Invasive meningococcal disease

What is invasive meningococcal disease (IMD)?

  • Invasive meningococcal disease is caused by the bacteria Neisseria meningitidis.
  • Neisseria meningitidis bacteria are divided into strains or “serogroups” that are designated by letters of the alphabet.
    • Strains A, B, C, W-135 and Y cause most of the meningococcal infections in Canada.
  • You can carry the bacteria and not have any symptoms (this is known as colonization or being a carrier).
    • About 10 to 20 percent of adolescents and adults carry the bacteria in the back of their noses and throats.
  • Sometimes the bacteria invade the body and cause illness, which is known as meningococcal disease.

Types of meningococcal disease

Meningococcal meningitis

  • Swelling in the lining of the brain and spinal cord.
  • Most common form of meningococcal infection.

Meningococcal septicemia (meningococcemia)

  • Infection in the bloodstream.
  • Less common form of meningococcal infection.
Invasive meningococcal disease can lead to severe consequences and long-term complications.
  • All forms of invasive meningococcal disease are medical emergencies and require immediate attention.
  • Prompt diagnosis and treatment with antibiotics improves the chance of a good outcome without complications.

How does invasive meningococcal disease spread?

  • Meningococcal bacteria is spread through direct contact with secretions from the nose and throat of a person who is a carrier of the bacteria, such as:
    • Sharing personal items such as:
      • drinking cups, water bottles
      • eating utensils
      • straws
      • lipstick
      • vapes, cigarettes, joints
      • mouthpieces on musical instruments
    • Open-mouth (intimate deep) kissing
  • You cannot catch the bacteria through casual contact or by breathing air where someone with meningococcal disease has been.
  • The bacteria are fragile and can not survive outside of the body.

Increased risk factors and examples

Age
  • Children under two years of age
  • Adolescents and young adults aged 16 to 21 years of age
  • Adults over the age of 65
Having close contact with someone who is sick with invasive meningococcal disease
  • Household members of someone sick with invasive meningococcal disease
  • People who share sleeping arrangements with someone sick with invasive meningococcal disease
  • Daycare workers and attendees
Living in closed or crowded conditions
  • Post-secondary students living in dormitories
  • Military groups
Being immune suppressed
  • HIV infection
  • Anatomic or functional asplenia
Travel to areas of the world where invasive meningococcal disease is very common
  • African meningitis belt
  • During the Hajj in Saudi Arabia
Other risk factors
  • Smoking or exposure to second-hand smoke
  • Recent respiratory viral infection

Signs and symptoms of invasive meningococcal disease

  • Symptoms may initially resemble the flu, then rapidly worsen.
  • Symptoms develop two to 10 (usually three to four days) after exposure.
  • A person with invasive meningococcal disease can spread the bacteria seven days before the onset of symptoms and up to 24 hours after the start of antibiotic treatment.

Fever, usually high

  • Meningitis: Yes
  • Septicemia: Yes

Cold hands and feet

  • Meningitis: Yes
  • Septicemia: Yes

Drowsiness. impaired consciousness

  • Meningitis: Yes
  • Septicemia: Yes

Irritability, agitation

  • Meningitis: Yes
  • Septicemia: Yes

Severe headache

  • Meningitis: Yes
  • Septicemia: Yes

Vomiting

  • Meningitis: Yes
  • Septicemia: Yes

Stiff neck

  • Meningitis: Yes
  • Septicemia: No

Pain when moving neck

  • Meningitis: Yes
  • Septicemia: No

Photophobia (sensitivity to light)

  • Meningitis: Yes
  • Septicemia: No

Rash

  • Meningitis: Not always
  • Septicemia: Yes

Rapid breathing

  • Meningitis: Rarely
  • Septicemia: Yes

Pain in muscles and legs

  • Meningitis: Rarely
  • Septicemia: Yes

Prevention

Avoid sharing

Avoid sharing anything that comes into contact with oral secretions, such as:

  • drinking cups, water bottles
  • eating utensils
  • straws
  • lipstick
  • vapes, cigarettes, joints
  • mouthpieces on musical instruments

Get vaccinated

  • Vaccines are available to prevent meningococcal disease caused by bacterial strains A, B, C, W, Y.

