.

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How soon after infection do symptoms appear?

The symptoms may occur 2 to 10 days after exposure, but usually within 5 days.

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When and for how long is an infected person able to spread the disease?

An infected person may be contagious from the time he or she is first infected until the germ is no longer present in discharges from the nose and throat.

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How is invasive meningococcal disease diagnosed?

Invasive meningococcal disease is usually diagnosed in an ill person by laboratory identification of the bacteria from either the blood or spinal fluid.

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What is the treatment for invasive meningococcal disease?

Several antibiotics are very effective in eliminating the bacteria from the nose and throat. Penicillin is still effective against the meningococcal organism and remains the recommended treatment.

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Should people who have been in contact with a diagnosed case of invasive meningococcal disease receive preventive treatment?

Only people who have been in prolonged close contact (household members, intimate contacts, health care personnel performing mouth-to-mouth resuscitation, day care center playmates, etc.) need to be considered for preventive treatment. Such people are usually advised to obtain a prescription for an antibiotic (either rifampin or ciprofloxacin) from their physician. Casual contact, as might occur in a regular classroom, office, factory or other work setting is not usually sufficient enough to cause concern.

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Is there a vaccine to prevent invasive meningococcal disease?

Presently, there are 3 vaccines that will each protect against four of the strains of the meningococcal organism (referred to as A, C, W, and Y). One common strain, referred to as B, is not included in any of the vaccines.

¹The Advisory Committee on Immunization Practices recommends routine vaccination with quadrivalent meningococcal conjugate vaccine for all persons aged 11-18 years:

• Children at the pre-adolescent visit (11-12 years of age);
• Adolescents at high school entry (15 years of age);
• All college freshmen living in dormitories.

²The Advisory Committee on Immunization Practices also recommends vaccination for persons aged 2-55 who are at increased risk of disease:

• College freshmen living in dormitories
• Persons with functional or anatomic asplenia;
• Persons with terminal complement deficiency;
• Laboratory personnel who are exposed routinely to aerosolized N. meningitidis;
• Persons who travel to or reside in countries in which N. meningitidis is epidemic (see www.cdc.gov/travel).
• Military recruits

³Persons with a history of Guillain-Barre syndrome may be at increased risk of post vaccination GBS related to MCV4 vaccination and could therefore be vaccinated with MPSV4 if indicated.

Use of conjugate vaccines is preferred to the polysaccharide vaccine in persons aged 2-55 years.  Conjugate vaccines are preferred in this age group over the polysaccharide vaccine because the conjugate vaccines results in a broader immunogenic response and also decreases the carriage of N. meningitidis in a person’s nose and throat ultimately aiding herd immunity.

For revaccination recommendations or other information about meningococcal recommendations from the ACIP, please go here.  

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Is meningococcal vaccine required for school entry or for summer camp?

No. However, New York State public health law requires that all students attending college, university, boarding schools,  or spending 10 or more nights at a children's sleep away camp be informed about  meningococcal disease and be aware of vaccine. More information can be obtained from:

• NY State Department of Health
• NYC Department of Health and Mental Hygiene

The law requires that the following information be provided:

• A description of meningococcal disease and its transmission,
• The benefits, risks and effectiveness of immunization, and
• The availability and estimated cost of immunization (and whether or not the camp itself offers the vaccine).

The law does not require that a person receive meningococcal vaccination.

For more information on invasive meningococcal disease, call 311.

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Last update October 2010