The most important form of prevention is a vaccine against N. meningitidis. Different countries have different strains of the bacteria and therefore use different vaccines. Twelve serogroups (strains) exist with six having the potential to cause a major epidemic - A, B, C, X, Y and W135 are responsible for virtually all cases of the disease in humans. Vaccines are currently available against all six strains, including the newest vaccine against serogroup B. The first vaccine to prevent<unk>  serogroup B (meningitis B) disease was approved by the European Commission on 22 January 2013. The vaccine is manufactured by GlaxoSmithKline and sold under the trade name Bexsero. Bexsero is for use in all age groups from two months of age and older. Menveo and Mencevax of GlaxoSmithKline Vaccines, Menactra and Menomune of Sanofi-Aventis, and NmVac4-A/C/Y/W-135 (has not been licensed in the US) of JN-International Medical Corporation, are the commonly used vaccines. Vaccines offer significant protection from three to five years (plain polysaccharide vaccine Menomune, Mencevax and NmVac-4) to more than eight years (conjugate vaccine Menactra). Vaccinations Children Children 2–10 years of age who are at high risk for<unk>  such as certain chronic medical conditions and travel to or reside in countries with hyperendemic or epidemic<unk>  should receive primary immunization. Although safety and efficacy of the vaccine have not been established in children younger than 2 years of age and under outbreak control, the unconjugated vaccine can be considered. Adolescents Primary immunization against<unk>  with meningitis A, C, Y and W-135 vaccines is recommended for all young adolescents at 11–12 years of age and all unvaccinated older adolescents at 15 years of age. Although conjugate vaccines are the preferred<unk>  vaccine in adolescents 11 years of age or older, polysaccharide vaccines are an acceptable alternative if the conjugated vaccine is unavailable. Adults Primary immunization with meningitis A, C, Y and W-135 vaccines is recommended for college students who plan to live in dormitories, although the risk for<unk>  for college students 18–24 years of age is similar to that of the general population of similar age. Routine primary immunization against<unk>  is recommended for most adults living in areas where<unk>  is endemic or who are planning to travel to such areas. Although conjugate vaccines are the preferred<unk>  vaccine in adults 55 years of age or younger, polysaccharide vaccines are an acceptable alternative for adults in this age group if the conjugated vaccine is unavailable. Since safety and efficacy of conjugate vaccines in adults older than 55 years of age have not been established to date, polysaccharide vaccines should be used for primary immunization in this group. Medical staff Health care people should receive routine immunization against<unk>  for laboratory personnel who are routinely exposed to isolates of N. meningitidis. Laboratory personnel and medical staff are at risk of exposure to N. meningitides or to patients with<unk> . Hospital Infection Control Practices Advisory Committee (HICPAC) recommendations regarding immunization of health-care workers that routine vaccination of health-care personnel is recommended, Any individual 11–55 years of age who wishes to reduce their risk of<unk>  may receive meningitis A, C, Y and W-135 vaccines and those older than 55 years of age. Under certain circumstances if unvaccinated health-care personnel cannot get vaccinated and who have intensive contact with oropharyngeal secretions of infected patients and who do not use proper precautions should receive anti-infective prophylaxis against<unk>  infection (i.e., 2-day regimen of oral rifampicin or a single dose of IM ceftriaxone or a single dose of oral ciprofloxacin). USA Military recruits Because the risk of<unk>  is increased among USA's military recruits, all military recruits routinely receive primary immunization against the disease. Travelers Immunization against<unk>  is not a requirement for entry into any country, unlike Yellow fever. Only Saudi Arabia requires that travelers to that country for the annual Hajj and Umrah pilgrimage have a certificate of vaccination against<unk> , issued not more than 3 years and not less than 10 days before arrival in Saudi Arabia. Travelers to or residents of areas where N. meningitidis is highly endemic or epidemic are at risk of exposure should receive primary immunization against<unk> . HIV-infected individuals HIV-infected individuals are likely to be at increased risk for<unk> ; HIV-infected individuals who wish to reduce their risk of<unk>  may receive primary immunization against<unk> . Although efficacy of meningitis A, C, Y and W-135 vaccines have not been evaluated in HIV-infected individuals to date, HIV-infected individuals 11–55 years of age may receive primary immunization with the conjugated vaccine. Vaccination against meningitis does not decrease CD4+ T-cell counts or increase viral load in HIV-infected individuals, and there has been no evidence that the vaccines adversely affect survival. Close contacts Protective levels of anticapsular antibodies are not achieved until 7–14 days following administration of a<unk>  vaccine, vaccination cannot prevent early onset disease in these contacts and usually is not recommended following sporadic cases of invasive<unk> . Unlike developed countries, in sub-Saharan Africa and other under developed countries, entire families live in a single room of a house.