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  • Defeating Vaccine-Preventable Disease: A Focus on Meningococcal Meningitis
    The global impact of meningococcal meningitis continues to be serious, as it can be highly fatal or, if survived, result in long-lasting health issues. Complications and sequelae include loss of hearing, loss of limbs, neurological disorders, developmental disabilities, and stroke. After implementing effective vaccine programs, the number of meningococcal disease cases in the US and other countries is lower than ever before. However, the disease, though largely preventable by vaccination, persists.

    Despite the obstacles of the current COVID pandemic, organizations devoted to advancing global awareness and preparedness related to meningococcal disease are continuing their endeavors. April 24, 2021 marks World Meningitis Day. Its theme of "Take Action, Defeat Meningitis" portrays the energy behind the quest to maintain and continue to build the momentum of the pursuit of eradicating preventable disease. The World Health Organization has established a dedicated initiative, Defeating Meningitis by 2030, to address all types of meningitis, focusing on acute bacterial meningitis, since there is a great need to increase related global prevention efforts.

    Any illness that is caused by the bacteria Neisseria meningitidis is referred to as meningococcal disease. Infections causing inflammation of the membranes surrounding the brain and spinal cord (the meninges) are designated as meningitis, with bacteremia or septicemia referring to bloodstream poisoning. Some drugs, cancer, injuries, or other infections also may cause meningitis. Rare causes such as fungal, parasitic, and amebic meningitis also occur, but viral and bacterial meningitis are the most prevalent infections. The N. meningitidis bacteria has the potential for widespread endemics and epidemics. Six identified serogroups cause most invasive meningococcal disease: A, B, C, W, X, and Y. N. meningitidis commonly colonizes in the nasopharynx of individuals and can spread through aerosolized respiratory droplets and direct contact with throat secretions (kissing and other close contact, coughing, sneezing).

    Symptomatic individuals usually begin to have clinical signs within two to ten days after being exposed to the bacteria. The swelling from meningitis often results in stiffness in the neck, headache, fever, nausea and vomiting, and photophobia. If it is untreated, invasive meningococcal disease can result in death, often within 24 hours of symptom onset. Some types of meningitis can cause death in up to 90% of people if they do not receive treatment. The Global Burden of Disease study from the Institute for Health Metrics and Evaluation credits meningitis for around 320,000 annual deaths across all ages.

    Due to bacterial infections' life-threatening nature, patients need to seek immediate emergency care if meningitis is suspected. To obtain an isolate and conduct molecular typing, blood cultures are necessary. Also, a lumbar puncture should be conducted to confirm spinal fluid purulence. Blood and spinal fluid can be tested through agglutination or polymerase chain reaction to help confirm a diagnosis. Aggressive, rapid treatment with antibiotics is necessary to reduce the risk of fatality, complications, and sequelae from meningococcal disease. Nearly 20% of bacterial meningitis survivors end up having long-term health issues, such as hearing loss or neurological disability.

    Certain individuals are at an increased risk of developing meningococcal disease. The largest group are infants aged 12 months or less, adolescents and young adults ages 16 through 23, immunocompromised individuals, scientists whose work involves interaction with isolates of N. meningitidis, and people in a community with an outbreak. Since meningococcal disease can become deadly exceptionally quickly, it is essential to protect those who are the most vulnerable from infection. There is no universal vaccine against meningococcal disease, but highly effective vaccines can combat meningococcal disease's most critical serogroups. Meningococcal vaccines fall into two categories: 1) conjugate, for serogroups A, C, W, and Y (MenACWY (eg, Menveo)) and 2) protein-based, directed at serogroup B (eg, Trumenba). The newest approval among meningococcal meningitis vaccines is MenQuadfi (meningococcal (groups A, C, Y, W) conjugate vaccine). Greenlit in mid-2020, MenQuadfi is the only FDA-approved quadrivalent meningococcal vaccine indicated for individuals who are aged 2 through 56 years or older. It is also the first quadrivalent meningococcal vaccine in the US to use tetanus toxoid as a protein carrier.

    It is valuable for healthcare providers to convey to patients current immunization recommendations, such as those related to meningitis. Convenient access to all immunization schedules is available for all mobile devices. The CDC Vaccine Schedules app is available for free for iOS and Android devices. The most current Advisory Committee on Immunization Practices Recommended Schedules are provided there, with any changes to them being released through app updates. Today, meningitis is largely preventable through vaccination, so when it is possible, discuss being up-to-date with immunizations with patients.

    There is a potential risk for patients and their families to have missed immunizations due to circumstances surrounding COVID-19. A large pharmaceutical company surveyed nearly 5,000 individuals from multiple countries and found that 50% of healthcare decision-makers in families had experienced a delay or cancellation of meningococcal disease vaccination appointments. If catch-up vaccination does not occur soon enough, the number of meningitis cases may rise as social gathering increases. Healthcare providers can help patients understand the signs of meningococcal disease and provide guidance regarding protection against infection, including vaccination. Education of this nature can go far to help communities avoid having to cope with outbreaks of meningitis along with the current pandemic. Healthcare providers should promote awareness regarding vaccine-preventable diseases such as meningococcal disease and confer with patients about recommended immunizations needed to protect themselves, their family members, and their communities.