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A fathering holding his infant child
Invasive meningococcal disease (IMD)

Invasive meningococcal disease is an uncommon but potentially life threatening disease that may be prevented through vaccination.[1]

 

“I’ve Seen Meningitis”

Doctors who have seen meningitis never want to see it again—here are their stories.

In this series of videos, you can learn about the firsthand experiences of doctors from various countries who have had to diagnose and treat meningitis.ᵃ

About invasive meningococcal disease (IMD)

  • IMD characteristics

    IMD characteristics

    Progression:

    IMD is unpredictable and easily misdiagnosed. It often presents as a mild disease at first, but then progresses rapidly and can become potentially lethal within 24 hours.²,³

     

    Classification:

    • Meningitis infection is caused by the strictly human pathogen, Neisseria meningitidis, a gram-negative aerobic diplococcus surrounded by a polysaccharide capsule⁴
    • N. meningitidis is classified into serogroups based on the immunologic reactivity of the capsular polysaccharides⁴
      • 5 of the 12 serogroups—A, B, C, W, and Y—cause the majority of the IMD cases⁴

    Transmission:

    • N. meningitidis is spread via droplets of respiratory or throat secretions from a human carrier or an infected person.³

    Carriage:

    •  Around 10% of the general population are asymptomatic carriers of N. meningitidis, but rates are highest (often >20%) in older adolescents and young adults.³

    Consequences:

    Although uncommon, IMD can be fatal or cause serious lifelong disabilities in survivors.¹,³

    Prevention:

    Centers for Disease Controls and Prevention advises that the best defense against meningococcal disease is to keep up to date with recommended immunisations. A healthy lifestyle, as well as not coming into close contact with people who are sick, can also help.⁸

  • IMD epidemiology

    IMD epidemiology

    Estimated 500,000 to 1,200,000 cases of IMD globally each year⁴

    Neisseria meningitidis serogroup distribution varies between regions/countries⁹⁻²¹,ᵃ

    ᵃSerogroup distribution cannot be directly compared across countries due to variability in surveillance data available. Serogroup data is across all age groups. Percentages may not total 100 due to rounding

  • At-risk populations

    At-risk populations

    Although uncommon, most cases of meningococcal disease develop in otherwise healthy people without warning and can result in serious sequelae and even death.¹,²²

    Certain groups are considered at increased risk including

    • Children under 5
    • Adolescents
    • Travelers and those living in crowded situations
    • Individuals with illnesses associated with immunodeficiency
    Particular groups at increased risk of IMD
    Child under 5 who is considered at-risk for invasive meningococcal disease (IMD)

    Children under 5 years

    Infant immune systems are immature and have not yet developed their own protective antibodies. Protective maternal antibody levels are waning in infants.²³,²⁴

    Adolescent girl who is considered at-risk for invasive meningococcal disease (IMD)

    Adolescents

    Adolescents and young adults’ increased participation in social behaviours—smoking, kissing, crowded living conditions, frequenting pubs and discos, sharing of drinks, cigarettes, and utensils.³,²⁵

    Travelers to high-risk areas who are considered at-risk for invasive meningococcal disease (IMD)v

    Travelers and crowded living

    Travel to high-risk areas and living in crowded conditions in university dormitories, large displacements at pilgrimages, or in the military— contributes to increased risk for acquisition and spread of N. meningitidis bacteria.³,⁶,²⁶

    Doctor examining infant patient with invasive meningococcal disease (IMD)

    Health risks

    Individuals suffering from immunodeficiency, including asplenia, terminal complement deficiencies, or advanced HIV infection.⁶,²⁶

    Incidence by age group:

    IMD case rate by age group in Europeᵇ 2017; total cases, N=3221²⁷

    Figure adapted from data from European Centre for Disease Prevention and Control.

    ᵇConfirmed cases: Austria, Belgium, Bulgaria (2006 onwards), Croatia (2012 onwards), Cyprus (2004 onwards), Czech Republic, Denmark, Estonia, Finland, France, Germany, Greece, Hungary (2003 onwards), Iceland, Ireland, Italy, Latvia (2002 onwards), Lithuania (2000 onwards), Luxembourg, Malta, The Netherlands, Norway, Poland, Portugal (2000 onwards), Romania (2006 onwards), Slovakia (2003 onwards), Slovenia, Spain, Sweden, United Kingdom.

