Language selection

Government of Canada / Gouvernement du Canada

Search

Invasive meningococcal disease: For health professionals

On this page

Key information

Meningococcal disease is caused by the aerobic, gram-negative bacterium Neisseria meningitidis (meningococcus). When N. meningitidis enters normally sterile sites in the body, it becomes known as invasive meningococcal disease (IMD). Invasive meningococcal disease is a nationally notifiable disease where infection can result in:

It's possible for an infection to result in both.

Meningococci also occasionally cause non-invasive infections such as conjunctivitis or urethritis.

The bacteria spreads person to person through respiratory droplets.

The National Advisory Committee on Immunization (NACI) recommends routine immunization against the disease. The Committee to Advise on Tropical Medicine and Travel (CATMAT) recommends immunization before travel to high-risk meningococcal destinations.

Learn more about:

Epidemiology

Meningococci can be classified based on the polysaccharide capsule into 12 different serogroups. Six of these (A, B, C, X, W and Y) are associated most frequently with invasive meningococcal disease in Canada and around the globe. Incidence varies by meningococcal serogroup.

Learn more about:

Reservoir

Humans are the only reservoir.

Incubation period

Invasive meningococcal disease is characterized by a short incubation period of 2 to 10 days (usually 3 to 4 days).

Transmission

Invasive meningococcal disease is transmitted through respiratory droplets and throat secretions.

Some people are asymptomatic carriers of meningococci, both typeable and non-typeable.

Learn more about:

Clinical manifestations

Invasive meningococcal infection can result in meningitis or sepsis, or both.

Symptoms occur 2 to 10 days (usually 3 to 4 days) after exposure.

Common signs and symptoms of meningitis can include sudden onset of:

Other common symptoms of meningitis can include:

A petechial rash with pink macules, or occasionally vesicles, may be observed as well as petechiae on the conjunctiva on the palate.

The rash can be harder to see on darker skin tones. Check paler areas, such as the:

Meningitis may present differently or more subtly in newborns and infants. Newborns and infants may:

Symptoms of meningococcemia can include an abrupt onset of:

Symptoms also include abrupt onset of:

Complications of invasive meningococcal disease

Between 2012 and 2021 there were 738 cases with outcome data available. Of these, 104 deaths associated with invasive meningococcal disease were reported. This represents an overall case fatality rate of 14.1%

The case fatality rate is highest in those younger than 1 year of age, followed closely by those:

About 15% to 20% of survivors will have long-term sequalae from infection. Long-term sequalae can include:

Images of clinical manifestations of invasive meningococcal disease

Image 1: Gangrene of hands and lower extremities Image 2: Lower extremities
light-skinned 4-month old infant with gangrene of the hands and lower extremities due to meningococcemia
Source: the Centers for Disease Control and Prevention.		 lower extremities of a child with the non-blanching petechial or purpuric rash caused by meningococcemia
Courtesy of the American Academy of Pediatrics.

Image 1 on the left shows a light-skinned 4-month old infant with gangrene of the hands and lower extremities due to meningococcemia.

Image 2 on the right shows the lower extremities of a child with the non-blanching petechial or purpuric rash caused by meningococcemia.

Image 3: Purpura of the foot Image 4: Purpura of the foot
marked purpura in the left foot of an adolescent
Courtesy of the American Academy of Pediatrics.		 rash on a darker-skinned child's leg, demonstrating that it can be harder to see on darker skin tones
Courtesy of the U.K.'s National Health Services.

Image 3 on the left shows marked purpura in the left foot of an adolescent.

Image 4 on the right shows a rash on a darker-skinned child's leg, demonstrating that it can be harder to see on darker skin tones.

Risk factors

Individuals with increased risk of meningococcal disease because of underlying medical conditions include those with:

Individuals at increased risk of exposure to invasive meningococcal disease include:

Age is a predictor of risk. Between 2012 and 2022 in Canada, the highest annual incidence rates were in:

In epidemiological studies, increased incidence of the disease has also been observed in those:

Diagnosis and laboratory testing

A health care provider suspecting invasive meningococcal disease based on history and presentation should confirm the diagnosis with a laboratory sample.

