Healthcare Diseases

Measles

Measles starts with fever, runny nose, cough, red eyes, and sore throat. It’s followed by
a rash that spreads over the body. Measles is highly contagious and spreads through
coughing and sneezing. Make sure you and your child are protected with measles,
mumps, and rubella (MMR) vaccine.

Pre-vaccine Era
In the 9th century, a Persian doctor published one of the first written accounts of
measles disease.

Francis Home, a Scottish physician, demonstrated in 1757 that measles is caused by

an infectious agent in the blood of patients.

In 1912, measles became a nationally notifiable disease in the United States, requiring
U.S. healthcare providers and laboratories to report all diagnosed cases. In the first
decade of reporting, an average of 6,000 measles-related deaths were reported each
year.

In the decade before 1963 when a vaccine became available, nearly all children got
measles by the time they were 15 years of age. It is estimated 3 to 4 million people in
the United States were infected each year. Also each year, among reported cases, an
estimated 400 to 500 people died, 48,000 were hospitalized, and 1,000 suffered
encephalitis (swelling of the brain) from measles.

Vaccine Development
In 1954, John F. Enders and Dr. Thomas C. Peebles collected blood samples from
several ill students during a measles outbreak in Boston, Massachusetts. They wanted
to isolate the measles virus in the student’s blood and create a measles vaccine. They
succeeded in isolating measles in 13-year-old David Edmonston’s blood.

In 1963, John Enders and colleagues transformed their Edmonston-B strain of measles
virus into a vaccine and licensed it in the United States. In 1968, an improved and even
weaker measles vaccine, developed by Maurice Hilleman and colleagues, began to be
distributed. This vaccine, called the Edmonston-Enders (formerly “Moraten”) strain has
been the only measles vaccine used in the United States since 1968. Measles vaccine
is usually combined with mumps and rubella (MMR), or combined with mumps, rubella
and varicella (MMRV). Learn more about measles vaccine.

Measles Elimination
In 1978, CDC set a goal to eliminate measles from the United States by 1982. Although
this goal was not met, widespread use of measles vaccine drastically reduced the
disease rates. By 1981, the number of reported measles cases was 80% less
compared with the previous year. However, a 1989 measles outbreaks among
vaccinated school-aged children prompted the Advisory Committee on Immunization
Practices (ACIP), the American Academy of Pediatrics (AAP), and the American
Academy of Family Physicians (AAFP) to recommend a second dose of MMR vaccine
for all children. Following widespread implementation of this recommendation and
improvements in first-dose MMR vaccine coverage, reported measles cases declined
even more.

Measles was declared eliminated (absence of continuous disease transmission for

greater than 12 months) from the United States in 2000. This was thanks to a highly
effective vaccination program in the United States, as well as better measles control in
the Americas region.

The symptoms of measles generally appear about seven to 14 days after a person is
infected.

Measles typically begins with

• high fever,

• cough,

• runny nose (coryza), and

• red, watery eyes (conjunctivitis).

Two or three days after symptoms begin, tiny white spots (Koplik spots) may appear
inside the mouth.

Three to five days after symptoms begin, a rash breaks out. It usually begins as flat red
spots that appear on the face at the hairline and spread downward to the neck, trunk,
arms, legs, and feet. Small raised bumps may also appear on top of the flat red spots.
The spots may become joined together as they spread from the head to the rest of the
body. When the rash appears, a person’s fever may spike to more than 104°
Fahrenheit.

Measles is a highly contagious virus that lives in the nose and throat mucus of an
infected person. It can spread to others through coughing and sneezing. Also, measles
virus can live for up to two hours in an airspace where the infected person coughed or
sneezed. If other people breathe the contaminated air or touch the infected surface,
then touch their eyes, noses, or mouths, they can become infected. Measles is so
contagious that if one person has it, 90% of the people close to that person who are
not immune will also become infected.

Infected people can spread measles to others from four days before through four days
after the rash appears.

Measles is a disease of humans; measles virus is not spread by any other animal
species.

Complications
Measles can be a serious in all age groups. However, children younger than 5 years of
age and adults older than 20 years of age are more likely to suffer from measles
complications.

Common Complications
Common measles complications include ear infections and diarrhea.

• Ear infections occur in about one out of every 10 children with measles and can
result in permanent hearing loss.

