Meningitis B: Who’s at Risk?
“The only thing worse than being blind is having sight but no vision.”
- Helen Keller, American author and disability advocate
“With infectious disease, without vaccines, there’s no safety in numbers.”
- Seth Berkley, American medical epidemiologist, CEO of Gavi, the Vaccine Alliance
News of the death of the classic rock guitar virtuoso, Jeff Beck (age 78), on January 10, 2023, reverberated throughout the jazz and rock and roll communities. While details of Beck’s medical history weren’t immediately reported, we do know that he died from bacterial meningitis. It also appears that “Meningitis B” was the type of meningitis that killed Beck—an unusual type of meningitis for someone of Beck’s age. In this Germ Gems post I provide a brief overview of bacterial meningitis (one of only a handful of infections that’s considered a medical emergency) and address special features of Meningitis B.
What is bacterial meningitis? The term meningitis refers to an inflammation of the meninges, the membranes that cover the brain and spinal cord. Meningitis can be caused by bacteria as well as other pathogens (viruses, fungi, and parasites) as well as non-infectious diseases, such as cancer, or even by drug reactions. Bacterial meningitis is life-threatening (without treatment the death rate is 70%) and death can occur in as little as a few hours. It is therefore crucial that everyone know something about the clinical presentation of bacterial meningitis.
Symptoms of bacterial meningitis. The symptoms of bacterial infection of the meninges generally develop rapidly and are severe. Any combination of these symptoms should raise suspicion of bacterial meningitis:
Sudden high fever.
Nausea or vomiting.
Confusion or trouble concentrating.
Sleepiness or trouble waking.
Sensitivity to light.
A variety of bacterial pathogens can cause meningitis, including Streptococcus pneumoniae, Group B Streptococcus, Neisseria meningitidis, Haemophilus influenzae, Listeria monocytogenes, and Escherichia coli. In the U.S.,Mycobacterium tuberculosis, the cause of TB, is an uncommon cause of meningitis.
A key determinant of the etiology or cause of bacterial meningitis is patient age:
Newborns: Group B Streptococcus, S. pneumoniae, L. monocytogenes, E. coli
Babies and young children: S. pneumoniae, N. meningitidis, H. influenzae, group B Streptococcus, M. tuberculosis
Teens and young adults: N. meningitidis, S. pneumoniae
Older adults: S. pneumoniae, N. meningitidis, H. influenzae, group B Streptococcus, L. monocytogenes
In addition to a person’s age, other factors increase the risk of contracting bacterial meningitis. These factors include:
Group settings: Infectious diseases tend to spread where large groups of people gather. For example, college campuses have reported outbreaks of meningococcal disease, caused by N. meningitidis.
Medical conditions: Certain medical conditions, medications, and surgical procedures put people at increased risk for meningitis. For example, having an HIV infection or a cerebrospinal fluid leak, or not having a spleen can increase a person’s risk for several types of bacterial meningitis.
Travel: Travelers may be at increased risk for meningococcal disease caused by N. meningitidis, if they travel to certain places, such as:
The meningitis belt in sub-Saharan Africa, particularly during the dry season when about 30,000 people develop meningitis due to N. meningitidis serogroup A per year.
Mecca during the annual Hajj pilgrimage.
Some bacterial species that cause bacterial meningitis, such as L. monocytogenes, can spread through contaminated food. But most of the other bacteria that cause meningitis are transmitted from person to person.
Treatment. Fortunately, antibiotics are available to treat all forms of bacterial meningitis. But timing is everything. Based upon the clinical presentation (that is, the symptoms noted earlier), if the diagnosis is suspected, many infectious diseases physicians recommend initiating antibiotic therapy even before the exact etiology is established. (The etiology is determined by analysis and culture of cerebrospinal fluid, obtained by lumbar puncture, or blood culture.)
Prevention. Immunization is the mainstay of prevention of bacterial meningitis. Routine immunization of children calls for vaccines that prevent meningitis caused by S. pneumoniae, H. influenzae, and N. meningitidis.
What is Meningitis B? “Meningitis B” refers to meningitis caused by the bacterium N. meningitidis that is encapsulated by a specific polysaccharide called “B.” Six serogroups (types) of N. meningitidis — A, B, C, W, X, and Y —cause most disease worldwide. Three of these serogroups (B, C, and Y) cause most of the disease seen in the U.S.
Teens and young adults are at greatest risk of developing Meningitis B and college students are more than five times more likely to contract Meningitis B than non-college students. More than 50 college campuses have reported cases of meningococcal meningitis since 2013, including 30 schools with Meningitis B cases since 2008. There is also a large, ongoing outbreak of Meningitis B in Florida in gay and bisexual men.
Vaccines that prevent meningococcal meningitis. Two kinds of meningococcal vaccine are recommended to prevent meningococcal meningitis. Both target young people. These vaccines are safe, 85-100% effective, and Federal Drug Administration (FDA) approved.
The first, MenACWY or MenQuadfi, prevents invasive meningococcal disease caused by four serogroups (A, C, W, and Y). It is recommended for adolescents as one primary dose at 11 to 12 years of age, with a booster at 16 years of age. The second vaccine, MenB, is specifically given to prevent Meningitis B. It was FDA approved in 2014; it is given in two doses at ages 16 to 23. If you are the parent of a teen, ask your healthcare provider if your teen is fully protected with the Men B vaccine.
Public health perspective. Given the fact that bacterial meningitis kills hundreds of thousands of people each year, it’s encouraging to know that on September 28, 2021, the World Health Organization and partners launched the first ever global strategy to defeat meningitis. The goals of this campaign are to eliminate epidemics of bacterial meningitis, halve the number of cases, and reduce deaths by 70% by 2030.