Guidance for health professionals on diagnoses, prevention and treatment of meningococcal disease.
Someone with meningococcal meningitis or septicaemia may begin with flu-like symptoms but is likely to rapidly become very ill. Some common symptoms are listed below but symptoms can occur in different orders and not all of these will occur. For more information see Meningitis Now and Meningitis Research Foundation.
In children and adults symptoms can include:
- sudden onset of a high fever
- a severe headache
- dislike of bright lights (photophobia)
- vomiting and/or severe diarrhoea or stomach pains
- painful joints
- pale and blotchy skin
- very cold hands and feet
- drowsiness that can deteriorate into a coma
Symptoms are harder to identify in babies but include:
- a fever while the hands and feet are cold
- high pitched moaning or whimpering
- blank staring, inactivity, hard to wake up
- poor feeding
- neck retraction with arching of the back
- pale and blotchy complexion
In septicaemia where the bacteria have entered the bloodstream. A characteristic rash often develops and may start as a cluster of pinprick blood spots under the skin, spreading to form bruises under the skin. The rash can appear anywhere on the body. It can be distinguished from other rashes by the fact that it does not fade when pressed under the bottom of a glass (the tumbler test). This tends to be a late symptom and should be treated as a medical emergency.
Symptoms can develop into a severe, life-threatening condition within hours and if you have any concerns it is important to seek early medical advice.
Confirmation of disease requires either:
- isolation of the organism from a normally sterile body site (usually cerebrospinal fluid (CSF) or blood) or
- DNA detection by PCR assay (from CSF, serum, plasma, EDTA-coagulated whole blood, or joint fluids)
For more information see ‘Laboratory investigation of suspected cases’ in the Guidelines for public health management of meningococcal disease in the UK and the Meningococcal Reference Unit user manual for testing services and specimen specifications.
The national surveillance protocol for invasive meningococcal disease (IMD) in England has been extended.
These changes have been made in recognition of:
- changes to the meningococcal group C (MenC) conjugate vaccination programme, including the removal of the infant MenC dose at 4 months from July 2016
- the emergency introduction of a quadrivalent conjugate vaccine against meningococcal groups A, C, W, and Y (MenACWY) for 14-18 year-olds from August 2015 in response to a national outbreak of a hypervirulent MenW. At the same time MenACWY vaccine also replaced the adolescent MenC dose that was introduced in June 2013
- the introduction of a MenB vaccine, Bexsero®, into the national infant immunisation schedule in September 2015
Prevention and treatment
- intravenous antibiotics
- early treatment - the earlier the treatment, the better the prospect of recovery. GPs may give treatment even before the person is admitted to hospital
- prompt action - if you suspect someone may have meningococcal disease, contact the doctor immediately. If the doctor is unavailable they should be taken to the nearest casualty department
Further information on clinical management is available on the NICE Clinical Knowledge Summaries.
MenB vaccination is recommended at 2,4 and 12 months. Hib/MenC vaccination is recommended at 12 months and MenACWY vaccination at 14 years of age. It is important to have these vaccinations when they are scheduled wherever possible as the timing is planned to ensure protection through ages at increased risk of disease. For further information about vaccination see Meningococcal: the green book, chapter 22.
Meningococcal vaccines and travel
Travel to the religious festivals of Hajj and Umrah requires vaccination with a quadrivalent vaccine which protects against meningococcal disease caused by serogroups A, C, W and Y. Saudi authorities request a certificate of vaccination from visiting pilgrims. This vaccine is also recommended for travellers to parts of Africa and other countries with high meningococcal incidence.
For more information on meningococcal vaccines for those travelling abroad, see the meningococcal disease health information sheet on the National Travel Health Network and Centre (NaTHNaC) website and Chapter 22 of The Green Book. For travellers to the Hajj and Umrah festivals see the advice for pilgrims on the NaTHNaC website.