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Traveler Summary

Key Points

  • Meningococcal infections are acute, often fatal bacterial infections (caused by one of the bacterial serogroups A, B, C, W, X, and Y) acquired through airborne droplets from an infected person or carrier (without symptoms) or through contact with contaminated objects. Disease occurs worldwide, but the highest incidence is in the meningitis belt of sub-Saharan Africa.
  • Risk to travelers is similar to that at home, except for travelers going to the meningitis belt and any other destination with a current local epidemic. Risk increases with the level of contact with the local population.
  • Symptoms of infection of the bloodstream or brain can be mild to severe and include fever, rash, severe headache, vomiting, neck and back pain with rigidity, altered consciousness, and coma.
  • Consequences of infection include deafness, difficulty concentrating and sleeping, or death (which may occur within 12-24 hours of first symptoms).
  • Prevention includes employing good respiratory etiquette and frequent, thorough handwashing.
  • Two types of meningococcal vaccines (protecting against different serogroups) are available. Quadrivalent (serogroups A, C, W, Y) meningococcal vaccines are routinely given as 2 doses for adolescents at age 11 years and then at age 16 years. At-risk travelers 2 years and older should receive 1 dose, and infants and children aged 2-23 months should receive either 2 or 3 doses, 8 to 12 weeks apart. Meningococcal B vaccines (serogroup B) are not indicated for travel but may be given to persons aged 16-23 years as a routine vaccine if not traveling.
  • Vaccine side effects for quadrivalent vaccine are mild and include injection-site reactions, headache, fatigue, muscle aches, weakness, and fever.
  • Duration of quadrivalent vaccine protection wanes to insufficient levels within several years following vaccination; a booster is recommended every 3 to 5 years if at continued risk.

Introduction

Meningococcal infections are acute, potentially fatal bacterial infections of the blood or brain caused by different serogroups (A, B, C, W, X, Y) of the bacteria.

Risk Areas

Meningococcal disease occurs worldwide. Highest incidence is in developing countries in the meningitis belt of sub-Saharan Africa, where large epidemics (caused primarily by serogroups C and W) occur semiannually in the hot dry season (December through June). Peak incidence is in children aged 5-12 years. In other developing countries, the seasonality is less marked.

In industrialized countries, the disease presents as single cases or small clusters. In countries with a temperate climate, peak transmission is during winter, and peak incidence is in infants younger than 1 year. Outbreaks (caused by serogroup A, B, C, or Y) may occur in crowded settings, childcare centers, schools, colleges, summer camps, and the military.

Epidemics are associated with poverty and crowding. This pattern influences vaccination policy and advice to travelers.

Transmission

Meningococcal bacteria are transmitted in airborne droplets (e.g., by sneezing or coughing) from an infected symptomatic person or carrier (without symptoms) or through contact with contaminated objects. The closer the contact, the greater the risk of transmission. Military barracks, college dormitories, and other types of close-living quarters facilitate transmission. Smoke-filled bars and clubs have been associated with outbreaks.

Risk Factors

Risk to travelers going to countries outside the meningitis belt is generally low and similar to that at home. Risk is highest for persons (especially health care workers [HCWs]) going to (or residing in) the African meningitis belt during the epidemic season or any country where an epidemic is ongoing; persons participating in the Hajj pilgrimage; persons having close contact with local residents who may be meningitis carriers.

Symptoms

Meningococcal infections progress rapidly. The most common signs and symptoms are fever and rash, followed hours or days later by severe headache, vomiting, and neck and back pain with rigidity, altered consciousness, and coma. Half of the persons with meningitis develop shock. In severe infections, a brief influenza-like illness with high fever leads directly to extreme weakness, collapse, and shock within hours.

Consequences of Infection

Nerve damage following infection is common. Deafness and difficulty concentrating and sleeping are common in those who have recovered. Death occurs in more than 70% of infected persons who were not treated and in about 10% of those who received treatment.

Need for Medical Assistance

Sudden onset of fever while in a risk situation, especially if accompanied by rash or headache, requires immediate medical attention.

Prevention

Non-vaccine: Employ good respiratory etiquette and frequent, thorough handwashing.

Vaccines: Quadrivalent meningococcal vaccines (Menactra, Menveo), providing protection against serogroups A, C, W, and Y, are available for routine vaccination and for persons at risk or during an outbreak, including healthy travelers going to the meningitis belt. Meningococcal B vaccines (Bexsero, Trumenba) are not indicated for travel but may be given to persons aged 16-23 years as a routine vaccine if not traveling, as well as to some people with underlying medical conditions. Meningococcal C vaccine, providing protection against serogroup C (associated with school and community outbreaks in certain countries) is available outside the U.S. and may be given following local guidance in the destination country. Protection against some serogroups wanes to an insufficient level within several years following vaccination.

Travel

Vaccination with quadrivalent (serogroups A, C, W, and Y) meningococcal vaccine (Menactra, Nimenrix, Menveo) is recommended for:

  • Travelers going to (or residing in) certain countries where meningococcal disease is constantly or highly present, or epidemic prone at certain times of the year, especially if prolonged close contact with local residents is anticipated
  • Travelers going to any country experiencing a current epidemic
  • HCWs traveling to any of the above countries at any time of year for health care work or research
  • Expatriates and long-stay child travelers in countries where meningococcal vaccine is given routinely to children and infants
  • University students who will be living in dormitories who have not previously received quadrivalent vaccine at age 16 years or older
  • Persons aged 11-18 years who have not previously received quadrivalent vaccine

Vaccination with quadrivalent meningococcal vaccine is required for:

  • Persons 2 years and older and participating in an annual pilgrimage to Mecca (Hajj or Umra) or doing seasonal work. Vaccination must have been received not more than 3 to 5 years (depending on vaccine) and not less than 10 days before arrival in Saudi Arabia.

Meningococcal C vaccine (not available in the U.S.) is recommended for expatriates and long-stay child travelers in countries where this vaccine is given routinely to infants/children.

Meningococcal B vaccines (Bexsero, Trumenba) are not indicated for travel but may be given to persons aged 16-23 years as a routine vaccine if not traveling, to some people 10 years and older with underlying medical conditions, and HCWs departing for a serogroup B disease outbreak.

Persons with underlying medical conditions or who have concerns about the vaccine should speak to their health care provider before vaccine administration.

Side Effects: The most common side effects of quadrivalent vaccine are mild and can include injection-site reactions, headache, fatigue, muscle aches, weakness, and fever. Some persons receiving quadrivalent vaccine experience a painful swelling of the arm.

Timing:

Quadrivalent vaccines (Menveo or Menactra) are given as follows:

  • Routine
    • Adolescents at age 11-12 years: 1 dose followed by a booster at age 16 years
  • Travel
    • Children older than 2 months and younger than 2 years: 2-3 doses (depending on age and vaccine brand), given 8-12 weeks apart. For imminent departures, doses may be given 4 weeks apart
    • Persons older than 2 years (healthy persons): 1 dose
    • Boost 5 years after a previous dose if at new or continued exposure; consider a booster dose 3 years after a previous dose for travelers going to Africa (due to waning immunity)

Meningococcal C vaccine: Will be given following local guidance in destination country if indicated.

Meningococcal B vaccines (Bexsero or Trumenba) for at-risk persons 10 years and older are given as follows:

  • Bexsero: 2 doses, given 1 month apart
  • Trumenba: 2 doses, given at 0 and 6 months or 3 doses at 0, 1-2, and 6 months
  • No booster dose is indicated.