The words “meningococcal meningitis” are frightening ones for anyone who has any experience with this disease. In many parts of Africa, yearly meningococcal meningitis outbreaks are the norm. The disease sweeps through the population during the dry season, killing thousands each year, mostly children. In the last decade, there were 700,000 cases and 100,000 deaths caused by meningitis in Africa.

In the United States, meningococcal meningitis outbreaks on this scale do not occur, but there are about 3,000 cases each year. Death occurs in about 10 percent of cases. Of those who survive, 10 to 20 percent suffer brain damage or other serious problems.

Meningitis is the general term for inflammation of the membranes that surround and protect the brain and spinal cord. (Encephalitis is inflammation of the brain itself.)

Meningococcal meningitis is caused by a type of bacteria called

Neisseria meningitidis. It is the most common cause of bacterial meningitis, especially in infants and adolescents. Most cases here occur in the winter and early spring. The bacteria live in the respiratory secretions (saliva, mucus) and are transmitted by direct contact. Some people carry these bacteria and do not become ill.

The symptoms of meningococcal meningitis include a sudden onset of:

high fever,

severe headache,

neck stiffness or pain,

sensitivity to light,

irritability, confusion,

nausea, vomiting,

weakness, drowsiness,

a rash, which does not fade with pressure.

Anyone suspected of having meningitis needs immediate medical evaluation, as early diagnosis is critical. Go quickly to an emergency room or call 911.

If a health care provider suspects meningitis, a spinal tap is done – a needle is inserted into the lower back to withdraw a small amount of fluid from the spinal canal. If bacteria are found, the type is identified in the laboratory so the correct antibiotic therapy can be given.

Patients with meningococcal meningitis are admitted to the hospital for intravenous antibiotics. Anyone who recently had close contact (meaning having contact with the respiratory secretions of the patient) should be advised to take an antibiotic as preventive treatment. People who had casual contact with the patient (such as spending time in the same classroom or office) do not require preventive treatment.

There are two vaccines available to prevent meningococcal meningitis.

Menomune has been available since 1981, and requires booster doses every three years. Menactra is a newer vaccine – approved in 2005 – and probably will not require booster doses.

The CDC recommends all children get a meningitis vaccine at age 11 or 12, or before high school. College freshman who will live in dormitories are at an increased risk for the disease, so should consider vaccination. Military recruits and many people with immune system disorders get the meningitis vaccine also.

These vaccines are effective against meningococcal meningitis types A, C, Y and W-135, but unfortunately, it does not prevent type B.

Although meningococcal meningitis is an extremely serious infection, it is not the most common type of meningitis.

The most common type is viral meningitis (also known as aseptic meningitis), which can be caused by many types of viruses. These can be transmitted person-to-person or they can be mosquito-borne. Viral meningitis usually lasts about 10 days; no specific treatment is needed and complete recovery is the norm.

Bacterial meningitis can also be caused by Streptococcus pneumoniae and Haemophilus influenzae type B (Hib). However, rates of these types of meningitis have been steadily decreasing since vaccines against these infections have been routinely recommended for young children. The PCV vaccine against S. pneumoniae – known as Prevnar – has been available since 2000. The Hib vaccine – brand names such as Comvax and Pedvax – has been recommended since 1988.

Kathryn B. Brown is a family nurse practitioner with a master’s degree in nursing from OHSU.