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Background

Meningococcal infection is caused by the bacteria Neisseria meningitidis. About 1 out of 10 people have this type of bacteria in the back of their nose and throat with no signs or symptoms of disease; this is called being 'a carrier'. Meningococcal meningitis is a bacterial form of meningitis, a serious infection of the meninges that affects the brain membrane. It can cause severe brain damage and is fatal in 50% of cases if untreated. Several different bacteria can cause meningitis. Neisseria meningitidis is the one with the potential to cause large epidemics. There are 13 serogroups of N. meningitidis that have been identified, 6 of which (A, B, C, W, X and Y) can cause epidemics. Geographic distribution and epidemic potential differ according to serogroup.

The most common symptoms are a stiff neck, high fever, sensitivity to light, confusion, headaches and vomiting. Even when the disease is diagnosed early and adequate treatment is started, 5% to 10% of patients die, typically within 24 to 48 hours after the onset of symptoms. Bacterial meningitis may result in brain damage, hearing loss or a learning disability in 10% to 20% of survivors.

The disease is mainly transmitted by direct contact through respiratory secretions from infected persons. The average incubation period is 3-4 days, but can range between 2 and 10 days. Neisseria meningitidis only infects humans; there is no animal reservoir.

The risk of infection is higher among close contacts of patients with meningococcal infections. Close contacts include family members, day care centre contacts, persons directly exposed to the patient's oral secretions, and those who frequently sleep or eat in the same dwellings as the patient. Certain patients with defective immune systems are also at higher risk. Other risk factors include antecedent viral infection, overcrowding, chronic illness, and active and passive smoking.

Meningococcal Meningitis Surveillance in Taiwan

Taiwan National Infectious Disease Statistics System–Meningococcal Meningitis 

Since 2011, approximately 3-8 people contract meningococcal meningitis each year in Taiwan. Most of all are sporadic cases. The annual incidence of meningococcal meningitis per 100,000 population in Taiwan has varied between 0.013 to 0.034.And that is most common in the younger under age 1 and the elder over age 75. The number of cases peaks in December and January.

 Fig1.The annual incidence of meningococcal meningitis per 100,000 population in Taiwan,2011-2016.

As for 2017, The predominant serogroups causing infection in Taiwan are serogroups B, C, and Y. The first one is serogroup B, accounting for 67% of ratio. And then, the second is serogroup C(11%), following by serogroup Y(3%).

 Fig2.Serogroup distribution of meningococcal meningitis  in Taiwan,2011-2017.

Prevention and Control

Meningococcal vaccination 

1.At present, only one of meningococcal vaccines is specially imported for use in Taiwan –Meningococcal conjugate vaccine (MCV4,serogroups A, C, Y & W135).

2.Since 2014, meningococcal conjugate vaccines against group B have been available and widely used. But it hasn’t been licensed for use in children and adults in Taiwan.

3. According to recommendations by Taiwan Advisory Committee on Immunization Practices (ACIP), MCV4 is recommended for those people at high risk for disease and travelers planning to visit areas affected by meningococcal meningitis. There is insufficient justification to include meningococcal vaccine in the Childhood Immunization Programme in Taiwan in light of current evidence.

Prevention

1.Keep hands clean：Wash hands with liquid soap and water properly especially when they are dirtied by respiratory secretions.

2.Maintaining good indoor ventilation and avoid staying in crowded or poorly ventilated rooms for long hours.

3.The public should seek medical assistance immediately, when symptoms such as fever, headache, neck stiffness, nausea and vomiting develop, and don’t forget to inform doctor of any recent travel history.

4.Travelers planning to visit areas affected by meningococcal meningitis to visit the contracted travel medicine outpatient clinic to evaluate the need of meningococcal meningitis vaccination before their trip. For more information, please visit the Taiwan CDC’s website at http://www.cdc.gov.tw or call the toll-free Communicable Disease Reporting and Care Hotline, 1922.

Treatment

Meningococcal Meningitis can develop very quickly. It’s important to be aware of the symptoms so you can get medical help straight away – whether it’s day or night. Meningococcal disease can be treated with antibiotics, but early treatment is very important.

Depending on how serious the infection is, other treatments may also be necessary. These can include such things as breathing support, medications to treat low blood pressure, and wound care for parts of the body with damaged skin. 

FAQs

1.What is meningococcal meningitis?

Meningococcal meningitis is a bacterial infection that causes inflammation of the membranes surrounding the brain and spinal cord. It is caused by the bacterium Neisseria meningitides , also known as meningococcus.

2.How is the disease spread?

The infection is spread by direct contact with infected individuals (for example, sharing a glass or cigarette, or kissing) or through the air via droplets of respiratory secretions (for example, coughing or sneezing).

3. What can be done to reduce the risk of acquiring meningococcal meningitis?
Some of the basic measures that reduce the risks of contracting meningococcal meningitis include washing hands frequently, maintaining good indoor ventilation, avoiding staying in poorly ventilated rooms for long hours, and seeking prompt medical attention when suspected symptoms developed. Travelers planning to visit areas affected by meningococcal meningitis to visit the contracted travel medicine outpatient clinic to evaluate the need of meningococcal meningitis vaccination before their trip.The public should seek medical assistance immediately when suspected symptoms develop and inform the doctor of any recent travel history. For more information, please visit the Taiwan CDC’s website at http://www.cdc.gov.tw or call the toll-free Communicable Disease Reporting and Care Hotline, 1922.

More Information

1. WHO Meningococcal Meningitis
2. USA CDC  Meningococcal
3. ECDC Invasive Meningococcal Disease