Rise in Bacterial Meningitis Cases Sparks Concern Among Doctors

Introduction to Bacterial Meningitis

Deaths from a rare and dangerous bacterial infection could rise if fewer teens are vaccinated, doctors warn. After the Centers for Disease Control and Prevention recommended that all adolescents get vaccinated against meningococcal disease in 2005, cases of the potentially deadly illness plummeted in the United States by 90%. However, cases have sharply risen since 2021, likely due to a combination of mutating bacteria and declining rates of vaccination overall, especially among teens getting a booster dose for bacterial meningitis, doctors suggest.

Concerns Over New Vaccine Schedule

Dr. Luis Ostrosky, an infectious disease doctor at UT Health in Houston, is concerned that as cases of bacterial meningitis climb in the United States, the CDC’s recent overhaul of the childhood vaccine schedule could lead to more deaths. Under Health Secretary Robert F. Kennedy Jr.’s guidance, the CDC is no longer recommending a meningitis vaccine for all adolescents. The vaccine and booster protect against the most common types of the infection in the U.S., serogroups A, C, Y, W.

High-Risk Groups

Under the new guidance, the vaccines will be recommended for “high-risk groups,” although parents can still ask doctors to vaccinate their children through a process called “shared clinical decision making.” Teenagers and college-age adults, who often spend a lot of time in groups or communal living spaces such as dorms, and people with HIV are considered at highest risk for the infection, caused by a group of bacteria called Neisseria meningitidis.

Importance of Vaccination

Vaccination is important not because the disease is common — around 3,000 people are diagnosed with bacterial meningitis in the U.S. each year — but because the infection is both extremely serious and fast-moving. Bacterial meningitis can progress quickly, causing the brain to swell and limbs to develop gangrene and sepsis, and can kill within 24 hours. Symptoms such as headache, stiff neck, vomiting and fever come on suddenly, and may be mistaken for other minor illnesses. It can be treated with antibiotics, but even with rapid diagnosis, about 15% of patients die.

Fast-acting and Life-threatening

Understanding the Disease

It’s really a devastating disease that keeps pediatricians up at night, said Dr. Kevin Messacar, a professor of pediatric infectious disease at University of Colorado Anschutz in Aurora, Colorado. It’s difficult to recognize, and we often see patients who are too late to bring back. Why some people are susceptible isn’t well understood. The infection develops when usually harmless bacteria travel through the respiratory tract and infiltrate the membranes surrounding the brain and spinal cord, causing severe inflammation. These bacteria, which commonly live in the back of the throat, can spread from person to person through close contact.

Consequences of Infection

Among patients who survive, as many as 20% have lifelong disability or complications, including amputated limbs, hearing impairment and neurological problems. You can die from a brain hernia, or from sepsis, Messacar said. And if you survive a brain hernia, you will most likely have severe complications. In 2024, the CDC issued an alert about a rise in cases of a type of invasive meningococcal disease. More than 500 cases were reported, the highest since 2013. Most of the infections were due to a specific strain of the Y serogroup of bacteria, which is included in the previously recommended vaccine.

What the Research Says

A CDC statement said the changes to the recommendation reflect the need for more data on certain vaccines, including placebo-controlled randomized trials and long-term observational studies to better characterize vaccine benefits, risks, and outcomes. While there haven’t been placebo-controlled trials for meningitis vaccines — which would test how well a vaccine works either by deliberately infecting people with bacteria or by seeing how well they fare if they are infected in the real world — there have been many randomized clinical trials and other studies that use decades of data collected from both vaccinated and unvaccinated individuals in the real world.

The Impact of Changing Guidance

Dr. Peter Chin-Hong, an infectious disease doctor at the UCSF School of Medicine in San Francisco, said the new approach to meningitis vaccination in the U.S., which is based on Denmark’s, is flawed. You can’t just look at another country’s vaccine approach and photocopy it. You really have to look at what is happening in your own country, Chin-Hong said. Given the safety of meningitis vaccines, it makes sense to vaccinate. Alicia Stillman, who serves on a World Health Organization task force for eliminating meningitis, worries that by moving the vaccine into shared decision making, the CDC is creating hurdles for parents who want to protect their children.

Personal Stories

In 2005, Katie Thompson, now 39, was infected with an antibiotic-resistant strain of bacterial meningitis when she was a college freshman, the same month the FDA approved the first MenACWY vaccine. I don’t know how to describe it besides it’s pure hell, she said. After five weeks in the hospital and nearly dying, she went home, but not without lifelong complications. Thompson, who lives outside of Charleston, South Carolina, still struggles with migraines and vestibular disorders that cause vertigo and nausea.

Conclusion

The rise in bacterial meningitis cases is a concerning trend that could have devastating consequences if not addressed. The importance of vaccination cannot be overstated, especially for high-risk groups such as teenagers and college-age adults. While the new vaccine schedule may have its flaws, it is crucial that parents and healthcare professionals work together to ensure that those who need the vaccine receive it.

FAQs

• What is bacterial meningitis? Bacterial meningitis is a serious and potentially life-threatening infection caused by bacteria that inflame the membranes surrounding the brain and spinal cord.
• How is bacterial meningitis spread? The bacteria can spread from person to person through close contact, such as kissing, sharing food or drinks, or living in close quarters.
• What are the symptoms of bacterial meningitis? Symptoms include headache, stiff neck, vomiting, fever, and can progress quickly to more severe complications such as brain hernia, sepsis, and death.
• Is there a vaccine for bacterial meningitis? Yes, there are vaccines available that protect against the most common types of bacterial meningitis, including serogroups A, C, Y, W, and B.
• Who is at high risk for bacterial meningitis? Teenagers, college-age adults, and people with HIV are considered at highest risk, as well as those who live in close quarters or have weakened immune systems.