Emergencies

Meningococcal meningitis

Defeating meningitis by 2030: Development of the roadmap

Updated 14 May 2019 - In March 2019, Wilton Park, WHO, and the Meningitis Research Foundation convened 50 government officials, health experts, researchers, and representatives of industry and civil society organizations to further develop a roadmap to “defeat meningitis by 2030” and agree on a path forward.

Participants recommended implementing the roadmap in conjunction with broader programmes to strengthen healthcare, enhance surveillance, and improve the lives of persons with disabilities and to avoid creating new systems that deal with meningitis alone. They also pleaded for actively mobilizing resources to defeat meningitis using both economic arguments (including the costs to families due to the disease) and values-based arguments that draw on the United Nations Convention on the Rights of Persons with Disabilities (UNCRPD). Next steps include to refine the roadmap with specific work groups, form a Strategy Support Group and obtain endorsement for the roadmap from the WHO Strategic Advisory Group of Experts on Immunization (SAGE) and the WHO Strategic and Technical Advisory Group for Infectious Hazards (STAG-IH).

Situation update on meningitis C epidemic risk

5 October 2018 - Despite a relatively calm meningitis epidemic season (January-June 2018), the risk of large-scale epidemics remains high. A convergence of factors is threatening the region with large outbreaks affecting millions since 2015.

Urgent action is needed to prepare for the worst and minimize the potentially devastating impact of outbreaks in the region.

Developing a new generation Rapid Diagnostic Tests for meningitis

Updated 10 October 2018 - A new scalable, rapid test for the diagnosis of meningitis is crucial and long overdue. Experts gathered in Geneva in March 2018 explored the scope, type, target user and timelines for making such product available. They identified key steps to make progress for three different types of diagnostic tests: 1) Rapid test in the African meningitis belt to identify the causative organism (meningococcal serogroup) at peripheral level, 2) rapid test in epidemic and endemic settings (global level) to identify bacterial infection for individual case management at peripheral level, 3) rapid test in epidemic and endemic settings (global level) to identify multiple meningitis pathogens for individual case management at hospital level.

The three different types of diagnostic tests are being described in the 2018 use cases document.

Serogroup distribution of invasive meningococcal disease, 2018

19 February 2018 - Neisseria meningitidis bacteria has the potential to cause large-scale epidemics. Twelve types of N. meningitidis, called serogroups, have been identified worldwide, six of which (A, B, C, W, X and Y) can cause devastating epidemics. The distribution and frequency of these serogroups varies from region to region. Take a look at the map to find out more about what types of N. meningitidis can be found where in the world.

Introductory-level online course on meningitis

This interactive online course on meningitis offers the most relevant scientific, technical and operational knowledge on managing infectious hazards through video lectures, presentations and self-tests. The module on meningitis focuses on the bacteria Neisseria meningitidis, as it can cause large-scale epidemics, and takes an hour to complete.

A group of children holding up their treatment record.
WHO

Meningitis is an inflammation of the meninges, the membranes covering the brain and spinal cord. It can be caused by a variety of organisms that include bacteria, fungi or viruses. It is a serious condition that can be life threatening.

Meningococcal meningitis is an acute form of bacterial meningitis caused by Neisseria meningitidis. Meningococcal meningitis is of particular importance as it has the potential to cause large epidemics.

Defeating Meningitis by 2030

Meningitis is a devastating disease and remains a major public health challenge. Meningitis can be caused by many different pathogens including viruses and fungi but the highest global burden is seen with bacterial meningitis. Together with sepsis, meningitis is estimated to cause more deaths in children under 5 years of age than malaria. Survivors can suffer severe sequelae with considerable social and economic costs. Recognizing the global importance of the problem, countries and partners issued calls for a global vision and the ambition to develop a global strategy to defeat meningitis by 2030. The WHO Secretariat acknowledged the global relevance of an approach fully aligned with the objectives of the Organization’s GPW13 (2019-2023).

Roadmap Development

The “Defeating meningitis by 2030” was introduced in May 2018 at the World Health Assembly by Eastern Mediterranean and African Regions. Download the brochure.
Under the leadership of WHO, members of the Technical Task Force, a consortium of major technical partners historically invested in long-term meningitis control, met 18-19 July 2018 in Geneva.

Read the full meeting report

Experts reviewed an analysis of the baseline meningitis global situation, defined strategic objectives and the structure of the roadmap and identified next steps for a global consultative process. The baseline situation analysis (BSA) informs the development of the global roadmap and provides a sound basis to inform its key priorities.

Several different bacteria can cause meningitis. Neisseria meningitidis is the one with the potential to cause large epidemics. There are 12 serogroups of N. meningitidis that have been identified, 6 of which (A, B, C, W, X and Y) can cause epidemics. Geographic distribution and epidemic potential differ according to serogroup.

