NEISSERIA MENINGITIDIS

I. Pathophysiology

1. Most common serogroups in human infections: A, B, C, Y, W-135
2. Infection is associated with a 10% fatality rate
3. Highly contagious

II. Clinical Features

1. In a retrospective study in children < 16yo with confirmed menningococcal disease, mean time to advanced disease stages (neck stiffness, unconsciousness, or seizures) was < 24h for 5-15yo and even faster for younger children; presented with septicemia in 66% and meningitis in 22%; some had rash other than classic purpural rash or even no rash (Lancet 367:397, 2006--JW)

III. Vaccination:

1. Polysaccharide meningoccal vaccine (Menomune)
   1. Contains capsular polysaccharides of serogroups A, C, Y, and W-135
   2. Single dose of 0.5ml SQ
   3. Recc'd by ACIP for high risk* pts 2-10yo or > 55yo (revaccination recc'd after 2-3y if initial received at < 4yo or after 5y for others)
   4. Immunity probably lasts at least 10y (Med. Lett. 42:69, 2000) but manufacturer recommends revaccination after 3-5y
2. Conjugate meningococcal vaccine (Menactra)
   1. Recc'd by ACIP for:
      1. All kids at 11-12yo (with catch-up through high school years)
      2. High risk* pts 11-55yo
   2. Single dose of 0.5ml IM
   3. Not approved for < 11yo or > 55yo

*--High risk pts include college freshmen living in dormitories, military recruits, travelers to endemic areas, or pts with terminal complement component deficiencies or anatomic or functional asplenia

Above-referenced ACIP recommendations were published in MMWR 5/27/2005.