• Diarrhea is reported in less than one out of 10 people with measles.

Severe Complications

Some people may suffer from severe complications, such as pneumonia (infection of
the lungs) and encephalitis (swelling of the brain). They may need to be hospitalized
and could die.

• As many as one out of every 20 children with measles gets pneumonia, the most
common cause of death from measles in young children.

• About one child out of every 1,000 who get measles will develop encephalitis
(swelling of the brain) that can lead to convulsions and can leave the child deaf or
with intellectual disability.

• For every 1,000 children who get measles, one or two will die from it.

Measles may cause pregnant woman to give birth prematurely, or have a low-birth-
weight baby.

Long-term Complications
Subacute sclerosing panencephalitis (SSPE) is a very rare, but fatal disease of the
central nervous system that results from a measles virus infection acquired earlier in
life. SSPE generally develops 7 to 10 years after a person has measles, even though
the person seems to have fully recovered from the illness. Since measles was
eliminated in 2000, SSPE is rarely reported in the United States.

Among people who contracted measles during the resurgence in the United States in
1989 to 1991, 4 to 11 out of every 100,000 were estimated to be at risk for developing
SSPE. The risk of developing SSPE may be higher for a person who gets measles
before they are two years of age.

Measles is a very contagious disease caused by a virus. It spreads through the air
when an infected person coughs or sneezes. Measles starts with fever. Soon after, it
causes a cough, runny nose, and red eyes. Then a rash of tiny, red spots breaks out. It
starts at the head and spreads to the rest of the body.

Measles can be prevented with MMR vaccine. The vaccine protects against three
diseases: measles, mumps, and rubella. CDC recommends children get two doses of
MMR vaccine, starting with the first dose at 12 through 15 months of age, and the
second dose at 4 through 6 years of age. Teens and adults should also be up to date
on their MMR vaccination.

The MMR vaccine is very safe and effective. Two doses of MMR vaccine are about
97% effective at preventing measles; one dose is about 93% effective.

Children may also get MMRV vaccine, which protects against measles, mumps,
rubella, and varicella (chickenpox). This vaccine is only licensed for use in children who
are 12 months through 12 years of age.

Before the measles vaccination program started in 1963, an estimated 3 to 4 million

people got measles each year in the United States. Of these, approximately 500,000
cases were reported each year to CDC; of these, 400 to 500 died, 48,000 were
hospitalized, and 1,000 developed encephalitis (brain swelling) from measles. Since
then, widespread use of measles vaccine has led to a greater than 99% reduction in
measles cases compared with the pre-vaccine era. However, measles is still common
in other countries. Unvaccinated people continue to get measles while abroad and
bring the disease into the United States and spread it to others.

Herpes Zoster

Almost 1 out of every 3 people in the United States will develop shingles, also known
as herpes zoster, in their lifetime. There are an estimated 1 million cases of shingles
each year in this country. Anyone who has recovered from chickenpox may develop
shingles; even children can get shingles. However, the risk of shingles increases as you
get older.

Some people have a greater risk of getting shingles. This includes people who

• have medical conditions that keep their immune systems from working properly,
such as certain cancers like leukemia and lymphoma, and human
immunodeficiency virus (HIV), and

• receive immunosuppressive drugs, such as steroids and drugs that are given after
organ transplantation.

Most people who develop shingles have only one episode during their lifetime.
However, a person can have a second or even a third episode.

Cause

Shingles is caused by the varicella zoster virus (VZV), the same virus that causes
chickenpox. After a person recovers from chickenpox, the virus stays dormant
(inactive) in the body. Scientists aren’t sure why the virus can reactivate years later,
causing shingles.

Signs & Symptoms

Shingles is a painful rash that develops on one side of the face or body. The rash
consists of blisters that typically scab over in 7 to 10 days. The rash usually clears up
within 2 to 4 weeks.

Before the rash develops, people often have pain, itching, or tingling in the area where
the rash will develop. This may happen anywhere from 1 to 5 days before the rash
appears.

Most commonly, the rash occurs in a single stripe around either the left or the right side
of the body. In other cases, the rash occurs on one side of the face. In rare cases
(usually among people with weakened immune systems), the rash may be more
widespread and look similar to a chickenpox rash. Shingles can affect the eye and
cause loss of vision.