The most common symptoms are a stiff neck, high fever, sensitivity to light, confusion, headaches and vomiting. Even when the disease is diagnosed early and adequate treatment is started, 5% to 10% of patients die, typically within 24 to 48 hours after the onset of symptoms. Bacterial meningitis may result in brain damage, hearing loss or a learning disability in 10% to 20% of survivors. A less common but even more severe (often fatal) form of meningococcal disease is meningococcal septicaemia, which is characterized by a haemorrhagic rash and rapid circulatory collapse.

The bacteria are transmitted from person-to-person through droplets of respiratory or throat secretions from carriers. Close and prolonged contact – such as kissing, sneezing or coughing on someone, or living in close quarters (such as a dormitory, sharing eating or drinking utensils) with an infected person facilitates the spread of the disease. The average incubation period is 4 days, but can range between 2 and 10 days.

Neisseria meningitidis only infects humans; there is no animal reservoir. The bacteria can be carried in the throat and sometimes, for reasons not fully understood, can overwhelm the body's defenses allowing infection to spread through the bloodstream to the brain. It is believed that 10% to 20% of the population carries Neisseria meningitidis in their throat at any given time. However, the carriage rate may be higher in epidemic situations.

Initial diagnosis of meningococcal meningitis can be made by clinical examination followed by a lumbar puncture showing a purulent spinal fluid. The bacteria can sometimes be seen in microscopic examinations of the spinal fluid. The diagnosis is supported or confirmed by growing the bacteria from specimens of spinal fluid or blood, by agglutination tests or by polymerase chain reaction (PCR). The identification of the serogroups and susceptibility testing to antibiotics are important to define control measures.

Laboratory methods for the diagnosis of meningitis caused by Neisseria meningitidis, Streptococcus pneumoniae, and Haemophilus influenzae

Laboratory materials for the diagnosis of bacterial meningitis by PCR

Rapid diagnosis is essential, not only for individual patient management, but also for management of epidemics, in particular in the African meningitis belt. At the beginning of meningitis outbreaks, confirmation of the responsible pathogen is essential to enable the launch of an appropriate response. The development and promotion of heat-stable rapid diagnostic tests which detect a range of common bacterial-causing pathogens (Streptococcus pneumoniae, Haemophilus influenzae, Neisseria meningitidis) has been recommended as a priority by a group of WHO-convened experts. The most critical diagnostics needed for meningitis outbreak control are being described in the 2018 use cases document.

Surveillance, from case detection to investigation and laboratory confirmation is essential to the control of meningococcal meningitis. Main objectives include: detect and confirm outbreaks; monitor the incidence trends, including the distribution and evolution of meningococcal serogroups; estimate the disease burden; monitor the antibiotic resistance profile; monitor the circulation, distribution and evolution of specific meningococcal strains (clones) as well as estimate the impact of meningitis control strategies, particularly preventive vaccination programmes.

Meningococcal disease is potentially fatal and should always be viewed as a medical emergency. Admission to a hospital or health centre is necessary, although isolation of the patient is not necessary. Appropriate antibiotic treatment must be started as soon as possible, ideally after the lumbar puncture has been carried out if such a puncture can be performed immediately. If treatment is started prior to the lumbar puncture it may be difficult to grow the bacteria from the spinal fluid and confirm the diagnosis. However confirmation of the diagnosis should not delay treatment.

A range of antibiotics can treat the infection, including penicillin, ampicillin, chloramphenicol and ceftriaxone. Under epidemic conditions in Africa in areas with limited health infrastructure and resources, ceftriaxone is the drug of choice.

Vaccines and immunization

Licensed vaccines against meningococcal disease have been available for more than 40 years. Over time, there have been major improvements in strain coverage and vaccine availability, but to date no universal vaccine against meningococcal disease exists. Vaccines are serogroup specific and confer varying degrees of duration of protection. There are three types of meningococcal vaccines available:

Polysaccharide vaccines are used during a response to outbreaks, mainly in Africa:
• They are either bivalent (serogroups A and C), trivalent (A, C and W), or tetravalent (A, C, Y and W)
• They are not effective before 2 years of age
• They offer a 3 year protection but do not induce herd immunity.

Conjugate vaccines are used in prevention (into routine immunization schedules and preventive campaigns) and outbreak response:
• They confer longer-lasting immunity (5 years and more), prevent carriage and induce herd immunity.
• They can be used as soon as of one year of age
•Available vaccines include:
Monovalent C
Monovalent A
Tetravalent (serogroups A, C, Y, W)

Protein based vaccine, against N. meningitidis B. It has been introduced into the routine immunization schedule (one country as of 2017) and used in outbreak response.

Chemoprophylaxis

Antibiotic prophylaxis for close contacts, when given promptly, decreases the risk of transmission.

• Outside the African meningitis belt, chemoprophylaxis is recommended for close contacts within the household.
• In the African meningitis belt, chemoprophylaxis for close contacts is recommended in non-epidemic situations.

Ciprofloxacin antibiotic is the antibiotic of choice, and ceftriaxone an alternative.

Technical information

Useful references and resources