Three main forms of the disease:

• Meningeal syndrome - presents with stiff neck, high fever, sensitivity to light, confusion, headaches and vomiting.
• Septic form - is less common but a more severe (often fatal) form of meningococcal disease, which is characterized by a haemorrhagic rash  and rapid circulatory collapse
• Pneumonia

The onset of symptoms is sudden and death can follow within hours. In as many as 10-15% of survivors, there are persistent neurological defects, including hearing loss, speech disorders, mental retardation and paralysis.

• Lumbar puncture shows a purulent spinal fluid
• Gram stain and culture from CSF and blood.
• PCR assay helpful for culture-negative cases and identification of serogroup during outbreaks.
• Acute and convalescent phase serology if highly suspicious for meningococcal disease but culture and PCR negative.

A legally notifiable disease in Singapore. Notify Ministry of Health (Form MD 131 or electronically via CD-LENS) not later than 24 hours from the time of diagnosis.

• Medical emergency
• Admission to a hospital is necessary
• Early diagnosis and institution of appropriate early intravenous antibiotics help reduce mortality to < 15%.
• Ceftriaxone IV 2 – 4 gm daily x 10-14 days; or
• Penicillin G 300,000 U/kg/day IV (up to 24 million U/day)

There are two quadrivalent vaccines against serotype A, C, Y and W135 available in the U.S - meningococcal polysaccharide vaccine and meningococcal conjugate vaccine. Only the polysaccharide vaccine is presently licensed in Singapore.

The US CDC indications for meningococcal vaccination include:

• Everyone aged 11 to 18 years;
• Adolescents during their 11- 12 year old healthcare visit;
• Adolescents upon high school entry (15 years of age), if they were not previously vaccinated;
• College freshmen living in dormitories, if not previously vaccinated;
• Persons with anatomic or functional asplenia;
• Military recruits;
• Certain international travellers to regions with hyperendemic or epidemic meningococcal disease;
• Microbiologists routinely exposed to Neisseria meningitidis isolates; and
• Patients with terminal complement deficiency.

(See also Appendix 1 Post-exposure prophylaxis)

Recommended for close contacts (³ 4 hours contact the week before onset of illness) and healthcare workers at risk i.e.

• those who had direct contact with patient’s secretions; or
• those who were involved in mouth-mouth resuscitation or intubation; or
• those who came into close proximity of patient’s oropharynx during examination.
• Chemoprophylaxis regimens:
• Rifampicin 600mg 12 hourly x two days (adults); children (> 1 month) 10mg/kg for 2 days; or
• Ciprofloxacin 500mg oral single dose; or
• IM ceftriaxone 250 mg single dose (adults); children <15years, 125mg single IM dose