Clinical Review

Meningococcal disease and its management in children

BMJ 2006; 333 doi: https://doi.org/10.1136/bmj.38968.683958.AE (Published 28 September 2006) Cite this as: BMJ 2006;333:685
  1. C Anthony Hart (cahmm@liv.ac.uk), professor of medical microbiology1,
  2. Alistair P J Thomson, honorary consultant paediatrician2
  1. 1 Department of Medical Microbiology, University of Liverpool, Liverpool L69 3GA,
  2. 2Royal Liverpool Children's Hospital (Alder Hey), Liverpool L12 2AP
  1. Correspondence to: C A Hart
  • Accepted 5 September 2006

Introduction

Meningococcal disease produces a considerable global burden of disease. In this clinical review we focus mainly on meningococcal disease in the United Kingdom, but we also acknowledge the wider issues across the world. Meningococcal disease, which may present clinically as septicaemia, as meningitis, or with a mixed picture, is caused by infection with Neisseria meningitidis or meningococcus.

Recent advances include greater knowledge about the pathogenesis of meningococcal disease, work to facilitate its early diagnosis, and some evidence of improved outcomes after meningococcal disease. Despite these advances, valid evidence from large controlled studies is scarce, so most recommendations are based on consensus or tradition rather than on firm scientific evidence.

Description of the disease only as “meningitis” is inaccurate and misleading to patients and professionals. Septicaemia is the more dangerous clinical syndrome,1 which needs urgent treatment; meningitis also needs rapid treatment but is more likely to lead to neurodevelopmental sequelae. In the meningitis belt of sub-Saharan Africa, meningococcal disease presents predominantly as meningitis alone.2

Meningococcal infection

What causes it

The meningococcus is solely a human pathogen, and up to 50% of the population may carry meningococci in the nasopharynx.3 w1 Factors that lead to invasion and production of disease include complex inter-relationships of genetic predisposition, host status, environmental conditions, and virulence of the organism.4 w2

Literature searches

We searched Medline in May 2006 (PubMed, since 1966, except where stated) with the terms meningococcus, meningococcal infection, meningococcal disease, meningococcal disease and predisposition (English, reviews, past 5 years), meningococcal disease and carriage (English, reviews, past 5 years), meningococcal disease and symptoms, meningococcal disease and signs, meningococcal disease and treatment, meningococcal disease and outcome, and meningococcal disease and prevention. We also did a Google search, which found about 2.5 million references on meningococcal disease

Summary points

Meningococcal disease is the most common infectious cause of death in childhood in …

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