Other symptoms of shingles can include

• Fever

• Headache

• Chills

• Upset stomach

Transmission
Shingles cannot be passed from one person to another. However, the virus that causes
shingles, the varicella zoster virus, can spread from a person with active shingles to
cause chickenpox in someone who had never had chickenpox  or received chickenpox
vaccine.

The virus is spread through direct contact with fluid from the rash blisters caused by
shingles.

A person with active shingles can spread the virus when the rash is in the blister-
phase. A person is not infectious before the blisters appear. Once the rash has
developed crusts, the person is no longer infectious.

Shingles is less contagious than chickenpox and the risk of a person with shingles
spreading the virus is low if the rash is covered.

If you have shingles, you should:

• Cover the rash.

• Avoid touching or scratching the rash.

• Wash your hands often to prevent the spread of varicella zoster virus.

• Avoid contact with the people below until your rash has developed crusts

◦ pregnant women who have never had chickenpox or the chickenpox

vaccine;

◦ premature or low birth weight infants; and

◦ people with weakened immune systems, such as people receiving

immunosuppressive medications or undergoing chemotherapy, organ
transplant recipients, and people with human immunodeficiency virus (HIV)
infection.

Complications
The most common complication of shingles is a condition called postherpetic neuralgia
(PHN). People with PHN have severe pain in the areas where they had the shingles
rash, even after the rash clears up. The pain from PHN may be severe and debilitating,
but it usually resolves in a few weeks or months. Some people can have pain from PHN
for many years and it can interfere with daily life.

A person’s risk of PHN also increases with age. Older adults are more likely to have
PHN and to have longer lasting and more severe pain. About 10 to 13% of people who
get shingles will experience PHN. PHN occurs rarely among people less than 40 years
of age.

Shingles may lead to serious complications involving the eye such as vision loss. Very
rarely, shingles can also lead to pneumonia, hearing problems, blindness, brain
inflammation (encephalitis), or death.

Prevention
Almost 1 out of every 3 people in the United States will develop shingles in their
lifetime.

The only way to reduce the risk of developing shingles and the long-term pain from
postherpetic neuralgia (PHN) is to get vaccinated. CDC recommends that healthy
adults 50 years and older get two doses of the shingles vaccine called Shingrix® to
protect against shingles and the complications caused by the disease. Shingles
vaccine is available in pharmacies and doctor’s offices. Talk with your healthcare
professional if you have questions about shingles vaccination.

Treatment
Several antiviral medicines—acyclovir, valacyclovir, and famciclovir—are available to
treat shingles and shorten the length and severity of illness. People with shingles
should start taking these medicines as soon as possible after the rash  appears to be
the most effective. People who have, or think they might have, shingles should call
their healthcare provider as soon as possible to discuss treatment options.

Analgesics (pain medicine) may help relieve the pain caused by shingles. Wet
compresses, calamine lotion, and colloidal oatmeal baths may help relieve some of the
itching.

Vaccination
Two vaccines are licensed and recommended to prevent shingles in the U.S..  Zoster
vaccine live (ZVL, Zostavax) has been in use since 2006. Recombinant zoster vaccine
(RZV, Shingrix), has been in use since 2017 and is recommended by ACIP as the
preferred shingles vaccine.

Shingles is a painful rash that usually develops on one side of the body, often the face
or torso. The rash consists of blisters that typically scab over in 7 to 10 days and clears
up within 2 to 4 weeks. Some people describe the pain as an intense burning
sensation. For some people, the pain can last for months or even years after the rash
goes away. This long-lasting pain is called postherpetic neuralgia (PHN), and it is the
most common complication of shingles. Your risk of getting shingles and PHN
increases as you get older.

Two vaccines are licensed and recommended to prevent shingles in the U.S.. Zoster
vaccine live (ZVL, Zostavax) has been in use since 2006. Recombinant zoster vaccine
(RZV, Shingrix), has been in use since 2017 and is recommended by ACIP as the
preferred shingles vaccine. Zostavax may still be used to prevent shingles in healthy
adults 60 years and older. For example, you could use Zostavax if a person is allergic
to Shingrix, prefers Zostavax, or requests immediate vaccination and Shingrix is
unavailable.

