Meningococcal Disease - National Centre For Infectious ... - NCID

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Causative agent

Neisseria meningitidis (serogroup A, B, C, W135, Y). Most infections are due to serogroup B.

Incubation period

4 days (range 2 to 10 days)

Transmission

Respiratory droplets and direct salivary contact with an infected person.

Epidemiology

The human upper respiratory tract is the main reservoir of carriage and site of meningococcal dissemination. There is no animal reservoir.

There were five laboratory confirmed cases of meningococcal infection in 2009. Of these, four were due to N. meningitidis group B and the other was not grouped.

Clinical Features

Investigations

Notification

Management

Prevention and Control

Post-Exposure Chemoprophylaxis

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Three main forms of the disease:

Meningeal syndrome - presents with stiff neck, high fever, sensitivity to light, confusion, headaches and vomiting.
Septic form - is less common but a more severe (often fatal) form of meningococcal disease, which is characterized by a haemorrhagic rash and rapid circulatory collapse
Pneumonia

The onset of symptoms is sudden and death can follow within hours. In as many as 10-15% of survivors, there are persistent neurological defects, including hearing loss, speech disorders, mental retardation and paralysis.

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Lumbar puncture shows a purulent spinal fluid
Gram stain and culture from CSF and blood.
PCR assay helpful for culture-negative cases and identification of serogroup during outbreaks.
Acute and convalescent phase serology if highly suspicious for meningococcal disease but culture and PCR negative.

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A legally notifiable disease in Singapore. Notify Ministry of Health (Form MD 131 or electronically via CD-LENS) not later than 24 hours from the time of diagnosis.

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Medical emergency
Admission to a hospital is necessary
Early diagnosis and institution of appropriate early intravenous antibiotics help reduce mortality to < 15%.
Ceftriaxone IV 2 – 4 gm daily x 10-14 days; or
Penicillin G 300,000 U/kg/day IV (up to 24 million U/day)

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There are two quadrivalent vaccines against serotype A, C, Y and W135 available in the U.S - meningococcal polysaccharide vaccine and meningococcal conjugate vaccine. Only the polysaccharide vaccine is presently licensed in Singapore.

The US CDC indications for meningococcal vaccination include:

Everyone aged 11 to 18 years;
Adolescents during their 11- 12 year old healthcare visit;
Adolescents upon high school entry (15 years of age), if they were not previously vaccinated;
College freshmen living in dormitories, if not previously vaccinated;
Persons with anatomic or functional asplenia;
Military recruits;
Certain international travellers to regions with hyperendemic or epidemic meningococcal disease;
Microbiologists routinely exposed to Neisseria meningitidis isolates; and
Patients with terminal complement deficiency.

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(See also Appendix 1 Post-exposure prophylaxis)

Recommended for close contacts (³ 4 hours contact the week before onset of illness) and healthcare workers at risk i.e.

those who had direct contact with patient’s secretions; or
those who were involved in mouth-mouth resuscitation or intubation; or
those who came into close proximity of patient’s oropharynx during examination.
Chemoprophylaxis regimens:
Rifampicin 600mg 12 hourly x two days (adults); children (> 1 month) 10mg/kg for 2 days; or
Ciprofloxacin 500mg oral single dose; or
IM ceftriaxone 250 mg single dose (adults); children <15years, 125mg single IM dose

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