Meningococcal Disease

Invasive meningococcal disease is a rare but serious bacterial infection that occasionally infects college students and others living in relatively isolated, confined communities. Meningococcal meningitis is one presentation of this life-threatening disease. Student Health Services wants students, faculty, and staff to have up-to-date information about this disease and know how to reduce the risk of exposure.

What is meningitis?
Meningitis is an inflammation of the linings of the brain and spinal cord caused by either viruses or bacteria.

Viral meningitis is more common than bacterial meningitis and usually occurs in late spring and summer. Signs and symptoms of viral meningitis may include stiff neck, headache, nausea, vomiting, and rash. Most cases of viral meningitis run a short, uneventful course. Since the causative agent is a virus, antibiotics are not effective. Persons who have had contact with an individual with viral meningitis do not require treatment.

Bacterial meningitis occurs rarely and sporadically throughout the year, although outbreaks tend to occur in late winter and early spring. Bacterial meningitis in college-aged students is most likely caused by Neisseria meningitidis (meningococcal meningitis) or Streptococcus pneumoniae. Because meningococcal meningitis can cause grave illness and rapidly progress to death, it requires early diagnosis and treatment. In contrast to viral meningitis, persons who have had intimate contact with a case require prophylactic therapy. Untreated meningococcal disease can be fatal.

How does meningococcal disease occur?
Approximately 10% of the general population carry meningococcal bacteria in the nose and throat in a harmless state. This carrier state may last for days or months before spontaneously disappearing, and it seems to give persons who harbor the bacteria in their upper respiratory tracts some protection from developing meningococcal disease.

During meningococcal disease outbreaks, the percentage of people carrying the bacterium may approach 95%, yet the percentage of people who develop meningococcal disease is less than 1%. This low occurrence of disease following exposure suggests that a person’s own immune system, in addition to bacterial factors, plays a key role in disease development.

Menningococcal bacteria cannot usually live for more than a few minutes outside the body. As a result, they are not easily transmitted in water supplies, swimming pools, or by routine contact with an infected person in a classroom, dining room, bar, restroom, etc.

Roommates, friends, spouses, and children who have had intimate contact with the oral secretions of a person diagnosed with meningococcal disease are at risk for contracting the disease and should receive prophylactic medication immediately. Examples of such contact include kissing, sharing eating utensils or beverages, and being exposed to droplet contamination from the nose or throat.

How many cases of meningococcal disease occur each year?
The annual incidence of meningococcal disease in the United States is about 1 case per 100,000 population. The case fatality rate is approximately 13%.

The incidence of meningococcal meningitis outbreaks has risen sharply in recent years, with a total of 33 outbreaks occurring from 1992 through 1996 according to data from the U.S. Centers for Disease Control and Prevention (CDC). In comparison, only 13 outbreaks occurred between the years 1980 and 1991. Over one-third of these outbreaks occurred in schools, universities, and other organizational-based settings.

Can meningococcal disease be mistaken for other health problems?
Meningococcal disease is potentially dangerous because it is relatively rare and can be mistaken for other conditions. The possibility of having meningitis may not be considered by someone who feels ill, and early signs and symptoms may be ignored. A person may have symptoms suggestive of a minor cold or flu for a few days before experiencing a rapid progression to severe meningococcal disease.

What are the signs and symptoms of meningococcal disease?
Understanding the characteristic signs and symptoms of meningococcal disease is critical and possibly lifesaving.

Common early symptoms of meningococcal meningitis include fever, severe sudden headache accompanied by mental changes (e.g. malaise, lethargy), and neck stiffness.

A rash may begin as a flat, red eruption, mainly on the arms and legs. It may then evolve into a rash of small dots that do not change with pressure (petechiae). New petechiae can form rapidly, even while the patient is being examined.

What is the treatment for meningococcal disease exposure?
Meningococcal disease can be rapidly progressive. With early diagnosis and treatment, however, the likelihood of a full recovery is increased.

Early recognition, performance of a lumbar puncture (spinal tap), and prompt initiation of antimicrobial therapy are crucial.

The use of such prophylactic antibiotics as ciprofloxacin or rifampin is recommended for those who may have been exposed to a person diagnosed with meningococcal disease. Anyone who suspects possible exposure should consult a practitioner immediately.

The Advisory Committee on Immunization Practices (ACIP) to the Centers for Disease Control and Prevention (CDC) recommends routine vaccination for first-year college students living in residence halls. The University of Delaware recommends vaccination for all first-year students.

Numerous studies have demonstrated the immunogenicity and clinical efficacy of meningococcal vaccines. There are three meningococcal vaccines available in the U.S. Meningococcal polysaccharide vaccine (MPSV4 or Menomune®) has been approved by the Food and Drug Administration (FDA) and available since 1981. Meningococcal conjugate vaccine (MCV4 or MenactraT®) was licensed in 2005. A new vaccine called Menveo® is now also available. These vaccines can prevent 4 types of meningococcal disease, including 2 of the 3 types most common in the U.S. (serogroup C, Y, and W-135) and a type that causes epidemics in Africa (serogroup A). Meningococcal vaccines cannot prevent all types of the disease. But they do protect many people who might become sick if they didn’t get the vaccine.

These vaccines work well and protect about 90% of those who get it. Menactra® and Menveo® are expected to give better, longer-lasting protection. Menactra® and Menveo® should also work better at preventing the disease from spreading from person to person.

Students: The Menactra® vaccine is available at Student Health Services. Please call 302-831-2226 to make an appointment. In an emergency, always dial 911. Please note that this vaccine is not covered by the Student Wellbeing Fee and because this vaccine is a “preventative” treatment, many health insurance plans will not pay for it.

Employees: Contact your practitioner or go to an emergency room.

CAUTION: Anyone who becomes ill with mild, flu-like symptoms should watch for more severe symptoms such as fever, headache, vomiting, rash, or changes in mental status. If any of these symptoms develops, do not delay seeking medical attention.

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