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    • Meningococcal Disease Information for Providers

    What is meningococcal disease?

    It is a sudden and severe illness caused by Neisseria meningitidis bacteria. It most commonly presents as meningitis or meningococcemia. The bacteria can also cause pneumonia, arthritis, or pericarditis. Symptoms include:

    • Sudden high fever.
    • Chills.
    • Severe headache.
    • Stiff neck and back.
    • Nausea.
    • Vomiting.
    • Purpura rash.
    • Decreased level of consciousness.
    • Difficulty breathing.
    • Seizures.

    It is spread through close or prolonged contact, usually by saliva or droplets produced by coughing. About 10% of people carry the bacteria with no signs or symptoms, though they can spread the infection to others.

    Six serogroups of N. meningitidis cause most meningococcal disease worldwide. In the United States, serogroups B, C, and Y cause most disease, and vaccines are available to protect against serogroups A, C, W, and Y (MenACWY vaccine) and serogroup B (MenB vaccine).

    Providers must immediately report confirmed meningococcal disease cases.

    To report, call (253) 649-1412. See our Report Notifiable Conditions page for more information.

    Additional information

    Epidemiology

    The incidence of meningococcal disease steadily declined in the United States from the late 1990s through 2021, when the incidence reached a low of 0.06–0.07 cases per 100,000 population. However, cases of meningococcal disease have increased sharply and now exceed pre-COVID-19 pandemic levels.

    In 2023, the preliminary incidence of meningococcal disease was 0.13 cases per 100,000. Incidence varies by age and is highest in infants younger than 1 year and particularly high in infants younger than 6 months.

    In 2022 and 2023, serogroup Y drove the increase in incidence and accounted for a larger proportion of cases. The relative distribution of serogroups varies by age. Serogroup B causes about 40% of cases in children and adults younger than 25 years. Serogroups C, W, and Y cause about 80% of all cases of meningococcal disease among people 25 years or older.

    Meningococcal disease’s case-fatality is 10%–15%, even with appropriate antibiotic therapy. Meningococcemia’s case-fatality is up to 40%. As many as 20% of survivors have permanent sequelae, like hearing loss, neurologic damage, or loss of a limb.

    Quadrivalent meningococcal conjugate vaccine that offers protection against serogroups A, C, Y and W-135 is routinely given at 11 years old. For longer duration of protection, a dose is repeated after the 16th birthday.

    Two vaccine products are available against serogroup B that can be given to adolescents based on risk and with shared clinical decision-making. This vaccine has been used as a control measure for outbreaks on college campuses in the United States.

    Meningococcal disease is spread by direct contact with nasal or throat secretions of a carrier or ill person.  The organism cannot be spread simply by being in the same room with an infected person.

    Household contacts are at highest risk for transmission, but transmission is possible through sharing eating utensils, glassware, cigarettes, or toothbrushes.

    The incubation period varies from 2 to 10 days, most commonly 3 to 4 days.

    Meningococcal disease is most often diagnosed by isolation of N. meningitidis from blood or cerebral spinal fluid (CSF). After administration of antibiotics, bacterial culture sensitivity can be low. In this situation, a Gram stain of CSF, assays to detect bacterial antigen in CSF, and polymerase chain reaction (PCR) tests can be helpful.

    Antibiotics are given to close contacts of cases with meningococcal disease, regardless of vaccination status. Close contacts include:

    • Household members.
    • Intimate contacts.
    • Healthcare personnel performing mouth-to-mouth resuscitation.
    • Daycare center playmates.
    • Very close friends with whom the case may have shared cups or utensils.

    Casual contacts, like classmates and co-workers, usually do not require treatment. Preventive medications include:

    Rifampin

    Drug of choice for most children; not recommended for pregnant women.

    • Children younger than 1 month: 5 mg/kg by mouth every 12 hours for 2 days.
    • Children older than 1 month: 10 mg/kg by mouth every 12 hours for 2 days.
    • Adults: 600 mg by mouth every 12 hours for 2 days.
    Ciprofloxacin

    Not recommended for pregnant women.

    • Children older than 1 month: 20 mg/kg in a single dose by mouth.
    • Adults: 500 mg in a single dose by mouth.
    Ceftriaxone
    • Children younger than 15 years: 125 mg single intramuscular (IM) injection.
    • Adults: 250 mg single IM injection.

    Resources for providers

    For patients