Cryptococcal Meningitis

Cryptococcus neoformans is a fungus that lives in the environment throughout the

world. Most people likely breathe in this microscopic fungus when they are children but
never get sick from it, but in people with weakened immune systems such as those
living with HIV/AIDS, Cryptococcus can stay hidden in the body and later become a
serious (but not contagious) brain infection called cryptococcal meningitis.

Why is cryptococcal meningitis a problem?

Most cases of cryptococcal meningitis occur in people who have HIV/AIDS. The
widespread availability of antiretroviral therapy (ART) in developed countries has helped
improve the immune systems of many HIV patients so that they don’t become
vulnerable to infection with Cryptococcus. However, cryptococcal meningitis is still a
major problem in resource-limited countries where HIV prevalence is high and access
to healthcare is limited. Worldwide, nearly 220,000 new cases of cryptococcal
meningitis occur each year, resulting in 181,000 deaths. Most of the illnesses and
deaths occur in sub-Saharan Africa.

Strategies to prevent deaths

CDC is working with several countries on strategies to prevent deaths due to
cryptococcal meningitis.

Although it’s not possible to prevent the initial exposure to Cryptococcus, diagnosing
and treating early cryptococcal infections in people at high risk for developing
cryptococcal meningitis can prevent associated deaths. Therefore, CDC is working to
improve diagnosis and treatment of cryptococcal meningitis in countries with large
populations of people living with HIV/AIDS. In these areas, CDC is helping implement
targeted cryptococcal screening programs and build laboratory capacity to detect
cryptococcal infections early. This allows for more timely treatment, reduced mortality
due to cryptococcal meningitis, and overall improved quality of life.

• Targeted screening for early cryptococcal infection


Cryptococcal antigen, a chemical marker for cryptococcal infection, can be
detected in the body weeks to months before symptoms of meningitis appear. In
a targeted screening program, people who have advanced HIV infection are
tested for cryptococcal antigen before starting ART. A patient who tests positive
for cryptococcal antigen can take antifungal medication to help the body fight the
early stage of the infection, which has been shown to prevent deaths due to
cryptococcal meningitis.

• Improved access to diagnostics


In order to screen people living with HIV for early cryptococcal infection and to
diagnose other patients with cryptococcal meningitis, healthcare facilities and
laboratories must have access to the right diagnostic tests. Currently, these tests
are unavailable in many district and provincial laboratories in sub-Saharan Africa.
Equipping these facilities with the ability to perform these tests is an important
step in reducing deaths from cryptococcal meningitis.

A new lateral flow assay for detecting cryptococcal antigen is simple to use on a
small sample of blood or spinal fluid. The test accurately detects both early and
advanced cryptococcal infections more than 95% of the time. In addition, the test
is inexpensive, rapid, and doesn’t require costly laboratory equipment and
expertise, making it ideal for resource-limited settings. CD4 testing is also needed
to help stratify HIV patients by their immune and clinical status and their related
risk for cryptococcal meningitis. Many countries currently do not have adequate
CD4 testing capacity to conduct cryptococcal antigen testing when it is needed.

• Improved access to antifungal medications


Essential medications for the treatment of cryptococcal infections are often
unavailable in areas of the world that are most in need. Amphotericin B and
flucytosine are two antifungal medications that have been shown to improve
survival in patients with cryptococcal meningitis. Although these drugs are the
standard-of-care in developed countries, they are widely unavailable in sub-
Saharan Africa and Asia.

Preventing deaths from cryptococcal meningitis: resources for countries

CDC’s training materials can be used to educate physicians, nurses, HIV/AIDS
counselors, pharmacists, and patients about the diagnosis, management, and
prevention of cryptococcal disease. These materials are intended to help healthcare
providers, particularly those in resource-limited settings, implement a screen-and-treat
strategy for cryptococcal disease among people living with HIV/AIDS. CDC can help
provide customized resources on training and case studies for cryptococcal screening.

Amoebiasis

Amebiasis is a disease caused by a one-celled parasite called Entamoeba histolytica.

Although anyone can have this disease, it is more common in people who live in
tropical areas with poor sanitary conditions. In the United States, amebiasis is most
common in:

• People who have traveled to tropical places that have poor sanitary conditions

• Immigrants from tropical countries that have poor sanitary conditions

• People who live in institutions that have poor sanitary conditions

• Men who have sex with men

E. histolytica infection can occur when a person:

• Puts anything into their mouth that has touched the feces (poop) of a person who
is infected with E. histolytica.

