Meningococcal Meningitis

ACIP Statement

Routine vaccination with meningococcal vaccine is recommended for college freshmen living in dormitories and for other populations at increased risk.

What is Meningitis?

Meningococcal meningitis is a form of bacterial meningitis (an infection of the lining surrounding the brain and spinal cord) caused by the bacterium Neisseria meningitidis. There are approximately 1400-2800 cases of meningococcal meningitis in the US each year. Despite the fact that this illness can be treated with antibiotics, the fatality rate--even with rapid intervention--is approximately 15%. Additionally, up to 20% of survivors have permanent sequelae (e.g., neurological disability).

Symptoms

Symptoms of meningococcal meningitis include:

fever
severe headache
neck stiffness

This may develop over several hours or take 1 to 2 days. Additional symptoms may include nausea/vomiting, confusion, or seizures.

More information is available on the meningococcal disease.

Freshmen and Meningitis

In the US it has been demonstrated that freshmen living in on-campus housing are at higher risk of contracting meningococcal disease than other students. (Approximately 5 cases per 100,000 students per year vs. a baseline rate of approximately 1 case per 100,000 per year.) Other at risk groups include military recruits, travelers to areas in which meningococcal disease is hyperendemic or epidemic, microbiologists who are routinely exposed to isolates of Neisseria meningitidis, patients with anatomic or functional asplenia, and patients with terminal complement deficiency.

Additional risk factors include:

Smoking (active and passive)
Recent upper respiratory illness
Corticosteroid use
New residence
New school
Household crowding

During outbreaks, recent alcohol use and bar patronage have also been shown to increase risk of contracting the disease.

Vaccines

A vaccine is available.

MenactraT is a tetravalent, polysaccharide-protein conjugate vaccine and it provides protection for 4 out of the 5 serogroups (types) of meningococcal meningitis (serogroups A,C,Y,W-135). Serogroup B meningococcal meningitis accounts for about one-third of cases but there is no vaccine for this serogroup. Therefore the current vaccine provides coverage for approximately two-thirds of annual cases seen. The vaccine is very safe, with redness and pain at the site of injection being the most frequent adverse reaction.

The following was published in the Centers for Disease Control and Prevention publication MMWR (May 27, 2005/ Vol. 54/ No. RR-7). The article title is "Prevention and Control of Meningococcal Disease - recommendations of the Advisory Committee on Immunization Practices". The full text article can be found at the CDC's website:

"In January 2005, a tetravalent meningococcal polysaccharide-protein conjugate vaccine ([MCV4] Menactra,TM manufactured by Sanofi Pasteur, Inc., Swiftwater, Pennsylvania) was licensed for use among persons aged 11-55 years. CDC's Advisory Committee on Immunization Practices (ACIP) recommends routine vaccination of young adolescents (defined in this report as persons aged 11-12 years) with MCV4 at the preadolescent health-care visit (at age 11-12 years).

Introducing a recommendation for MCV4 vaccination among young adolescents might strengthen the role of the preadolescent visit and have a positive effect on vaccine coverage among adolescents.

For those persons who have not previously received MCV4, ACIP recommends vaccination before high-school entry (at approximately age 15 years) as an effective strategy to reduce meningococcal disease incidence among adolescents and young adults. By 2008, the goal will be routine vaccination with MCV4 of all adolescents beginning at age 11 years. Routine vaccination with meningococcal vaccine also is recommended for college freshmen living in dormitories and for other populations at increased risk (i.e., military recruits, travelers to areas in which meningococcal disease is hyperendemic or epidemic, microbiologists who are routinely exposed to isolates of Neisseria meningitidis, patients with anatomic or functional asplenia, and patients with terminal complement deficiency).

Other adolescents, college students, and persons infected with human immunodeficiency virus who wish to decrease their risk for meningococcal disease may elect to receive vaccine."