A culture or polymerase chain reaction (PCR) from a sterile site of N. meningitidis confirms the diagnosis. The National Microbiology Laboratory in Canada confirms samples of suspected N. meningitidis to identify the serogroup and conducts further bacteriologic testing, including:

A health care provider should obtain and send a sample of:

A sample from a purpuric or petechial lesion scraping, synovial fluid and other sterile sites may also sometimes be positive.

Other diagnostic methods can include PCR and antigen detection.

Health care providers are required to report suspected cases of invasive meningococcal disease to their local public health unit as it's a nationally notifiable disease.

Only cases meeting the national case definition are reported to the National Enhanced Invasive Meningococcal Disease Surveillance System.

Learn more about:

Treatment

Empiric treatment for suspected invasive meningococcal disease should be started as soon as possible. There have been reported cases of penicillin-resistant invasive meningococcal disease. Consult current guidelines or consult an infectious diseases expert.

Supportive care in a hospital is usually required. Many patients require ICU and surgical care.

Learn more about:

Prevention

Immunization can reduce invasive meningococcal disease due to infection by serogroups A, B, C, W, and Y. The following meningococcal vaccine preparations are authorized for use in Canada:

Vaccine effectiveness depends on the serogroup and time since vaccination. Additional doses may be recommended for certain groups.

Use of Men-C-C vaccine is recommended by NACI as a part of routine childhood immunization schedules.

NACI recommends that adolescents and young adults, depending on local epidemiology and programmatic considerations, receive a dose of monovalent conjugate meningococcal C (Men-C-C) or quadrivalent conjugate meningococcal (Men-C-ACYW) vaccine routinely at the age of 12, even if previously vaccinated as infants or toddlers.

4CMenB or MenB-fHBP vaccine may be considered on an individual basis, depending on:

Additionally, meningococcal vaccines are recommended for selected individuals:

For specific recommendations about meningococcal vaccines and their use, refer to:

Learn more about:

Booster doses and re-vaccination

Additional doses of Men-C-ACYW vaccines to protect against invasive meningococcal disease may be recommended:

Men-C-C vaccines or Men-C-ACYW may also be recommended:

Learn more about:

Adverse events and contraindications

Side effects of immunization are usually mild and resolve on their own, including local injection site reactions that may occur soon after vaccination. Some side effects may develop after vaccination, including fever and malaise.

There are very few individuals who cannot receive meningococcal vaccines. A history of anaphylaxis to the vaccine is a contraindication. Administration of meningococcal vaccine should be postponed in persons with moderate or severe acute illness.

Persons with minor acute illness, with or without fever, may be vaccinated.

Reporting of adverse events following immunization is important to inform vaccine safety surveillance and is mandatory in all provinces and territories. To enable the detection of safety concerns, reports from across the country are compiled and analyzed along with:

Health care providers should report serious adverse events following immunization to the local public health authority.

Learn more about:

Post-exposure and control management

Post-exposure management

Close contacts of individuals with meningococcal infections have an increased risk of developing invasive meningococcal disease. Antibiotic chemoprophylaxis is recommended for all persons having close contact with a case of the disease from 7 days before onset of symptoms in the case to 24 hours after onset, regardless of their immunization status.

Vaccination or re-vaccination of certain close contacts should be considered in addition to chemoprophylaxis when the serogroup is vaccine preventable, as it may further reduce the risk of subsequent meningococcal disease.

Learn more about:

Outbreak management

During an outbreak of invasive meningococcal disease, it is important to consult with public health officials and experts in communicable diseases.

Outbreaks may be controlled with the use of a conjugate meningococcal vaccine, depending on the serogroup causing the outbreak and the age of those being vaccinated. This can include the re-vaccination of previously vaccinated individuals.

Learn more about:

Surveillance and monitoring

Invasive meningococcal disease is endemic, but rare in Canada.

Surveillance systems in Canada

Since becoming a nationally notifiable disease in 1924, invasive meningococcal disease has affected over 23,000 people in Canada.

Cases meeting the national case definition must be reported by health care providers to their local public health unit. Information is subsequently forwarded to provincial or territorial public health officials and then to the Public Health Agency of Canada.

The National Enhanced Invasive Meningococcal Disease Surveillance System is a part of the Public Health Agency's national surveillance system. It was established to capture enhanced epidemiologic and laboratory information on invasive meningococcal disease cases for the purpose of describing annual trends, in particular serogroup trends. The system was established in 1992 and has collected anonymized data since 1985 (data from 1985 to 1991 was collected retrospectively).