• Swallows something, such as water or food, that is contaminated with E.

histolytica.

• Swallows E. histolytica cysts (eggs) picked up from contaminated surfaces or

fingers.

Only about 10% to 20% of people who are infected with E. histolytica become sick
from the infection. The symptoms are often quite mild and can include loose feces
(poop), stomach pain, and stomach cramping. Amebic dysentery is a severe form of
amebiasis associated with stomach pain, bloody stools (poop), and fever. Rarely, E.
histolytica invades the liver and forms an abscess (a collection of pus). In a small
number of instances, it has been shown to spread to other parts of the body, such as
the lungs or brain, but this is very uncommon.

Only about 10% to 20% of people who are infected with E. histolytica become sick
from the infection. Those people who do become sick usually develop symptoms
within 2 to 4 weeks, though it can sometimes take longer.

Your healthcare provider will ask you to submit fecal (poop) samples. Because E.
histolytica is not always found in every stool sample, you may be asked to submit
several stool samples from several different days.

Diagnosis of amebiasis can be very difficult. One problem is that other parasites and
cells can look very similar to E. histolytica when seen under a microscope. Therefore,
sometimes people are told that they are infected with E. histolytica even though they
are not. Entamoeba histolytica and another ameba, Entamoeba dispar, which is about
10 times more common, look the same when seen under a microscope. Unlike
infection with E. histolytica, which sometimes makes people sick, infection with E.
dispar does not make people sick and therefore does not need to be treated.

If you have been told that you are infected with E. histolytica but you are feeling fine,
you might be infected with E. dispar instead. Unfortunately, most laboratories do not
yet have the tests that can tell whether a person is infected with E. histolytica or with E.
dispar. Until these tests become more widely available, it usually is best to assume that
the parasite is E. histolytica.

A blood test is also available but is only recommended when your healthcare provider
thinks that your infection may have spread beyond the intestine (gut) to some other
organ of your body, such as the liver. However, this blood test may not be helpful in
diagnosing your current illness because the test can be positive if you had amebiasis in
the past, even if you are not infected now.

Several antibiotics are available to treat amebiasis. Treatment must be prescribed by a

physician. You will be treated with only one antibiotic if your E. histolytica infection has
not made you sick. You probably will be treated with two antibiotics (first one and then
the other) if your infection has made you sick.

The following items are safe to drink:

• Bottled water with an unbroken seal

• Tap water that has been boiled for at least 1 minute

• Carbonated (bubbly) water from sealed cans or bottles

• Carbonated (bubbly) drinks (like soda) from sealed cans or bottles

You can also make tap water safe for drinking by filtering it through an “absolute 1
micron or less” filter and dissolving chlorine, chlorine dioxide, or iodine tablets in the
filtered water. “Absolute 1 micron” filters can be found in camping/outdoor supply
stores.

The following items may NOT be safe to drink or eat:

• Fountain drinks or any drinks with ice cubes

• Fresh fruit or vegetables that you did not peel yourself

• Milk, cheese, or dairy products that may not have been pasteurized.

• Food or drinks sold by street vendors

Causal Agent
Several protozoan species in the genus Entamoeba colonize humans, but not all of
them are associated with disease. Entamoeba histolytica is well recognized as a
pathogenic ameba, associated with intestinal and extraintestinal infections. The other
species are important because they may be confused with E. histolytica in diagnostic
investigations.

Life Cycle

Cysts and trophozoites are passed in feces (1). Cysts are typically found in formed
stool, whereas trophozoites are typically found in diarrheal stool. Infection by
Entamoeba histolytica occurs by ingestion of mature cysts (2) in fecally contaminated
food, water, or hands. Excystation (3) occurs in the small intestine and trophozoites (4)
are released, which migrate to the large intestine. The trophozoites multiply by binary
fission and produce cysts (5), and both stages are passed in the feces (1). Because of
the protection conferred by their walls, the cysts can survive days to weeks in the
external environment and are responsible for transmission. Trophozoites passed in the
stool are rapidly destroyed once outside the body, and if ingested would not survive
exposure to the gastric environment. In many cases, the trophozoites remain confined
to the intestinal lumen (A: noninvasive infection) of individuals who are asymptomatic
carriers, passing cysts in their stool. In some patients the trophozoites invade the
intestinal mucosa (B: intestinal disease), or, through the bloodstream, extraintestinal
sites such as the liver, brain, and lungs (C: extraintestinal disease), with resultant
pathologic manifestations. It has been established that the invasive and noninvasive
forms represent two separate species, respectively E. histolytica and E. dispar. These
two species are morphologically indistinguishable unless E. histolytica is observed with
ingested red blood cells (erythrophagocystosis). Transmission can also occur through
exposure to fecal matter during sexual contact (in which case not only cysts, but also
trophozoites could prove infective).