About invasive meningococcal disease (IMD)

IMD characteristics

Progression:

IMD is unpredictable and easily misdiagnosed. It often presents as a mild disease at first, but then progresses rapidly and can become potentially lethal within 24 hours.2-3

Time chart showing the progression of invasive meningococcal disease (IMD)

Classification:

  • Meningitis infection is caused by the strictly human pathogen, Neisseria meningitidis, a gram-negative aerobic diplococcus surrounded by a polysaccharide capsule4
  • N. meningitidis is classified into serogroups based on the immunologic reactivity of the capsular polysaccharides4
    • 5 of the 12 serogroups—A, B, C, W, and Y—cause the majority of the IMD cases4

 

Transmission:

  • N. meningitidis is spread via droplets of respiratory or throat secretions from a human carrier or an infected person.3

 

Carriage:

  •  Around 10% of the general population are asymptomatic carriers of N. meningitidis, but rates are highest (often >20%) in older adolescents and young adults.3

 

Consequences:

Although uncommon, IMD can be fatal or cause serious lifelong disabilities in survivors.1 3

Depiction of stats showing 1 in 10 death rate of patients diagnosed with invasive meningococcal disease (IMD)
Depiction of stats showing 1 in 5 rates of serious sequelae of patients diagnosed with invasive meningococcal disease (IMD)

Prevention:

Centers for Disease Controls and Prevention advises that the best defense against meningococcal disease is to keep up to date with recommended immunisations. A healthy lifestyle, as well as not coming into close contact with people who are sick, can also help.8

IMD epidemiology

Classification:
Estimated 500,000 to 1,200,000 cases of IMD globally each year4

Neisseria meningitidis serogroup distribution varies between regions/countries9-21 a

Map showing estimated cases of invasive meningococcal disease (IMD) globally

ᵃSerogroup distribution cannot be directly compared across countries due to variability in surveillance data available. Serogroup data is across all age groups. Percentages may not total 100 due to rounding.

At-risk populations

Although uncommon, most cases of meningococcal disease develop in otherwise healthy people without warning and can result in serious sequelae and even death.1 22

Certain groups are considered at increased risk including

  • Children under 5
  • Adolescents
  • Travelers and those living in crowded situations
  • Individuals with illnesses associated with immunodeficiency
Baby on window glass
Particular groups at increased risk of IMD
Child under 5 who is considered at-risk for invasive meningococcal disease (IMD)

Children under 5 years

Infant immune systems are immature and have not yet developed their own protective antibodies. Protective maternal antibody levels are waning in infants.23 24

Adolescent girl who is considered at-risk for invasive meningococcal disease (IMD)

Adolescents

Adolescents and young adults’ increased participation in social behaviours.3 25

Travelers to high-risk areas who are considered at-risk for invasive meningococcal disease (IMD)

Travelers and crowded living

Travel to high-risk areas and living in crowded conditions in university dormitories, large displacements at pilgrimages, or in the military— contributes to increased risk for acquisition and spread of N. meningitidis bacteria.3 6 26

Pediatrician holding a beautiful newborn baby boy

Health risks

Individuals suffering from immunodeficiency, including asplenia, terminal complement deficiencies, or advanced HIV infection.6 26

Incidence by age group:

IMD case rate by age group in Europeᵇ 2017; total cases, N=322127

Bar chart showing incidence of invasive meningococcal disease by age group
Figure adapted from data from European Centre for Disease Prevention and Control.

ᵇConfirmed cases: Austria, Belgium, Bulgaria (2006 onwards), Croatia (2012 onwards), Cyprus (2004 onwards), Czech Republic, Denmark, Estonia, Finland, France, Germany, Greece, Hungary (2003 onwards), Iceland, Ireland, Italy, Latvia (2002 onwards), Lithuania (2000 onwards), Luxembourg, Malta, The Netherlands, Norway, Poland, Portugal (2000 onwards), Romania (2006 onwards), Slovakia (2003 onwards), Slovenia, Spain, Sweden, United Kingdom.

