Amisha Malhotra, MD
Associate Professor, Department of Pediatrics, Division of Pediatric Infectious Disease,
Rutgers-Robert Wood Johnson Medical School
Meningococcal disease is a serious illness caused by the bacterium Neisseria meningitidis, which can lead to meningitis and meningococcemia. It’s known for its rapid onset and early symptoms that can be flu-like, with fever, chills, malaise, myalgias, and a characteristic rash that initially can be macular or maculopapular but usually becomes petechial or purpuric within hours. The illness may quickly progress, to include signs/symptoms of meningitis, such as severe headache, neck stiffness, and sensitivity to light. Prompt medical attention and timely administration of antibiotics to infected individuals is crucial since this infection can be life-threatening. Three serogroups (B, C, and Y) cause most meningococcal disease in the US and prevention of meningococcal disease by keeping up to date with recommended vaccines is the best protection.
Recent Cases and Surveillance
Cases of meningococcal disease in the US have increased sharply since 2021 and now exceed prepandemic levels. In 2023, the largest number of US meningococcal cases (422) were reported since 2014. NJ cases have followed similar national trends. Most of the increase in meningococcal disease is driven by N. meningitidis serogroup Y.
In 2023, the New Jersey Department of Health (NJDOH) reported 17 total confirmed meningococcal cases, including 2 deaths. This was the largest number of NJ meningococcal cases since 2013. Since January 1, 2024, a total of 15 cases have been reported in NJ, including 3 deaths, with the majority belonging to serogroup Y.
Certain groups have been disproportionately infected by the increase including black/African -Americans; adults between the ages of 30 and 60 years; and adults with HIV infection.
Management and Treatment Concerns
Cultures of blood and cerebrospinal fluid (CSF) are indicated for patients with suspected invasive meningococcal disease and empiric therapy for treatment of meningococcal disease should contain an extended spectrum cephalosporin such as ceftriaxone or cefotaxime. Antibiotic-resistant N. meningitidis isolates in the US have been largely susceptible to the antibiotics recommended for treatment and prophylaxis. However, reports of small number of isolates containing a Beta lactamase associated with penicillin resistance, as well as mutations associated with ciprofloxacin resistance have been on the rise in the US since 2013. Due to this concern, it is important that antimicrobial sensitivity testing be performed to determine susceptibility of all meningococcal isolates to penicillin before changing empirical treatment with cephalosporins to ampicillin or penicillin.
Prevention and Control
The best way to prevent meningococcal disease is to get vaccinated. Since three serogroups (B, C, and Y) cause most meningococcal disease in the US, 3 meningococcal vaccines are licensed and available for use in children and adults against serogroups A, C, W, and Y (MenACWY), and 2 vaccines are licensed for people 10 through 25 years of age against serogroup B (MenB). In addition, the US Food and Drug Administration licensed a MenABCWY pentavalent meningococcal vaccine in 2023, for persons 10 through 25 years of age. All these vaccines are safe, effective and provide protection.
Vaccination Recommendations
- Routine Vaccination: The New Jersey Department of Health and CDC recommend that adolescents receive the meningococcal conjugate vaccine (MenACWY) at ages 11-12, with a booster dose at age 16.
- MenB Vaccine: The meningococcal B vaccine (MenB) is also recommended for some adolescents and young adults, especially those who are at increased risk or wish to have additional protection against the less common serogroup B strain.
CDC recommends meningococcal vaccination for:
- All preteens and teens
- Children at increased risk for meningococcal disease
- Adults at increased risk for meningococcal disease
Certain medical conditions, exposures, and medications place people at higher risk for developing meningococcal disease. These conditions include:
- Functional or anatomic asplenia
- Persistent complement deficiencies (e.g., C3, C5-9, properidin, factor H, factor D)
- HIV infection
- People who receive complement inhibitors (e.g., eculizumab, ravulizamab)
- Microbiologists who are routinely exposed to isolates of N. meningitidis
- People identified as being at increased risk because of an outbreak of meningococcal disease
- People traveling to a country where meningococcal disease is epidemic or highly endemic
- In 2024, 12 cases of meningococcal disease associated with Umrah travel to Saudi Arabia were identified
- First-year college students who live in residence halls
- Military recruits
Antibiotic Prophylaxis
Regardless of immunization status, close contacts including household contacts of all people with invasive meningococcal disease are at high risk of infection and should promptly receive chemoprophylaxis. Close contacts of individuals with meningococcal disease may be given antibiotics to prevent the spread of the disease. At this time, the NJ Vaccine Preventable Disease Program continues to recommend ciprofloxacin as the first-line agent for postexposure prophylaxis; however, continued surveillance of ciprofloxacin-resistant strains may lead to updated recommendations by the Vaccine Preventable Disease Program in the future.
The ASP, representing pediatric providers, including pediatric infectious disease specialists and pharmacists, exchange ideas, discuss case management strategies and develop and implement guidelines to be shared system wide, as well as serve as a resource for community physicians.
For more educational information, research and best practices from the Children’s Health Network at RWJBarnabas Health, visit rwjbh.org/childrenshealthresearch.
Resources
New Jersey Department of Health: New Jersey Department of Health - Meningococcal Disease (LINCS_Update_Increase_Mening_Cases_PEP_Recs_08162024.pdf (nj.gov)
American Academy of Pediatrics. Meningococcal Infections. In: Kimberlin DW, Banerjee R, Barnett ED, Lynfield R, Sawyer MH, eds. Red Book: 2024 Report of the Committee on Infectious Diseases. American Academy of Pediatrics; 2024.
Cases of Meningococcal Disease Associated with Travel to Saudi Arabia for Umrah Pilgrimage — United States, United Kingdom, and France, 2024 | MMWR (cdc.gov)
Meningococcal Disease | Meningococcal | CDC