Meningococci, Neisseria Meningitidis, the bacteria in meningitis. Seen under optical microscopy X … [+]
The CDC (Centers for Disease Control and Prevention) is reporting an outbreak of meningococcal diseases in Florida. So far, at least 26 cases and 7 deaths have occurred, all among gay and bisexual men.
There are two ways serious meningococcal infections present. One is meningitis, with classic symptoms of headache, stiff neck, nausea and vomiting, and light sensitivity (photophobia). The second is a bloodstream infection from the bacteria Neisseria meningitidis, which can be fulminant and lead to shock and death within hours. A purplish rash due to hemorrhage is a warning of impending shock. Early treatment is critical in either to prevent death. One problem is delayed recognition, as early symptoms can appear flu-like.
There are several strains of meningococcus. Serogroup C is causing the outbreak among men who have sex with men who live in or have traveled to Florida. About half the cases are in Hispanic men.
Another outbreak, from serotype B, occurred in Tallahassee last month among college students. This is typically the group in which meningococcal infections are seen. We had such an outbreak in our community a number of years ago. Two students died, one from meningitis and the other from sepsis. One recovered but lost hearing in one ear, which is a typical complication.
Meningococcus is transmitted by secretions, such as sharing glasses or a bottle, or by kissing. This is part of why infections are more common among high school/college kids. (Parents, teach your kids not to share drinking bottles!). This is also why many universities require immunization against meningococcus.
Treatment is generally with ceftriaxone or penicillin; resistance to these antibiotics is infrequent but does occur.
Epidemics of meningococcus occur each year in North Africa, in a sub-Saharan belt.
A common question in hospital infection control settings was whether health care workers wanting cultures or prophylactic treatment with rifampin should receive it. Rifampin, an antibiotic used for prophylaxis, does offer protection from infection. There were a couple of problems with this. One reason for questioning this approach is that ~2% of healthy people can carry (be colonized with) meningococcus in their nose and remain healthy. Antibiotics are not indicated for this. Another is that rifampin can cause oral contraceptives to fail.
The mortality rate from meningococcal infections is still 10-15%, despite advances in supportive care and the treatment of shock. A somewhat higher rate is seen in outbreak settings. Up o 20% of survivors are left with long-term neurologic abnormalities.
Because of the frequent poor outcomes from infection, even when it is aggressively and appropriately treated, vaccination is the mainstay of responding to an outbreak—or preventing them, to begin with.
This is why the CDC is recommending gay, bisexual, and other men who have sex with men get a meningococcal vaccine (MenACWY) if they live in Florida. Those who are traveling to Florida should discuss vaccination with their provider. People with HIV should also be vaccinated routinely with this particular meningococcal vaccine. The vaccine can be obtained through the local health department. Insurance providers should pay for meningococcal vaccination for those for whom it is recommended during an outbreak. In Florida, anyone can get a MenACWY vaccine at no cost at any county health department during the outbreak. A different, serotype-specific vaccine is available for Type B meningococcus, and can also be obtained through the health department.
This outbreak is coming at a difficult time, with public health departments stretched thin and an outbreak of monkeypox requiring attention nationally. There are 142 cases of this viral infection (orthopoxvirus) identified so far in the US with 13 in Florida. Cases of Covid are also rising there with a high risk of transmission (351/100k). Health departments—especially Florida’s—are facing numerous concurrent challenges. In addition to the meningococcal meningitis and monkeypox outbreaks, Florida is the only state without Covid vaccines for children through its health department. Governor Ron DeSantis has refused to order the vaccine. Nikki Fried, Florida’s agriculture commissioner and candidate for governor, said, “It’s just one more anti-science dangerous COVID denialism from the governor and Dr. Ladapo.” Such stances add to the burden of an already strained health department in responding to these critical and urgent outbreaks.