References

  1. Pelton SI. Meningococcal disease awareness: clinical and epidemiological factors affecting prevention and management in adolescents. J Adolesc Health. 2010;46:S9-S15
  2. Thompson MJ, Ninis N, Perera R, et al. Clinical recognition of meningococcal disease in children and adolescents. Lancet. 2006;367(9508):397–403.
  3. World Health Organization. Meningococcal meningitis. https://www.who.int/news-room/fact-sheets/detail/meningococcal-meningitis. Accessed April 17, 2020.
  4. Gabutti G, Stefanati A, Kuhdari P. Epidemiology of Neisseria meningitidis infections: case distribution by age and relevance of carriage. J Prev Med Hyg. 2015;56(3):E116–E120. 
  5. Christensen H, May M, Bowen L, Hickman M, Trotter CL. Meningococcal carriage by age: a systematic review and meta-analysis [published correction appears in Lancet Infect Dis. 2011 Aug;11(8):584]. Lancet Infect Dis. 2010;10(12):853–861.
  6. World Health Organization (WHO). Weekly epidemiological record. No. 47. (2011) 521-540. 
  7. Viner RM, Booy R, Johnson H, et al. Outcomes of invasive meningococcal serogroup B disease in children and adolescents (MOSAIC): a case-control study. Lancet Neurol. 2012;11(9):774–783.
  8. Centers for Disease Control and Prevention. Meningococcal Disease: Prevention. https://www.cdc.gov/meningococcal/about/prevention.html. Accessed April 23, 2020.
  9. Government of Canada, 2017. Vaccine Preventable Disease: Surveillance Report to December 31, 2015. (Accessed October 2019).
  10. Centers for Disease Control and Prevention 2017. Enhanced meningococcal disease surveillance report, 2017. (Accessed October 2019).
  11. Instituto Nacional de la Salud, Grupo de Microbiologia, 2018. Vigilancia por laboratorio Neisseria meningitidis (aislaminetos invasores) periodo 1987–2017. (Accessed October 2019).
  12. Meningite – Casos Confirmados Notificadoes No Sistema de Informacao de Agravos de Notificacao. 2018 Brasil. TabNet.Datasus;2018; http://tabnet.datasus.gov.br/cgi/tabcgi.exe?sinannet/cnv/meninbr.def (Accessed December 2019).
  13. Servicio Bacteriología Clínica-Departamento Bacteriología-INEI-ANLIS, Malbrán CG, 2018. Información sobre la vigilancia de las neumonías y meningitis bacterianas. SIREVA II. OPS. 2018. (Accessed October 2019).
  14. European Centre for Disease Prevention and Control. Invasive meningococcal disease. In: ECDC. Annual epidemiological report for 2017. Stockholm: ECDC, 2019. 
  15. Ceyhan M et al. Open Forum Infect Dis. 2018;5(Suppl 1):S246 and poster 682 presented at: IDWeek 2018; October 3–7; San Francisco, CA, USA.
  16. Memish Z, Al Hakeem R, Al Neel O, Danis K, Jasir A, Eibach D. Laboratory-confirmed invasive meningococcal disease: effect of the Hajj vaccination policy, Saudi Arabia, 1995 to 2011. Euro Surveill. 2013;18(37):20581. 
  17. World Health Organization (WHO). Wkly Epidemiol Rec 2016;91:209–216.
  18. National Institute for Communicable Diseases, 2017. GERMS–South Africa Annual Report 2017. (Accessed October 2019). 
  19. Fukusumi M, Kamiya H, Takahashi H, et al. National surveillance for meningococcal disease in Japan, 1999-2014. Vaccine. 2016;34(34):4068–4071.
  20. Australian Government Department of Health. Invasive meningococcal disease national surveillance report. Q4 2018. (Accessed October 2019);  
  21. New Zealand Public Heath Surveillance ESR Invasive Meningococcal Disease Report 19 Dec 2018 (Accessed October 2019). 
  22. Centers for Disease Control and Prevention. Prevention and control of meningococcal disease: recommendations of the Advisory Committee on immunization practices (ACIP). MMWR Recomm Rep. 2013;62(RR-2):1-28. 
  23. Rosenstein NE, Perkins BA, Stevens DS, Popovic T, Hughes JM. Meningococcal disease. NEJM,2001;344(18):1378-1388. 
  24. Judelsohn R, Marshall GS. The burden of infant meningococcal disease in the united states. J Pediatric Infect Dis Soc. 2012;1(1):64–73. 
  25. Imrey PB, Jackson LA, Ludwinski PH, et al. Meningococcal carriage, alcohol consumption, and campus bar patronage in a serogroup C meningococcal disease outbreak. J Clin Microbiol. 1995;33(12):3133–3137. 
  26. Centers for Disease Control and Prevention (CDC). Prevention and control of meningococcal disease. Recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Recomm Rep. 2005;54(RR-7):1–21. 
  27. European Center for Disease Prevention and Control. Surveillance atlas of infectious diseases. http://atlas.ecdc.europa.eu/public/index.aspx. Accessed April 2020.

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PM-SA-BEX-WCNT-200004 Date of preparation: October 2020