Meningococcal Meningitis and Meningococcemia (Neisseria Meningitis)
General Description: A potentially fatal multi-system bacterial infection including the bloodstream (meningococcemia) and central nervous system (meningococcal meningitis). Persons who recover from meningitis due to N. meningitidis and other bacteria are at increased risk of seizure (see Effect on LEO Fitness for Duty in the section on Encephalitis and Meningitis Other Than Due to Neisseria Meningitidis).
Mode of Transmission: Upper respiratory tract secretions and droplets. Asymptomatic carriage of the bacteria in the nasopharynx ranges widely and may occur in up to 25% of the adult population.
Efficiency of Transmission/Attack Rate: The risk of contracting meningococcal disease in a LEO is not increased compared to the general population, unless exposed to a known case. Meningococcal disease is included here because outbreaks have occurred in institutional settings such as military basic training barracks and college dorms. Timely exposure assessment is required if the LEO has come in contact with a case. Agencies responsible for training LEOs may consider immunization prior to beginning training, depending upon the type of housing provided (see Appendix A).
Period of Communicability: Persons with meningococcal disease are generally considered non-infectious within 24 hours of starting antibiotic therapy.
Effect upon LEO Fitness for Duty: The LEO who has been exposed to N. meningitidis may continue on duty while taking post-exposure prophylaxis.
Sequelae of meningococcal meningitis may include seizures, hearing loss, and neurocognitive impairment (forgetfulness, inability to concentrate, fatigue, changes in behavior). Estimating the long-term risk of seizures based upon a review of outcome studies15-20 has been confounded by changes in the management of bacterial meningitis (use of corticosteroids and prophylactic anti-seizure medications). Fitness for return to duty should be determined on a case-by-case basis, based upon the symptoms that the LEO experienced during the illness, and post-discharge neurologic and neuropsychological evaluations.
LEO-specific Clinical Studies and Reports: In 2009, the LEO who was dispatched to a private home for a wellbeing check came into contact with an individual who was subsequently diagnosed with meningococcal meningitis. The index case was transported to the local hospital by fire/rescue personnel who wore respiratory protection; the LEO did not. Within several days, the LEO and a respiratory therapist who treated the index case at the hospital developed meningococcal disease. An investigation uncovered a breakdown in communication among several agencies and a delay in the exposure assessment of those who came in contact with the index case (see Occupational transmission of Neisseria meningitidis – California, 2009. MMWR. November 19, 2010).