Meningococcal Meningitis (Menveo and Menomune)

KEY POINTS

1. The bacterial agent of this disease is carried in the respiratory passages and transmitted through casual contact in close quarters (shared air-space), such as in school dormitories and military barracks.
2. Meningococcal meningitis is yearound and worldwide, but tends to occur in certain locations epidemically (such as during the annual Islamic Haj pilgrimage from Mecca to Medina).
3. In the U.S., most children are increasingly required by colleges to receive this vaccine prior to entry.

Disease: Neisseria meningitidis, a bacterium, can cause systemic illness by bloodstream infection (meningococcemia) or central nervous system infection (meningitis).

Symptoms:

1. Fever
2. Headache
3. Rash (hemorrhagic)
4. Neurological findings/deficits
5. Stiff neck
6. Light aversion (photophobia)

Transmission:

• Airborne aerosols
• Kissing
• Contact with objects freshly contaminated with infectious nasal secretions (cigarettes, food, beverages, eating utensils, lip gloss)

Prevalence:

1. Sub-Saharan “meningitis belt” from Senegal and Guinea to Ethiopia in the dry season (December – June); also the Middle East and parts of Asia
2. Worldwide in overcrowded, impoverished areas; outbreaks also occur in childcare centers, schools, colleges, military barracks settings, etc.
3. Risk to travelers is low, but increases with length of stay in high-risk areas and contact with the local populace. The highest rates of meningococcal disease are in 16 – 21 yrs. old. It is the leading cause of bacterial meningitis in children 2 – 18 yrs-old in the U.S.

Treatment: Antibiotics

Prevention

1. The Vaccines (Menveo; Menomune)
   1. Menveo (2 – 55 yrs-old)
      1. Covers meningococcal bacterial serogroups A, C, Y, and W135
      2. Given intramuscularly, 0.5cc
      3. Certified by Islamic Services of America as suitable for Hajj (Mecca to Medina) pilgrimage.
      4. Dosing:
         1. Non-Immune Compromised
            1. Adults – 1 dose; booster every 5 yrs.
            2. Adolescents
               1. If 1st dose at 11 – 12 yrs, booster at 16 yr
               2. If 1st dose at 13 – 15 yrs, booster at 16 – 18yrs (or up to 21yrs)
            3. Children – booster after 3 yrs; if 1st dose at 16 yrs-old, no routine booster needed; unless high risk exposure, as under “Targets”.
         2. Immune compromised: Initially, 2 doses, 8 weeks apart
         3. The vaccine should be received 1 – 2 weeks pre-travel for protection.
   2. Menomune (Over 55 yrs-old)
      1. Covers bacterial serogroups A, C, Y, and W135
      2. Given subcutaneously, 0.5cc
      3. Certified by Islamic Services of America as suitable for Hajj (Mecca to Medina) pilgrimage.
      4. Dosing
         1. Single dose for adult
         2. Booster: 2 – 3 yrs after 1st dose
   3. Side-Effects
      1. Menveo: Common adverse effects are injection site pain, headache, muscle aches, malaise, and nausea.
      2. Menomune: very infrequent adverse reactions; mainly local redness 1 – 2 days after injection
      3. Guillaine-Barre’ syndrome (polyneuritis) risk unknown with meningococcal vaccines
   4. Precautions/Contraindications
      1. Postpone vaccination with moderate illness.
      2. Menomune may be a risk with latex allergy.
      3. In immune compromised, response to the vaccine may be suboptimal (discuss with a physician).
      4. Use with pregnancy only if clearly indicated (definitive disease risk).
      5. Caution use with breastfeeding.
   5. Targets
      1. Required for travelers to Saudi Arabia for Hajj pilgrimage or Umra.
      2. Exposure to active meningococcal disease case
      3. Freshman college students entering dormitory
      4. HIV, persistent complement deficiency, diminished spleen function
      5. Travelers to Africa’s sub-Saharan “meningitis belt” during December – June (dry season)
      6. Travelers entering a country endemic for N. meningitidis when disease activity is increased
      7. Military recruits
      8. Occupations with exposure to N. meningitidis
      9. All 11yrs-old
2. Special Considerations
   1. Travelers arriving in the African meningitis belt, in addition to being required to show proof of vaccination, will also be given a preventive antibiotic (by mouth) at the point of entry.
   2. Anyone participation in the Hajj pilgrimage will be required to show proof of meningococcal vaccination within the prior 3 yrs.
   3. Meningococcal vaccine can be given concurrently with other vaccines except in those with sickle cell disease or without a spleen.

• Other Preventive Measures
  1. In areas where N. meningitidis is endemic (naturally present),
     1. Avoid crowded places (to minimize direct human contact).
     2. Avoid being near those sneezing and coughing.
     3. Do not share drink containers, cigarettes, lip gloss/balm.
     4. Wash hands frequently.

Access the VIS Sheet here

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