Meningococcal C

  • Healthy children in Ontario: monovalent conjugate C meningococcal (Men-C-C) vaccine routinely provided for free at 12 months of age.

Meningococcal ACWY

  • Healthy adolescents and young adults in Ontario: conjugate meningococcal (Men-C-ACYW-135) vaccine, routinely provided for free in grade 7, even if they have previously been vaccinated as an infant or toddler.

Meningococcal B

  • Vaccination against meningococcal B (MenB) is not part of the routine (free) vaccination schedule in Ontario.
  • Talk to your health-care provider about getting your MenB vaccine.

High-risk individuals

  • Men-C-ACYW-135 provided together with the MenB vaccine is provided at no cost for people aged two months to 17 years who are at high risk of invasive meningococcal disease.
  • High-risk eligibility:
    • acquired complement deficiencies
    • asplenia
    • cochlear implant recipient (pre or post-implant)
    • complement, properdin, factor D or primary antibody deficiencies
    • HIV
  • Individuals at increased risk of exposure to meningococcal disease, such as travellers to areas with high rates of endemic meningococcal disease, should consult a health-care provider for advice on receiving meningococcal vaccines. Vaccine provided for travel is not publicly funded (free).

How is invasive meningococcal disease diagnosed and treated?

  • If a doctor suspects meningococcal disease, they will collect samples of blood or cerebrospinal fluid (fluid near the spinal cord).
    • The sample is sent to the lab for testing
  • Growing the bacteria in the laboratory allows doctors to know the specific type of bacteria that is causing the infection.
    • Knowing this helps doctors decide which antibiotic will work best.
  • It is important that treatment start as soon as possible.

Frequently asked questions

When someone is diagnosed with invasive meningococcal disease public health will identify and follow up with individuals who are considered close contacts.

Close contacts are people who:

  • Live in the same household as the case.
  • Someone who shared sleeping arrangements with the case.
  • Attend or work in a child care setting with the case.
  • Someone who has direct nose or mouth contact with oral or nasal secretions from a case (kissing, sharing drinks or personal items).
  • Health-care workers who cared for the case without proper personal protective equipment (PPE).
  • Airline passengers who sat directly beside the case.

Close contacts should be aware of the signs and symptoms of invasive meningococcal disease and seek immediate medical attention if any symptoms develop.

Close contacts may be offered antibiotics to eliminate the bacteria from their nose and throat, to prevent them from becoming ill or spreading the infection to others. Close contacts who will continue to be in contact with the case are also recommended to receive vaccine based on the type of meningococcal bacteria they were exposed to.

Post-secondary students living on-campus for the first time are at increased risk of a meningococcal infection. It is important for these students to check if they have been vaccinated against all types of meningococcal disease including B, and if not, consider getting vaccinated before attending post-secondary education.

  • Step 1
    • Contact your on-campus Health Centre or local health-care provider to get your MenB vaccine prescription.
  • Step 2
    • Fill your prescription at the pharmacy.
  • Step 3
    • Book your appointment at your on-campus Health Centre or on-campus pharmacy to have your vaccine administered.
  • Repeat steps 2 and 3 at the recommended interval for subsequent dose(s).
  • If you are not in the Southeast Public Health region right now, contact your health-care provider.

The MenB vaccine is not a routine (free) vaccine. The cost of the vaccine may be covered by your health benefit plan.

  • Attend a local walk-in clinic.
  • Consider using a virtual care clinic to get a prescription and ask your pharmacist to administer the vaccine.
  • If you have one of the listed high-risk conditions, book an appointment.

The meningococcal B vaccine is licensed for those 24 years of age and under, but may be indicated for use in adults 25 years of age and older in certain situations, such as travel to areas with high rates of meningococcal disease.

  • The overall incidence of invasive meningococcal disease is low, but the fatality rate is high.
  • Up to one in five survivors will have long term complications, affecting quality of life such as;
    • loss of limb(s)
    • deafness
    • nervous system problems
    • brain damage