Meningococcal Infection

What are meningitis and septicaemia?

• Meningitis is an inflammation of the lining that covers the brain and spinal cord (the meninges). Bacterial or viral infection is the usual cause. Bacterial meningitis is uncommon but serious. Viral meningitis is quite common, but much less serious than a bacterial cause.
• Septicaemia is an infection of the blood with bacteria ('blood poisoning'). If bacteria multiply and release toxins (poisons) into the blood it can cause serious illness.

Various viruses and bacteria can cause meningitis. However, meningococcus typically causes meningitis and septicaemia at the same time.

How common is meningococcal infection?

Meningococcal infection is uncommon, but it is the most common cause of bacterial meningitis in the UK. About 4 in 100,000 people in the UK have bacterial meningitis each year.

Are there different types of meningococcal infection?

Meningococcal bacteria are divided into several groups (types or strains):

• Groups B and C were the usual causes of meningococcal infection in the UK. Until 1999, about half the cases were due to Group B, and just under half due to Group C. However, cases of Group C are now rare in the UK due to immunisation against Group C which was introduced in 1999. See separate leaflets called 'Meningococcal Immunisation' and 'Meningococcal Group C Immunisation'.
  Group B is now the usual cause of meningococcal infection in the UK.
• Group A infection is the most common in the world, but tends to be confined to certain hot countries. It is rare in the UK, but travellers to certain countries are offered immunisation against Group A.
• There are other groups that are rare in the UK.

Who gets meningococcal infection?

It can affect anyone at any age. However, children under the age of five years are the most at risk. The second most common age group at risk are teenagers aged 15, 16 and 17.

How do you get meningococcal infection?

Meningococcal bacteria live harmlessly in the noses and throats of about 1 in 4 people. These people are called 'carriers'. Meningococcal bacteria do not survive outside the body. Close contact is needed to pass it on to others, such as intimate kissing, coughing, or sneezing near to others.

Rarely, this bacterium overcomes the body's immune system and gets into the blood to cause meningitis and/or septicaemia. It is not clear why a few people are prone to serious illness, and many other people are carriers of the same bacterium but have no ill effect.

Most cases of meningococcal infection are isolated cases. The risk of others 'catching' it are low, as many people are carriers and/or have natural immunity. Sometimes small outbreaks occur when two or more people in the same household or community are affected.

What are the symptoms of meningococcal infection?

One or more of the following symptoms may occur:

Note: not all symptoms may occur. For example, the classic symptoms of neck stiffness and rash may not occur. If you suspect meningitis or septicaemia - get medical help immediately.

Common early warning symptoms

Many children who are developing meningitis or septicaemia have 'nonspecific' symptoms such as just feeling or looking generally unwell. These symptoms may include having a high temperature, being more tired than usual and feeling sick.

However, three symptoms that commonly develop early on - often before the more classic symptoms listed later - are:

• Leg pains. The pains can become severe and prevent a child from standing or walking.
• Cold hands or feet - even if the child has a high temperature.
• Pale, dusky or blue colour of the skin around the lips.

Rash - commonly occurs, but not always

A typical rash is common with meningococcal infection. The rash is red or purple. Small spots develop at first and may occur in groups anywhere on the body. They often grow to become blotchy and look like little bruises. One or two may develop at first, but many may then appear in different parts of the body.

The spots/blotches do not fade when pressed (unlike many other rashes). To check for this do the glass test. Place a clear glass firmly on one of the spots or blotches. If the spot/blotch does not fade and you can still see it through the glass, get medical help immediately.

The rash is a sign of septicaemia. It may not occur with meningitis alone.

Other symptoms to look out for include the following.

Other symptoms that may occur in babies:

• Excessive crying - often high-pitched or moaning and different to their usual cry.
• Fast breathing, or unusual patterns of breathing.
• Fever - but the baby may not look hot and the skin may look pale or blotchy, or turn blue. The hands and feet may feel cold. The baby may shiver.
• Will not take feeds - sometimes repeated vomiting.
• Being irritable - especially when picked up and handled.
• Drowsiness or sleepiness - does not wake easily.
• A bulging fontanelle sometimes develops. The is the 'soft spot' on the baby's head.
• Jerky movements may occur and the body may appear stiff. Sometimes the opposite occurs and the body appears quite floppy. Convulsions (fits or seizures) sometimes develop.

