Meningococcal Meningitis (ACWY)

What is meningococcal disease?

Meningococcal disease is a serious disease caused by the bacterium Neisseria meningitidis. According to the World Health Organization (WHO), meningitis is fatal in 50% of untreated cases.

Approximately 10-20% of the general UK population carry the bacteria at the back of their nose and throat. Carriers do not have symptoms but can develop the disease when the bacteria invade the bloodstream from the back of the nose and throat. Rarely it can progress to septicaemia (blood poisoning) or meningitis (infection of the lining of the brain).

There are 12 different types of N. meningitidis and out of these, 6 are responsible for the majority of invasive disease: A, B, C, W, X and Y. Effective vaccinations are available against groups A, B, C, W and Y.1

The following is a summary about the disease. For further details speak to your local pharmacist or GP.

How is meningococcal disease spread?

Meningococcal infection is spread through tiny droplets when coughing or sneezing by infected individuals or individuals who carry the bacteria but are not ill themselves.  The infection can also spread through kissing, sharing food/drink and contact through utensils, cutlery and toothbrushes.

Most infections do not cause clinical disease and many people carry the bacteria without any symptoms; they may serve as a carriers of infection for others. Such carriage may provide some immunity to the host against invasive disease.

In the UK, between 5 -11% of adults and up to 25% of adolescents are asymptomatic carriers.  Spread of infection is higher in closed populations such as schools and university halls of residence.1

In which countries is meningococcal disease found?

Meningococcal disease occurs worldwide. The highest rates of disease occur in the ‘meningitis belt’ of sub-Saharan Africa typically during the dry season. The full list can be found here:2

Meningococcal disease in the UK

In the UK the incidence has reduced following the introduction of vaccines to control infections caused by Haemophilus influenzae type B, group B and C meningococcus and pneumococcal disease.1

Meningococcal disease and mass gatherings

Mass gatherings provide the potential for large outbreaks. The annual Hajj pilgrimage to Mecca in Saudi Arabia is one of the largest gatherings of its kind in the world. Crowded conditions increase the risk of meningococcal disease transmission, and carriage rates during the Hajj can rise up to 80% due to intense overcrowding, high humidity and dense air pollution.1

What are the signs and symptoms of meningococcal disease?

Typically, the incubation period for meningococcal disease is 2-7 days. Symptoms of invasive meningococcal disease  that lead to meningitis and/or septicaemia can cause:

  • Fever
  • Headache
  • Stiff neck
  • Non-blanching rash (does not disappear when a glass is pressed on the skin)
  • Light sensitivity (photophobia)
  • Altered mental state/consciousness
  • Severe muscular and joint pains
  • Vomiting and diarrhoea
  • Seizures
  • Coma

The symptoms can appear in any order and not everyone develops the more common signs and symptoms associated with meningococcal disease.

Presentation in children

Children and young people with the more specific symptoms and signs are more likely to have bacterial meningitis or meningococcal septicaemia and the symptoms and signs may become more severe over time.

Early features to watch for in children:

  • Leg pain
  • Thirst
  • Diarrhoea
  • Abnormal skin colour
  • Breathing difficulty
  • Cold hands and feet

Classic features (develop later)

  • Non-blanching rash: early on, the rash may be nonspecific or absent. By the time the rash develops, the person may already be very ill. Therefore seek medical assistance at the earliest opportunity.
  • Neck stiffness or pain
  • Light sensitivity

Late features

  • Confusion or delirium
  • Seizures
  • Unconsciousness3

What are the complications of meningococcal disease?

Some of the most common complications associated with meningococcal disease are:

  • Hearing loss
  • Recurrent seizures (epilepsy)
  • Problems with memory and concentration
  • Co-ordination, movement (walking difficulty) and balance problems
  • Cognitive impairment, learning difficulties and behavioural problems
  • Vision loss, which may be partial or total
  • Loss of limbs – amputationis is sometimes necessary to stop the infection spreading through the body and remove damaged tissue
  • Chronic kidney disease
  • Skin complications (including scarring)3

How is meningococcal disease diagnosed and treated?

If meningococcal disease is suspected then seek medical assistance urgently. The main distinguishing feature is a non-blanching rash but it does not appear in some cases. Other symptoms include high fever and stiff neck. Refer to “What are the signs and symptoms of meningococcal disease?” section for more details.

A full list of signs and symptoms can also be found here.4

What advice is there for those travelling to high risk countries?

Travellers who may be at higher risk include:

  • Travellers visiting areas within the meningitis belt of Africa or to an area where a known outbreak is occurring
  • Long stay travellers who have close contact with the local population
  • Backpackers
  • Travellers visiting remote areas with delayed access to high quality medical care

Travellers are advised to:

  • Practice good hand hygeine
  • Avoid sharing drinks and eating utensils (activities that require exchange of respiratory secretions)
  • Avoid over crowded and confined areas1

Vaccinations available against meningococcal disease?

There are three types of vaccines against the following meningococcal infections:

  • MenB vaccine – protects only against group B
  • MenC vaccine – protects against group C only
  • MenACWY vaccine – protects against groups A, C, W and Y5

The vaccines stimulates the immune system to protect against meningococcal infection in case of infection with the bacteria.1

Travellers who are at continued risk are advised to obtain boosters every 5 years.

When to consider vaccination?

Meningococcal ACWY vaccine is recommended for:

  • Travel – vaccination should be given at least 10 days before travel
  • Immunisation for pilgrims and seasonal workers for Hajj and Umrah – proof of vaccination is a visa requirement for entry into the Kingdom of Saudi Arabia
  • Routine immunisation – recommended for those without a spleen or have a weakened immune system in addition to Men B vaccine

Vaccination against meningococcal disease is also available on the NHS in some cases. Individuals may be eligible if:

  • Routine MenACWY immunisation of school children is usually done in year 9 and/or 10 as per national recommendations
  • Routine MenACWY conjugate vaccine is given to those born on or after 1 Sep 1996 and until their 25th birthday, who have missed the routine vaccination offering in year 9 or year 10
  • If aged between 10 years to 25 years with an incomplete or unknown MenC vaccination history
  • Any prospective students 18 to 25 years of age who are entering university for the first time and who have not received a dose of MenACWY conjugate vaccine after their tenth birthday
  • Those who are close contacts of a person with confirmed case of Neisseria meningitidisgroup A, C, W or Y disease
  • If there is a local outbreak of N. meningitidis and vaccination has been recommended by Public Health England and the local health protection team.5

References

This information is taken from trusted third party websites, NaTHNaC (Travel Health Pro) and EMIS (Patient info) and use of all information has been licenced under the Open Government. Licence http://www.nationalarchives.gov.uk/doc/open-government-licence/version/3/

Although the materials are being used/replicated under the provisions of the Open Government Licence this in no way represents endorsement of Traveljab.co.uk by NaTHNaC, Emis, Public Health England, the NHS or the Department of Health and Social Care.

  1. Travel Health Pro: National Travel Health Network and Centre (NaTHNaC)
  2. World Health Organsation (WHO): Meningococcal meningitis, countries or areas at high risk, 2017
  3. Patient.info: Meningococcal disease
  4. NHS: Meningitis Symptoms
  5. The Green Book: Chapter 22 Meningococcal
  6. UK: Meningococcal ACWY (Men ACWY) vaccination Programme
  7. Maps Adapted from WHO 2017
  8. Public Health England: MenACWY Patient Group Direction

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