<unk>  infection is usually introduced into a household by an asymptomatic person. Carriage then spreads through the household, reaching infants usually after one or more other household members have been infected. Disease is most likely to occur in infants and young children who lack immunity to the strain of organism circulating and who subsequently acquire carriage of an invasive strain. By preventing susceptible contacts from acquiring infection by directly inhibiting colonization. Close contacts are defined as those persons who could have had intimate contact with the patient's oral secretions such as through kissing or sharing of food or drink. The importance of the carrier state in<unk>  is well known. In developed countries the disease transmission usually occurs in day care, schools and large gatherings where usually disease transmission could occur. Because the<unk>  organism is transmitted by respiratory droplets and is susceptible to drying, it has been postulated that close contact is necessary for transmission. Therefore, the disease transmission to other susceptible person cannot be prevented. Meningitis occurs sporadically throughout the year, and since the organism has no known reservoir outside of man, asymptomatic carriers are usually the source of transmission. Additionally, basic hygiene measures, such as handwashing and not sharing drinking cups, can reduce the incidence of infection by limiting exposure. When a case is confirmed, all close contacts with the infected person can be offered antibiotics to reduce the likelihood of the infection spreading to other people. However, rifampin-resistant strains have been reported and the indiscriminate use of antibiotics contributes to this problem. Chemoprophylaxis is commonly used to those close contacts who are at highest risk of carrying the pathogenic strains. Since vaccine duration is unknown, mass select vaccinations may be the most cost-effective means for controlling the transmission of the<unk> , rather than mass routine vaccination schedules. Chronic medical conditions Persons with component deficiencies in the final common complement pathway (C3, C5-C9) are more susceptible to N. meningitidis infection than complement-satisfactory persons, and it was estimated that the risk of infection is 7000 times higher in such individuals. In addition, complement component-deficient populations frequently experience frequent<unk>  since their immune response to natural infection may be less complete than that of complement non-deficient persons. Inherited properdin deficiency also is related, with an increased risk of contracting<unk> . Persons with functional or anatomic asplenia may not efficiently clear encapsulated Neisseria meningitidis from the bloodstream Persons with other conditions associated with immunosuppression also may be at increased risk of developing<unk> . Antibiotics An updated 2013 Cochrane review investigated the effectiveness of different antibiotics for prophylaxis against<unk>  and eradication of N. meningitidis particularly in people at risk of being carriers. The systematic review included 24 studies with 6,885 participants. During follow up no cases of<unk>  were reported and thus true antibiotic preventative measures could not be directly assessed. However, the data suggested that rifampin, ceftriaxone, ciprofloxacin and penicillin were equally effective for the eradication of N. meningitidis in potential carriers, although rifampin was associated with resistance to the antibiotic following treatment. Eighteen studies provided data on side effects and reported they were minimal but included nausea, abdominal pain, dizziness and pain at injection site. Disease outbreak control Meningitis A, C, Y and W-135 vaccines can be used for large-scale vaccination programs when an outbreak of<unk>  occurs in Africa and other regions of the world. Whenever sporadic or cluster cases or outbreaks of<unk>  occur in the US, chemoprophylaxis is the principal means of preventing secondary cases in household and other close contacts of individuals with invasive disease. Meningitis A, C, Y and W-135 vaccines rarely may be used as an adjunct to chemoprophylaxis,1 but only in situations where there is an ongoing risk of exposure (e.g., when cluster cases or outbreaks occur) and when a serogroup contained in
Meningococcal disease
Disseminated disease
Postvaccinal encephalitis
Meningeal syphilis
Leukomyelitis
Herpesviral meningitis
Granulomatous meningoencephalitis
Fungal meningitis