Meningococcemia

Risk Factors
Certain people are at increased risk for meningococcal disease. Some risk factors
include:

• Age

◦ Doctors more commonly diagnose meningococcal disease in infants,

teens, and young adults..

• Community setting

◦ Infectious diseases tend to spread wherever large groups of people gather

together. Several college campuses have reported outbreaks of serogroup
B meningococcal disease during the last several years..

• Certain medical conditions

◦ Certain medical conditions and medications put people at increased risk of

meningococcal disease. They include not having a spleen, having a
complement component deficiency, and being infected with HIV.

• Travel

◦ Travelers to the meningitis belt in sub-Saharan Africa may be at risk for

meningococcal disease.

Causes
Bacteria called Neisseria meningitidis cause meningococcal disease. About 1 in 10
people have these bacteria in the back of their nose and throat with no signs or
symptoms of disease; this is called being ‘a carrier’. But sometimes the bacteria invade
the body and cause certain illnesses, which are known as meningococcal disease.

There are five serogroups (types) of Neisseria meningitidis — A, B, C, W, and Y — that

cause most disease worldwide. Three of these serogroups (B, C, and Y) cause most of
the illness seen in the United States.

Spread to Others
People spread meningococcal bacteria to other people by sharing respiratory and
throat secretions (saliva or spit). Generally, it takes close (for example, coughing or
kissing) or lengthy contact to spread these bacteria. Fortunately, they are not as
contagious as germs that cause the common cold or the flu. People do not catch them
through casual contact or by breathing air where someone with meningococcal disease
has been.

Sometimes the bacteria spread to people who have had close or lengthy contact with a
patient with meningococcal disease. Those at increased risk of getting sick include:

• People who live with the patient

• Anyone with direct contact with the patient’s oral secretions, such as a boyfriend
or girlfriend

Close contacts of someone with meningococcal disease should receive antibiotics to

help prevent them from getting the disease. This is known as prophylaxis (pro-fuh-lak-
sis). Health departments investigate each case of meningococcal disease to identify all
close contacts and make sure they receive prophylaxis. This does not mean that the
contacts have the disease; it is to prevent it. People who are not a close contact of a
patient with meningococcal disease do not need prophylaxis.

Signs and Symptoms

Seek medical attention immediately if you or your child develops symptoms of
meningococcal disease. Symptoms of meningococcal disease can first appear as a flu-
like illness and rapidly worsen. The two most common types of meningococcal
infections are meningitis and septicemia. Both of these types of infections are very
serious and can be deadly in a matter of hours.

Meningococcal Meningitis

Doctors call meningitis caused by the bacteria Neisseria meningitidis meningococcal

meningitis. When someone has meningococcal meningitis, the bacteria infect the
protective membranes covering their brain and spinal cord and cause swelling.

The most common symptoms include:

• Fever

• Headache

• Stiff neck

There are often additional symptoms, such as

• Nausea

• Vomiting

• Photophobia (eyes being more sensitive to light)

• Altered mental status (confusion)

Newborns and babies may not have or it may be difficult to notice the classic
symptoms of fever, headache, and neck stiffness. Instead, babies may be slow or
inactive, irritable, vomiting, or feeding poorly. In young children, doctors may also look
at the child’s reflexes for signs of meningitis.

Meningococcal Septicemia (aka Meningococcemia)

Doctors call septicemia (a bloodstream infection) caused by Neisseria meningitidis
meningococcal septicemia or meningococcemia. When someone has meningococcal
septicemia, the bacteria enter the bloodstream and multiply, damaging the walls of the
blood vessels. This causes bleeding into the skin and organs.

