Updated October 06, 2014.

Written or reviewed by a board-certified physician. See About.com's Medical Review Board.

Students at Princeton University and University of California at Santa Barbara  (UCSB) had more to worry about than their grades. An outbreak of Meningoccal disease resulted in 13 cases and one death on the campuses in 2013. It's a sudden, but small, risk faced by those in dorms who may have close contact, sharing drinks or kissing.

Meningococcal meningitis starts with a abrupt fever and headache. It can feel like the flu.

Patients develop neck stiffness that progresses over hours. Symptoms may include nausea, vomiting, confusion, drowsiness, light sensitivity (pain looking at lights). There may be a rash on the abdomen, chest, arms, legs made of small dots (petechiae) or purple spots that look like bruising (purpura). If one presses against the rash, it does not disappear.

The disease leads to death in 10-15% infected. It is important anyone with symptoms seeks immediate medical attention.

Disease Impact

Meningococcal disease causes about 600-1000 cases annually in the US; 10-20% of survivors may have permanent injury - hearing loss, brain damage, loss of fingers, toes, or limbs. Worse outcomes are seen when bacteria spread to the blood (meningococcemia). 

Transmission

Meningococcal disease is caused by a bacteria, Neisseria meningitidis, that spreads through saliva or respiratory droplets (especially from coughing or sneezing, but not necessarily). This can spread 3 feet from the infected person. Close contact and close living quarters hasten spread.

 

Disease incubation is 3-4 days (2-10 days).

Most cases are sporadic. Some people carry a small amount of meningococcal bacteria in their noses and throats without being sick. They can pass it to someone else unknowingly. This "carriage" can be as high as 10% and is highest in older teenagers and patient contacts. Rates may be as high as 1 in 5 in older teens (in Europe) or household contacts (in New Zealand).

Risk

Infants are at highest risk, followed by teens and young adults. Those who have no spleen or who have certain genetic factors (complement deficiency) face more risk.

Risk depends on socializing. Sharing drinks or utensils or children playing in daycare can spread the infection. First year college students in dorms have higher risk. New military recruits are at risk - but are universally vaccinated in the US.

Gay men have faced outbreaks of meningococcal disease, unrelated to other infections like HIV. New York City saw sudden cases in 2012-2014, as did Los Angeles in 2014. British Columbia saw an outbreak in 2004.

The Hajj pilgrimage to Mecca, which is the largest mass gathering worldwide, has seen W-135 strain outbreaks in the past (2000-2001). Attendees are now required to show proof of vaccination.

In Africa, the Meningitis Belt stretches from Senegal to Ethiopia with over 20,000 cases and 2,000 deaths a year. During each dry season from December through June, meningitis epidemics occur. Most cases and deaths occur in 3 countries: Burkina Faso, Nigeria, Chad.

Other areas of the world see outbreaks. Chile has had continued spread of W-135

Different Types

In the US, there are 3 main serogroups: B,C, Y. Worldwide, there are also A and W-135. US vaccines cover A, C, W-135, Y -- but not B. The meningococcal polysaccharide vaccine (Menomune®) only works for children aged 2 and over (but infants at highest risk). The other vaccines, Menactra® and Menveo® (and MenHibrix®), are meningococcal conjugate vaccines and so can create immune responses in children as young as 9 and 2 months, respectively. Vaccines are recommended in the US at age 11-12 and boosted at 16 (and for all in college).

Serotype B vaccine was formulated separately.

Meningococcus B

About 1 in 3 cases are due to serotype B in the US. ?Most infant cases are. Of those over 11 years old, fewer than 1 in 4 are. Rates are higher in Europe. After serotype B outbreaks, Cuba and then Norway developed a special serotype B vaccines (using outer membrane vesicles (OMV)). This was modified for New Zealand and elsewhere. This special vaccine was permitted by the FDA at Princeton and UCSB; both faced serotype B outbreaks with no vaccine in the US. Another US college outbreak in 2010 was also attributed to serotype B.

Prophylaxis

Prophylactic antibiotics can be given to prevent disease in close contacts of infected patients. However, only 3-4% of affected households have secondary cases.

Treatment

For those who are ill, immediate medical attention is required. Antibiotics are needed; intensive care may be required. Patients should have droplet precautions to avoid transmission.