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