Symptoms may include:

• Fever

• Fatigue

• Vomiting

• Cold hands and feet

• Cold chills

• Severe aches or pain in the muscles, joints, chest or abdomen (belly)

• Rapid breathing

• Diarrhea

• In the later stages, a dark purple rash

Diagnosis, Treatment, and Complications

Meningococcal disease is very serious and can be deadly in a matter of hours. Early
diagnosis and treatment are very important.

Diagnosis
Meningococcal disease can be difficult to diagnose because the signs and symptoms
are often similar to those of other illnesses. If a doctor suspects meningococcal
disease, they will collect samples of blood or cerebrospinal fluid (fluid near the spinal
cord; see image below). Doctors then test the samples to see if there is an infection
and, if so, what germ is causing it. If Neisseria meningitidis bacteria are in the samples,
laboratorians can grow (culture) the bacteria. Growing the bacteria in the laboratory
allows doctors to know the specific type of bacteria that is causing the infection.
Knowing this helps doctors decide which antibiotic will work best. Other tests can
sometimes detect and identify the bacteria if the cultures do not.

Lumbar puncture to collect sample of cerebrospinal fluid

©Teresa Winslow – US Government has certain rights

Treatment
Doctors treat meningococcal disease with a number of effective antibiotics. It is
important that treatment start as soon as possible. If a doctor suspects meningococcal
disease, they will give the patient antibiotics right away. Antibiotics help reduce the risk
of dying.

Depending on how serious the infection is, people with meningococcal disease may
need other treatments, including:

• Breathing support

• Medications to treat low blood pressure

• Wound care for parts of the body with damaged skin

Complications
Even with antibiotic treatment, 10 to 15 in 100 people infected with meningococcal
disease will die. About 11 to 19 in 100 survivors will have long-term disabilities, such as
loss of limb(s), deafness, nervous system problems, or brain damage.

Prevention
Keeping up to date with recommended immunizations is the best defense against
meningococcal disease. Maintaining healthy habits, like getting plenty of rest and not
having close contact with people who are sick, also helps.

Vaccination
Vaccines help protect against all three serogroups (B, C, and Y) of Neisseria
meningitidis bacteria commonly seen in the United States. Like with any vaccine,
meningococcal vaccines are not 100% effective. This means there is still a chance you
can develop meningococcal disease after vaccination. People should know the
symptoms of meningococcal disease since early recognition and quick medical
attention are extremely important.

Antibiotics
Close contacts of a person with meningococcal disease should receive antibiotics to
prevent them from getting sick. This is known as prophylaxis (pro-fuh-lak-sis).
Examples of close contacts include:

• People in the same household or roommates

• Anyone with direct contact with a patient’s oral secretions (saliva or spit), such as
a boyfriend or girlfriend

Doctors or local health departments recommend who should get prophylaxis.

Re-Infection

If you get meningococcal disease twice, your doctor should check to see if you have
an underlying immune deficiency.

Although rare, people can get meningococcal disease more than once. A previous
infection will not offer lifelong protection from future infections. Therefore, CDC
recommends meningococcal vaccines for all preteens and teens. In certain situations,
children and adults should also get meningococcal vaccines.

Meningococcal Vaccination
Vaccines help protect against all three serogroups (B, C, and Y) of meningococcal
disease commonly seen in the United States:

• Meningococcal conjugate vaccines (Menactra® and Menveo®)

• Serogroup B meningococcal vaccines (Bexsero® and Trumenba®)

Surveillance
Rates of meningococcal disease are at historic lows in the United States. Tracking for
meningococcal disease is very good in the United States. Health departments respond
to every case of meningococcal disease and implement control measures to reduce
spread of the disease.

Disease Trends
Rates of meningococcal disease have been declining in the United States since the
late 1990s. In 2016, there were about 370 total cases of meningococcal disease
reported (See Figure 1). Anyone can get meningococcal disease, but rates of disease
are highest in children younger than 1 year old, followed by a second peak in
adolescence. Among adolescents and young adults, those 16 through 23 years old
have the highest rates of meningococcal disease (See Figure 2). The proportion of
cases caused by each serogroup varies by age group (See Figure 3).

Meningococcal disease is also seasonal: the number of cases generally peaks each
year in January, February, and March.

