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Meningococcal disease 

Meningococcal disease
Chapter:
Meningococcal disease
DOI:
10.1093/med/9780198729228.003.0089
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date: 19 November 2019

Meningococcal disease is caused by the Gram-negative diplococcus Neisseria meningitidis. The confirmed case rate of invasive meningococcal disease across Europe is currently approximately 0.73/100 000 population, with large regional variability. During epidemics in sub-Saharan Africa, the incidence can be as high as over 100/100 000 population. The disease is caused by serogroups A, B, C, Y, and W135. Most endemic cases occur in young children and teenagers. Meningococcal disease often presents with a petechial or purpuric rash and symptoms consistent with meningitis or sepsis (e.g. neck stiffness, photophobia, confusion, leg pain, or cold hands and feet in a child with acute febrile illness). Mortality is around 10%, and up to 30% suffer sequelae, including hearing loss, amputations, or neurological disability. Urgent antibiotic treatment and management of sepsis are required. Meningitis may be treated with adjuvant corticosteroids. Paediatric intensive care treatment is required in a significant number of cases. Meningococcal disease must be officially reported, and household contacts must receive chemoprophylaxis and, if possible, vaccination to prevent secondary cases. Effective conjugate vaccines have been developed for most of the serogroups. Vaccination against serogroup C forms part of many European national immunization programmes. A multicomponent Men B vaccine has recently been licensed in Europe and may be implemented in routine vaccination schedules if cost-effectiveness can be reached. Risk populations for meningococcal disease include children with complement deficiency asplenia and travellers to endemic regions.

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