Immunization programs in Canada

The implementation of invasive meningococcal disease routine immunization programs in Canada began in 2002 with the conjugate meningococcal C (Men-C-C) vaccine. By 2007, monovalent (targeting serogroup C) and quadrivalent (targeting serogroups A, C, W and Y) conjugate vaccines were being used across Canada. The multicomponent meningococcal B vaccine (4CMenB) has been used to control outbreaks.

Epidemiology in Canada

The average incidence rate of invasive meningococcal disease was:

This is an overall incidence rate decrease of 66% (Figure 1).

More specifically, with routine vaccination, the incidence of serogroup C has declined by 96%, (Figure 2). Canada is on track to meet its reduction target of less than 5 cases of serogroup C annually in children less than 19 years of age by 2025.

Between 2017 to 2021, serogroup B has accounted for 33% of reported cases in Canada. Serogroup B has also accounted for the majority of reported deaths. Serogroup B disproportionally affects the young (children under 1 year of age and children between 1 and 4 years of age).

Serogroup B is responsible for the majority of cases and has been declining overall since its peak in 2007. However, the incidence rates of serogroup W has been increasing. The remaining other serogroups have been relatively stable (Figure 2).

Between 2017 to 2021, serogroup W, Y and C accounted for 32%, 17% and 4% of respective cases.

Between 2017 to 2021, there was a 5.2% case-fatality rate for invasive meningococcal disease-associated deaths.

Figure 1. Number of reported invasive meningococcal disease cases and overall incidence rates in Canada, 1997 to 2021
Figure 1. Text version below.
Figure 1 - Text description
Number and incidence rate (per 100,000 population) of reported invasive meningococcal disease cases in Canada by year, 1997 to 2021
Year Cases Incidence rate
(per 100,000 population)
1997 265 0.89
1998 174 0.58
1999 214 0.7
2000 242 0.79
2001 366 1.18
2002 234 0.75
2003 195 0.62
2004 196 0.61
2005 182 0.56
2006 212 0.65
2007 233 0.71
2008 195 0.59
2009 212 0.63
2010 154 0.45
2011 175 0.51
2012 154 0.44
2013 121 0.34
2014 101 0.29
2015 108 0.3
2016 98 0.27
2017 119 0.33
2018 141 0.38
2019 139 0.37
2020 86 0.23
2021 49 0.13
Figure 2. Serogroup specific invasive meningococcal disease incidence rates in Canada, 1997 to 2021
Figure 2. Text version below.
Figure 2 - Text description
Incidence of invasive meningococcal disease (per 100,000 population) in Canada by serogroup and year, 1997 to 2021
Year Incidence rate by serogroup (per 100,000 population)
B C Y W Other
1997 0.36 0.23 0.11 0.03 0.14
1998 0.22 0.13 0.06 0.02 0.16
1999 0.30 0.21 0.06 0.04 0.10
2000 0.22 0.34 0.08 0.03 0.12
2001 0.28 0.60 0.10 0.03 0.17
2002 0.29 0.25 0.12 0.02 0.05
2003 0.26 0.15 0.13 0.05 0.02
2004 0.27 0.17 0.08 0.04 0.04
2005 0.30 0.12 0.07 0.05 0.02
2006 0.35 0.13 0.08 0.02 0.07
2007 0.40 0.09 0.11 0.04 0.06
2008 0.29 0.09 0.11 0.04 0.04
2009 0.38 0.06 0.10 0.04 0.05
2010 0.27 0.03 0.08 0.02 0.04
2011 0.31 0.01 0.10 0.03 0.05
2012 0.32 0.04 0.05 0.01 0.03
2013 0.23 0.02 0.07 0.01 0.02
2014 0.15 0.03 0.08 0.02 0.01
2015 0.18 0.01 0.07 0.03 0.02
2016 0.13 0.01 0.07 0.04 0.02
2017 0.13 0.02 0.06 0.08 0.03
2018 0.07 0.02 0.05 0.12 0.03
2019 0.11 0.01 0.07 0.12 0.05
2020 0.08 0.003 0.05 0.07 0
2021 0.06 0 0.005 0.05 0

Learn more about:

Related links

Guidelines and recommendations

General information

Page details

Date modified: