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JAMA Patient Page
March 12, 2019

Meningococcal Meningitis

Author Affiliations
  • 1Department of Internal Medicine, Division of Infectious Diseases, University of Michigan, Ann Arbor
JAMA. 2019;321(10):1014. doi:10.1001/jama.2019.0772

Meningitis is a disease in which the meninges (tissues surrounding the brain and spinal cord) become inflamed.

Meningitis is most commonly caused by infection with a bacterial, viral, or fungal infection. Symptoms of meningitis include high fever, stiff neck, headache, sensitivity to light, drowsiness, rash, and confusion. Meningitis can progress rapidly, so patients with symptoms of meningitis should seek medical attention immediately. If meningitis is suspected, a lumbar puncture (“spinal tap”) is performed to sample the fluid around the spinal cord to look for signs of infection.

One of the bacteria that can cause meningitis is called Neisseria meningitidis, or meningococcus. Meningococcal meningitis is very serious. Even with treatment, 10 to 15 of every 100 people who have meningococcal meningitis die as a result. It can also cause permanent disabilities, including loss of limbs, deafness, or brain damage.

There are 5 main types (serogroups) of meningococcus: A, B, C, W, and Y. The meningococcus bacteria can live in the nose and throat of some healthy people without signs of infection (these individuals are called “carriers”). However, in some cases, these bacteria invade the body and cause meningococcal disease. Meningococcus can spread from person to person through saliva and respiratory secretions. This spread usually requires close and prolonged contact such as kissing, coughing, or sharing cups. Meningococcal disease is not spread through the air.

Meningococcal disease can occur at any age, but people are at increased risk if they are living in a place with many new people, like a college dormitory or military barracks. People without a spleen and those with certain problems with their immune system are also at high risk. Meningococcal vaccines are available to prevent infection in people at increased risk of meningococcal disease.

Vaccination

There are several vaccines to prevent meningococcal infection. The conjugate meningococcal vaccine covers 4 of the most common serogroups that can cause meningococcal meningitis (A, C, W, and Y). This vaccine is recommended for children aged 11 to 12 years, with a booster dose around age 16 years. This vaccine is required for students entering college in most states. The conjugate vaccine does not cover all strains of meningococcus that can cause meningitis, including serogroup B.

Two vaccines are now available in the United States for serogroup B meningococcal disease. Vaccines for serogroup B meningococcus can be given to teens and young adults between 16 and 23 years old. Because protection wears off for most people in about 5 years, vaccination is recommended around age 16 years so that protection is best during the late teens (the time of highest risk). Depending on the timing of the vaccine, either 2 or 3 doses are recommended.

Outbreaks

Meningococcal meningitis is becoming less common, partially because of vaccination. However, outbreaks do occur. In recent years, serogroup B meningococcus has been responsible for several outbreaks at US colleges and universities. As a result, some institutions are beginning to require vaccination against group B meningococcus.

If an outbreak of meningococcal disease occurs, people who might have had close contact with an affected patient are sometimes given antibiotics to prevent meningitis. Vaccinating others who have not been immunized previously can also help prevent disease from spreading.

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Article Information

Conflict of Interest Disclosures: None reported.

Source: Patton ME, Stephens D, Moore K, MacNeil JR. Updated recommendations for use of MenB-FHbp serogroup B meningococcal vaccine—Advisory Committee on Immunization Practices, 2016. MMWR Morb Mortal Wkly Rep. 2017;66(19):509-513. doi:10.15585/mmwr.mm6619a6

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