For many of us, the memory of some of the most awful diseases has faded. Others are fortunate enough to have never witnessed their devastating effects. Through the power of vaccines we have been able to control these diseases almost to the point of elimination. In this blog series I am refreshing our memories or bringing to light some of these diseases to help us remember why we still vaccinate. In my last post I wrote about Haemophilus influenzae type B (Hib). This post will be about Meningococcal disease. Meningococcal disease is caused by a type of bacteria called Neisseria Meningitidis. Though it is less common than Hib, Meningococcal disease is much more deadly. Infection by Neisseria Meningitidis bacteria generally presents as meningitis or septicemia (blood infection).
It was a busy Sunday afternoon. Walking into the examining room, I saw a very sick toddler. The boy was listless and pale. I could tell by looking at him he was poorly perfused. He was covered in petechiae (blood spots) and purple bruises were spreading over his body. The child’s worried parents reported he had been well just a few hours earlier. His condition had deteriorated quickly, and was continuing to get worse. I thought, “oh no, he’s so young! Please let him be one of the few who survive.” I was reminded of a teenager I had taken care of as a resident. Meningococcal disease caused her to have a stroke that led to her being a ventilator-dependent quadriplegic. She was discharged home after 8 months on a ventilator, but subsequently died as a result of the consequences of her infection. I was very concerned for my toddler patient.
Despite my young patient having received immediate antibiotics, he spent the last week of his life in an ICU bed getting sicker each day. He died from a particularly deadly form of septicemia called fulminant meningococcemia. This was the nightmare of Neisseria Meningitidis in the pre-vaccine era.
Meningococcal disease is a medical emergency. Even now with advancements in medical care, the mortality rate is 10- 50%. Neisseria Meningitidis bacteria cause shock, blood clotting abnormalities and multi-organ system failure. Up to 20% of those who do survive live with permanent disabilities such as deafness, nervous system problems, loss of limbs, and brain damage. Neisseria Meningitidis spreads from person to person, most often by asymptomatic carriers who carry the bacteria in the back of the throat. Only a small percentage of people who acquire the bacteria end up with a case of invasive disease. Though invasive disease occurs most often as sporadic cases, congregate living spaces such as college dorms or military barracks can become clusters of infection. At this time, the bacteria that cause Meningococcal Disease are sensitive to antibiotics. However, bacterial resistance is an emerging threat and there have been cases reported.
Treatments for this disease are imperfect, but we do have an effective method of prevention. Vaccination! Meningococcal vaccines are a part of routine vaccination schedules for pre-teens. However, the vaccine can be given to higher risk children as young as 2 months. I vaccinated my daughters as soon as they were eligible. Every patient that I lost to Neisseria Meningitidis bacteria related disease left a permanent hole in my heart.