Surveillance Systems
Bact Facts Interactive

Analyze and visualize ABCs N. meningitidis data using Bact Facts Interactive.

Meningococcal disease is a reportable condition in all states, with cases immediately

reported to the local and state health departments. CDC closely tracks meningococcal
disease through the National Notifiable Diseases Surveillance System and Active
Bacterial Core surveillance.

In 2015, CDC implemented enhanced meningococcal surveillance. The goals for

enhanced meningococcal disease surveillance are to:

• Collect more complete data on key variables for monitoring meningococcal

disease epidemiology

• Inform vaccine policy decisions

• Collect meningococcal isolates from a broad and representative population

Data and isolates are now routinely collected from most state and large jurisdiction
health departments.

The most recent Council of State and Territorial Epidemiologists (CSTE) case
classification (2015) for meningococcal disease is:

Suspected

• Clinical purpura fulminans in the absence of a positive blood culture; or

• Gram-negative diplococci, not yet identified, isolated from a normally sterile body
site (e.g., blood or cerebrospinal fluid [CSF])

Probable

• Detection of Neisseria meningitidis antigen

◦ In formulin-fixed tissue by immunohistochemistry (IHC); or

◦ In CSF by latex agglutination

Confirmed

• Detection of N. meningitidis-specific nucleic acid in a specimen obtained from a

normally sterile body site (e.g., blood or CSF), using a validated polymerase chain
reaction (PCR) assay; or

• Isolation of N. meningitidis

◦ From a normally sterile body site (e.g., blood or CSF, or less commonly,
synovial, pleural, or pericardial fluid); or

◦ From purpuric lesions.

Meningococcal Outbreaks
Outbreaks of meningococcal disease are rare in the United States. In fact, only about 2
to 3 out of every 100 cases are related to outbreaks. However, the onset of an outbreak
is unpredictable and the outcomes can be devastating to affected communities and
organizations. In certain outbreaks, CDC recommends vaccination against
meningococcal disease to help stop the disease from spreading.

Outbreak Definition
An outbreak occurs when multiple cases of the same serogroup (types) happen in a
population over a short time period. Outbreaks can occur in communities, schools,
colleges, prisons, and other populations. Depending on the population size and
specific circumstances, health officials may declare an outbreak after just two cases.

Outbreak Control Measures

State and local health departments lead outbreak investigations and implement control
measures to reduce spread of the disease. They often work closely with CDC, which
has guidance to assist with this. In the setting of an outbreak, such recommendations
often include:

• Vaccinating people identified as being at increased risk

• Making sure all close contacts of a patient receive antibiotics to prevent them
from getting the disease; this is known as prophylaxis

CDC supports state and local health departments in identifying a response that best
protects their residents’ health. Contact the state or local health department, or
institution, for information about a specific outbreak and their specific
recommendations.

Vaccination
CDC recommends vaccinating people identified as being at increased risk during a
meningococcal outbreak. Which vaccine they should receive depends on the
serogroup causing the outbreak.

Outbreaks caused by serogroup A, C, W, or Y

CDC recommends vaccination with a meningococcal conjugate vaccine for anyone 2

months or older identified as being at increased risk.

Outbreaks caused by serogroup B

CDC recommends vaccination with a serogroup B meningococcal vaccine for anyone
10 years or older identified as being at increased risk.

Two vaccines provide protection against serogroup B meningococcal disease:

Bexsero® (GlaxoSmithKline) and Trumenba® (Pfizer). In the setting of an outbreak,
CDC recommends either two doses of Bexsero® or three doses of Trumenba®. It does
not matter which brand someone receives. People should get the same vaccine brand
for all doses — Bexsero® and Trumenba® are not interchangeable. If someone
decides to switch brands, CDC recommends waiting at least 1 month between
products and then getting the full series of the second vaccine.

Experts expect both vaccines to help protect against most serogroup B meningococcal
strains circulating in the United States. However, neither vaccine will prevent all cases.
Each vaccine may perform better against some strains than others, but actual
effectiveness against specific strains remains unknown.

Prophylaxis
Close contacts include people in the same household, roommates, or anyone with
direct contact with the patient’s saliva (such as a boyfriend or girlfriend through French
kissing). CDC supports state and local health departments in identifying a response
that best protects their residents’ health.