Meningococcal disease in the UK: what you need to know

Thanks to the vaccination programmes introduced over the last two decades, IMD in England has shown an overall decline since its peak in 1999 to 2000, when 2,595 cases were reported.

Current outbreak in Kent

As of 18 March, 27 cases of meningococcal disease have been reported in Kent. Initial cases were recorded between 13 and 15 March. Fifteen cases have been confirmed, while twelve additional cases remain under investigation. Nine of the confirmed cases are MenB, and two patients have died.

Several affected people had visited Club Chemistry in Canterbury between 5 and 7 March. Health teams are offering antibiotics to people who may have been exposed, including students at the University of Kent. 

Because the MenB vaccine was introduced for infants only in 2015, most people in this age group are unlikely to have received it routinely.

This outbreak is among young adults, from multiple Kent school communities. Other cases are occurring elsewhere in the UK, in line with typical trends and are not connected to the Kent outbreak.

Although this outbreak has drawn national interest because of its size and severity, it is not currently being treated as a national incident. Public health teams have acted quickly and on a large scale. More cases may appear, but wider spread is unlikely. The UK health secretary has said that the overall risk to the public remains very low.

What is meningococcal disease?

Meningococcal disease is an infection caused by the bacterium Neisseria meningitidis. This bacterium lives in the nose and throat of humans - and only humans. Many people carry it for long periods without any symptoms. These people are known as carriers. It is seen most often in young children, with a second rise in cases during adolescence. Fewer than 1% of carriers will become ill. 

Meningococcal disease can be life‑threatening and can worsen very fast. Without quick diagnosis and antibiotic treatment, the risk of death is high. Invasive meningococcal disease (IMD) is the most severe form. It can cause septicaemia, which is a blood infection, or meningitis, which is an infection of the lining of the brain.

Symptoms of meningococcal meningitis and meningococcal septicaemia 

Symptoms vary from person to person. Possible symptoms, which will not occur in every case, include:

• A rash that does not fade under a glass
• Sudden high fever
• Severe or worsening headache
• Stiff neck
• Vomiting and diarrhoea
• Joint and muscle pain
• Sensitivity to bright light
• Very cold hands and feet
• Seizures
• Confusion or delirium
• Extreme drowsiness or difficulty waking

Not everyone will show all of these signs. Many, including the rash, often appear later when the person is already very unwell.

Patients with early meningitis often have only non-specific flu-like symptoms – this can make it hard to distinguish this illness from common harmless viral infections.  Reasons to be more concerned include:

• The patient saying that they feel more unwell than they have ever felt before
• The patient’s condition appearing to get much worse over a few hours with little or no relief from paracetamol

How it spreads, how it is diagnosed and how it is treated

Transmission

Meningococcal bacteria spread through close contact, such as coughing, kissing or sharing drinks or vaping devices. People at higher risk include babies and young children, teenagers and young adults, and those with weakened immune systems, such as people living with HIV. Adolescents and young adults are particularly vulnerable because they carry the bacteria more often than other age groups and tend to have more close‑contact social behaviour.

Diagnosis

Doctors diagnose meningococcal disease through clinical assessment. This includes taking a medical history, examining the patient and reviewing blood test results. A lumbar puncture is often needed to test the fluid around the brain and spine for bacteria.

Treatment

Antibiotics need to be given as soon as a doctor suspects meningococcal disease. Treatment does not wait for test results. Most people with suspected or confirmed disease are admitted to hospital for further care and monitoring.

Protection through vaccination

Vaccines are available for several serogroups of Neisseria meningitidis, including A, B, C, Y and W135. These are used for prevention in babies, adolescents, travellers and healthcare workers, and can also be given during outbreaks.

In the UK, infants have been offered the MenB vaccine since September 2015. Teenagers can receive the MenACWY vaccine up to their 25th birthday. Checking that routine vaccinations are up to date remains one of the most effective ways to reduce the risk of invasive meningococcal disease.

Key takeaways: Stay alert to signs of meningococcal disease

If your children attend school, college or university in the UK, follow all guidance from the NHS and your local public health teams. Anyone identified as a close contact will be told directly if treatment or vaccination is advised. Check that routine vaccinations are up to date where eligible. Practise good hygiene - wash hands often and avoid sharing drinks, cutlery or utensils. 

Early symptoms can look like a cold, flu or even a hangover, so students may miss early warning signs. If you or someone you know develops any of the symptoms above, seek urgent medical help. Use NHS 111 or emergency services if symptoms are severe in the UK, or your local healthcare provider if overseas. Don’t wait for all symptoms to appear.