San Diego, California - On February 14, the San Diego County Health and Human Services Agency (HHSA) reported the death of a high school student believed to have died from meningococcal disease. Several days later, local media inquired about a possible woman’s death due to meningitis. Both cases were described in media reports as cases of “meningitis.”
The reports of the two cases led to some questions:
- Are the two cases related?
- Should the public be concerned?
- Is HHSA investigating the woman’s case?
- What can the public do to protect themselves from getting sick?
What is known is the following:
- Only one death due to probable meningococcal disease has been reported this year to the County—that of a local high school student.
- The deceased woman reported in the media was diagnosed with meningitis caused by a different type of bacteria.
“These are isolated cases of meningitis that are not related to each other and caused by different types of bacteria. There is no meningitis of any type that is rampant in San Diego,” said Wilma Wooten, M.D., M.P.H., County public health officer. “The 14-year-old who died last week is believed to have had meningococcal disease, which posed a potential risk to close contacts of the student. The bacterial meningitis identified in the woman is due to a different type of bacteria that did not pose a risk to her close contacts.”
Let’s look at meningitis more closely.
Meningitis is an infection of the tissues covering the brain and spinal cord. It can be caused by many different types of viruses, bacteria, or other organisms. The severity of the illness and treatment for meningitis is based on the cause; the cause determines how to best treat the condition.
Symptoms of meningitis may include sudden onset of fever, intense headache and stiff neck, as well as nausea, vomiting, increased sensitivity to light, drowsiness and confusion or an altered mental state.
Meningitis caused by viruses is very common and contagious, but in most cases is not serious and rarely fatal. Viral meningitis generally resolves without specific treatment. The risk of infection is greatest for infants and people with a weak immune system.
Many different bacteria can cause meningitis, with Streptococcus pneumoniae being the most common cause. However, meningococcal bacteria are the leading cause of meningitis in adolescents and teens, ages 11-17. It is rare, but very serious, and can be fatal in as little as a few hours. Antibiotics are needed to treat all kinds of bacterial meningitis.
Not all meningitis infections are a public health threat
HHSA investigates all possible cases of meningitis, primarily to determine if it’s meningococcal disease, which can be contagious to close contacts of an infected person. Meningococcal disease is not spread by casual contact, but rather is spread from close personal contact, such as living in the same household or through contact with saliva of an infected person.
In the case of the high school student, the bacterium called Neisseria meningitidis—also known as “meningococcus” or meningococcal disease—is the probable cause of death. HHSA worked with school officials to identify those who were in close contact with the student and recommended antibiotics to prevent the infection from developing.
Other types of bacteria that cause meningitis, such as Streptococcus pneumonaie, have a very low risk of person-to-person spread and antibiotics are not recommended for close contacts. Additionally, antibiotics are also not used in either the treatment or prevention of viral meningitis.
What is meningococcal disease?
Meningococcal disease is an infection caused by the meningococcal bacteria. The bacteria can cause meningitis and it can also cause an infection of the bloodstream, septicemia, which is suspected in the death of the 14-year-old.The bacteria enter the walls of the blood vessels causing bleeding into the skin and organs. Additional symptoms can include joint pain, and in later stages, a red or purple rash, which does not blanch or turn white under pressure, can occur.
How often does meningococcal disease occur?
According to the Centers for Disease Control and Prevention, every year, 1,000 to 1,200 people get meningococcal disease (infection of the meninges – tissues surrounding the brain or spinal cord – or the bloodstream) in the United States. Of those, 10 to 15 percent die. Another 11-19 percent of people infected with meningococcal bacteria lose their arms or legs, become deaf, develop problems with their nervous systems, or suffer seizures or strokes.
The 14-year-old is the second case of possible meningococcal disease reported in the county this year and the first death. In 2013, there were 16 meningococcal disease cases and three deaths.
“More than 95 percent of cases of meningococcal disease are sporadic. Very few cases turn into an outbreak,” Wooten said. “San Diego does not have a meningitis outbreak.”
In the case of the woman, the type of bacterial meningitis identified does not spread from person-to-person, so there is no risk of public exposure, including close contacts or family members. No preventive antibiotics are recommended.
How contagious is it?
While serious, and sometimes deadly, meningococcal disease is not as contagious as the common cold or the flu. Because meningococcal disease is known to cause serious illness in adolescents and teens, a vaccine is available to prevent transmission of certain strains.
“Vaccinations have significantly reduced meningococcal disease in the past decade,” said Dr. Wooten. “However, while the meningococcal vaccine is effective, no vaccine provides 100 percent coverage. Even when we do all the right things, sometimes tragedy can happen.”
Two doses of the meningococcal disease vaccine are routinely recommended for adolescents 11 to 18 years old: the first dose between 11 and 12 years and a booster at 16 years of age. Those at increased risk include college students living in dorms, military recruits and those traveling to parts of the world where meningococcal disease is common.
For more information about meningococcal disease and other vaccine-preventable illnesses, please visit www.sdiz.org.