Meningococcal Vaccine (Meningitis)

Meningococcal disease is caused by a bacterium called Neisseria meningitidis, which lives harmlessly in the nose and throat of many healthy people. Occasionally it gets into the bloodstream or the fluid around the brain and spinal cord and causes meningitis or blood poisoning. It is uncommon in Canada, but it can turn severe within hours, which is why any suspected case is treated as a medical emergency.

What meningococcal disease is, and what it is not

Meningitis is not a single illness. It means inflammation of the lining around the brain and spinal cord, and it can be caused by viruses, by several different bacteria, and occasionally by other things entirely. Meningococcal disease is one specific bacterial cause, and it does not always take the form of meningitis: it can appear instead as blood poisoning, with cold hands and feet, severe limb pain, rapid breathing and a spreading rash, and that form can be the more dangerous of the two.

It is also not an infection you catch from casual contact in passing. The bacterium spreads through saliva and close, prolonged contact, and carrying it without being ill is common. What makes it serious is speed rather than frequency. Rates in Canada are low and have fallen 66 percent since the late 1990s, but the Public Health Agency of Canada reports a case fatality rate of 5.2 percent for 2017 to 2021, and about 15 to 20 percent of survivors are left with lasting effects such as hearing loss or amputation.

Signs and symptoms

• Sudden high fever with severe headache
• A stiff neck, or pain when bending the head forward
• Sensitivity to bright light
• Nausea and vomiting
• Confusion, unusual drowsiness or difficulty waking
• A rash of small red or purple spots that does not fade when a glass is pressed against it
• Cold hands and feet, severe limb or joint pain, and rapid breathing

Early symptoms can look like influenza, and in babies and young children the picture is often vaguer still. What matters is how fast things change: hours, not days.

What raises the risk

Some things cannot be changed:

• Being an infant under 1 year, or a child aged 1 to 4
• Being an adolescent aged 15 to 19, or a young adult aged 20 to 24
• Having no spleen or a poorly functioning spleen, sickle cell disease, or complement deficiency
• Taking complement inhibitor medicines such as eculizumab or ravulizumab

Others can often be worked on, usually with support from a health care team:

• Living in crowded settings such as university residences and military barracks
• Close contact activities that share saliva, including kissing and sharing drinks, utensils, water bottles or vaping devices
• Smoking tobacco, and exposure to second-hand smoke
• Travel to areas with higher rates, including the African meningitis belt and mass gatherings such as the Hajj

How meningococcal disease is diagnosed in Canada

Invasive meningococcal disease is confirmed by growing Neisseria meningitidis from a normally sterile site, usually a blood culture or cerebrospinal fluid taken by lumbar puncture, or by detecting it with polymerase chain reaction, or PCR, testing. A CT scan of the head is sometimes done before a lumbar puncture. Because the illness moves quickly, antibiotics are usually started as soon as it is suspected, before any results come back. Isolates are sent to the National Microbiology Laboratory for serogroup identification, which is what allows Canada to track serogroups B, C, W and Y over time.

Treatment and management, including immunisation

Clinical research for Meningococcal Vaccine (Meningitis) is enrolling. See the current studies ↓

Suspected meningococcal disease is handled as an emergency, and public health follows up around every confirmed case. Canada also has childhood and adolescent immunisation programmes aimed at the serogroups that circulate here. Depending on the situation, a health care team or public health unit may discuss:

• Emergency hospital care with intravenous antibiotics started as soon as the illness is suspected, plus fluids and intensive care support when needed
• Antibiotic prophylaxis offered by public health units to close contacts of a confirmed case
• Meningococcal conjugate vaccines authorised in Canada: monovalent Men-C-C (Menjugate, NeisVac-C) and quadrivalent Men-C-ACYW (Menactra, Menveo, Nimenrix, MenQuadfi)
• Serogroup B vaccines authorised in Canada: 4CMenB (Bexsero) from 2 months of age for people at high risk, and MenB-fHBP (Trumenba) for people aged 10 and older
• Rehabilitation and follow-up services for long-term effects such as hearing loss, limb loss, seizures and neurological disability

The Canadian Immunization Guide describes one dose of Men-C-C vaccine for children at 12 to 23 months, routinely at 12 months, and a dose of either Men-C-C or Men-C-ACYW for adolescents and young adults aged 12 to 24, even if they were immunised as infants or toddlers. Serogroup B vaccines may be considered on an individual basis. Programmes are set by each province and territory, so ages and serogroups covered vary, and these are decisions for you and your own clinician rather than anything this page can settle.

When to talk to a doctor

• Call 911 or go to an emergency department immediately for a fever with severe headache and a stiff neck, a rash that does not fade when pressed with a glass, confusion, seizures, or a person who cannot be woken.
• Call 911 for a baby with fever who is very drowsy or floppy, is refusing feeds, has a high-pitched cry, or has a bulging soft spot on the head.
• Contact your local public health unit if you have been in close contact with someone diagnosed with meningococcal disease, since preventive antibiotics are arranged through public health.

Why clinical research matters for meningococcal disease

Serogroup B accounted for the largest share of Canadian cases in 2017 to 2021, but it is handled differently from serogroups C, A, W and Y, because protein-based serogroup B vaccines are not part of routine publicly funded schedules in most provinces and territories. How long protection lasts after adolescent doses, and how much vaccines affect carriage of the bacterium in the throat, are still open questions. Research now includes pentavalent MenABCWY combination vaccines, carriage and herd-effect studies in adolescents, next-generation serogroup B antigens, and rapid molecular diagnostics for use in emergency departments.

Because the disease is uncommon, studies often need many sites and many volunteers to answer anything at all, and NACI has concluded that regional programmes may be better suited than a pan-Canadian targeted programme to address the serogroups currently circulating. Taking part in a study is voluntary, it is explained to you in full during informed consent, and you can withdraw at any time without affecting the care you get from your own doctor or your access to publicly funded immunisation. No one can say in advance whether a study will help you personally.

Learn more from Canadian sources

• Public Health Agency of Canada: invasive meningococcal disease
• Canadian Immunization Guide: meningococcal vaccines
• Government of Canada: provincial and territorial immunization information
• NACI update on invasive meningococcal disease epidemiology and prevention