• Fever and shivering - however, the hands and feet often feel cold.
• Stiff neck - cannot bend the neck forward.
• Headache - which can become severe.
• Fast breathing.
• Aches and pains in muscles or joints - the pains can become quite severe.
• The skin may look pale or blotchy, or turn blue.
• Dislike of bright lights - will shut eyes and turn away from the light.
• Drowsiness or confusion - may appear 'vacant'.
• Repeated vomiting. Sometimes abdominal pain and diarrhoea.

The course of symptoms

The symptoms usually develop quickly, over a few hours or so. Symptoms can occur in any order, and not all may occur. Sometimes symptoms develop more slowly, over a few days. The symptoms may suggest a less serious illness at first. For example, fever, headaches, and vomiting are common with many viral illnesses such as flu. Therefore, even if you think it was flu to start with, if symptoms become worse then it may be meningitis or septicaemia.

What is the treatment for meningococcal infection?

Antibiotic injections are needed urgently. High doses are usually given. Intensive care is often also needed at first as the infection often causes 'shock' and problems throughout the body.

What is the outlook (prognosis) for meningococcal infection?

The outlook often depends on how soon antibiotics are given after the illness starts. Most people make a good recovery if treated early enough. Without treatment, most people will die.

A difficulty is that meningococcal infection can develop very quickly and can mimic other illnesses when symptoms first begin. Treatment may be delayed if the cause of early symptoms is not clear at first. In some cases a person can be well in the morning, develop 'flu-like' symptoms by the afternoon, and be critically ill or dead by the evening.

In the UK about 1 in 10 people who have meningococcal meningitis without septicaemia die. Of those that survive, some are left with some permanent damage such as brain injury or deafness. If septicaemia occurs then up to half of cases may die depending on how quickly treatment is given.

Can meningococcal infection be prevented?

Immunisation

Children are routinely immunised against certain causes of meningitis. These include Haemophilus influenzae type B (Hib), Group C meningococcus, pneumococcus and mumps. Other vaccines may be used for travellers going to meningitis-prone countries.

Vaccines are not yet available for other causes of meningitis - in particular, Group B meningococcus. See separate leaflets called 'Meningococcal Immunisation' and 'Meningococcal Group C Immunisation'.

Contacts

Close contacts of a person with meningococcal infection have an increased risk of developing the illness. However, the risk is still low. Close contacts usually means household members or intimate kissing contacts within the previous seven days. These people are offered a short course of antibiotics to prevent possible infection.

If Group C meningococcus is the cause, then immunisation is also offered to close contacts. Occasionally, an outbreak of two or more cases of meningococcal infection occurs in the same school, college or similar community. Antibiotics and/or immunisation may then be offered to a wider group of people.

Further help and information

Meningitis Trust

Fern House, Bath Road, Stroud, Gloucestershire, GL5 3TJ
Tel (24-hour helpline): 0845 6000 800 Web: www.meningitis-trust.org

Meningitis Research Foundation

Midland Way, Thornbury, Bristol, BS35 2BS
Tel (24-hour helpline): 080 8800 3344 Web: www.meningitis.org

Meningitis UK

Tel: 0117 373 7373 Web: www.meningitisuk.org

References

• Management of invasive meningococcal disease in children and young people, SIGN (May 2008)
• Donovan C, Blewitt J; An overview of meningitis and meningococcal septicaemia. Emerg Nurse. 2009 Nov;17(7):30-6; quiz 37. [abstract]
• Campbell H, Borrow R, Salisbury D, et al; Meningococcal C conjugate vaccine: the experience in England and Wales. Vaccine. 2009 Jun 24;27 Suppl 2:B20-9. Epub 2009 May 23. [abstract]