The N.C. Department of Health and Human Services has updated its guidance on the meningitis vaccine series. A booster is now required for many incoming high school seniors. A few things to know about meningitis: 

  • It’s uncommon, but life-threatening.
  • It often strikes without warning.
  • Teens and young adults are at increased risk for meningococcal disease.
  • About 1 in 10 people who get the disease will die from it. And those who survive it may have long-lasting health impacts.

The old news: All 11- and 12-year-olds should be vaccinated with the meningococcal conjugate vaccine (MCV4).

What’s new: As of last August, a booster dose to protect against meningococcal disease is now required in North Carolina for adolescents entering the 12th grade – or by 17 years of age – whichever comes first. The Centers for Disease Control and Prevention (CDC) has long recommended a second dose at 16. Now, it’s required for students.

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Dr. Allison Hudson

“It’s been a recommendation for our patients for quite some time,” said pediatrician Dr. Allison Hudson, lead physician at Novant Health Pediatrics Oak Hollow in High Point, North Carolina. “But it wasn't required by the state of North Carolina until August of 2020.”

Adolescents who receive their first dose of MCV4 at, or after, age 16 years do not need a booster dose.

Children 2 through 10 years of age should receive two doses of meningococcal vaccine only if they are at increased risk for the disease.

We talked to Hudson about why this vaccine is important, why other vaccines are important and the fact that COVID-19 has not gone away.

What is meningitis?

Meningitis is an infection of the lining of the brain and spinal cord. “It's very serious, but it’s also very rare,” Hudson said. “There are different forms, and thankfully we vaccinate for the major causes of bacterial meningitis in our country. It's been a long, long time since I've had a case of bacterial meningitis, thankfully.”

The bacteria that cause this infection (Neisseria meningitidis) can spread when people have close or lengthy contact with someone’s saliva, such as through kissing, coughing and sharing drinking cups or utensils. About 1 in 10 people have these bacteria in the back of their nose and throat without being ill, according to the CDC. This is called being “a carrier.” Sometimes the bacteria invade the body and cause certain illnesses.

Symptoms of bacterial meningitis include fever, headache, body aches and trouble with light hurting the eyes. It can progress quickly to more serious symptoms such as the neck being stiff, lethargy, neurological abnormalities and sometimes a purplish rash on the body.  

Another type of meningitis – viral meningitis – is the most common form. “Most people get better on their own without treatment,” according to the CDC’s website. “However, anyone with symptoms of meningitis should see a doctor right away because any type of meningitis can be serious.”

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How it spreads

Meningitis spreads the same way the coronavirus does – through respiratory droplets. “That’s one of the reasons it spreads so easily,” Hudson said. “And anybody who knows adolescents knows they're often crowded closely together, snuggled up next to each other. They travel in packs.”

The possible side effects, or expected effects, associated with the meningitis vaccine are the same as those associated with most other vaccines – swelling, redness and pain at the site of the injection; headache; fever or tiredness. Serious problems, such as allergic reactions, are rare.

A good pairing: The meningitis and COVID-19 vaccines

Both vaccinations can be given at the same time.

If you’re making an appointment for a physical that includes vaccines, it’s helpful for office staff to know you need the COVID-19 vaccine at the same time.

“We keep it frozen and have to thaw it,” Hudson explained. “It doesn't have a long shelf life. Once you've tapped into a bottle of the vaccine, you have six hours to use it. We want to preserve the integrity of that vaccine, so we appreciate knowing ahead of time if a patient wants it.”

COVID is still here

“My partners and I are encountering questions about the COVID vaccine multiple times a day,” Hudson said. “What seems to resonate the most with our patients is understanding that everybody, at some point, will have to become immune to COVID, and they will either get the disease and have some level of immunity or they’ll get the vaccine. Coronavirus is here to stay. It's not going anywhere, and we are not at a level where any of us should feel comfortable. There’s no herd immunity yet; we don’t have enough vaccinated people right now.

“If you get the disease, you are more likely to have major side effects,” Hudson continued. “The risk of serious illness is significantly higher than any risk, of any kind, from the vaccine series.”

Don’t be complacent. The pandemic is not over. “Among unvaccinated people, COVID is still at higher levels,” Hudson said. “We hear about numbers going down with COVID, and that's really because we're incorporating people who've been vaccinated into those numbers. When you take the people who've been vaccinated out of that data, and you're looking at just unvaccinated people, the rates are still pretty high.”

Children and COVID

Children who get COVID-19 tend to get less sick than most adults. But that doesn’t mean they can’t suffer long-term consequences. Some kids are not recovering 100% from the virus.

“We are seeing a lot of heart complications from COVID in children,” Hudson said. “We're seeing neurological complications, just like in adults. There may be some cognitive decline after the disease. We're seeing respiratory concerns. The multi-system inflammatory syndrome we're seeing in children is still a real thing. Those risks are very low, but they exist, and it's preventable. That’s the message I want to get to parents. It’s preventable.” 

“There's this myth that’s still circulating about infertility as a side effect of the COVID vaccine,” she added. “I can tell you that's a myth. There’s no science to back that up.”

The importance of the annual physical

“Prevention for illnesses later on in life starts in childhood,” Hudson said.

Something like a lipid abnormality – that could put a child at risk for heart disease as an adult – can be uncovered during bloodwork at an annual physical.

“We might uncover a diabetes risk or some problems with how a child is growing that points to a hormonal or an endocrine problem,” Hudson said. “We’re trained to look for these subtleties. We use checkups to screen for those things. We're also looking at mental health. There are a lot of mental health issues that will come up in a yearly visit that might not have been brought up before or that parents weren't even aware of. Mental health is an important aspect of yearly health care.”

Adults and meningitis

Adults should get the meningitis vaccine if they:

  • Are a college freshman living in a dormitory or other group setting.
  • Are a military recruit.
  • Have a damaged spleen or a spleen that’s been removed.
  • Are traveling or residing in countries in which the disease is common.

The last word on meningitis

Mortality rates from meningitis are as high as 15%. And survival often comes with serious side effects.

“With bacterial meningitis, you are probably not going to recover 100%,” Hudson said. Hearing loss, brain damage, kidney damage, loss of limbs, neurological issues or scars from skin grafts are all possible after a bout with meningitis.

“And it’s a preventable illness,” Hudson said. “I stress that with all my families.”