See also

Meningitis and encephalitis
Sepsis
Recognition of the seriously unwell neonate and young infant
Fever and petechiae/purpura
Contact prophylaxis for invasive meningococcal or Hib disease

Key points

1. Meningococcal disease can be rapidly fatal, even with treatment
2. Give ceftriaxone/cefotaxime as soon as meningococcal disease is suspected, within 15 min. If unavailable, give benzylpenicillin
3. Carefully titrated fluid resuscitation with repeated assessment of clinical condition is vital
4. Collect blood cultures prior to antibiotics, if possible, but do not delay antibiotic administration

Background

• Meningococcal disease is acute infection caused by Neisseria meningitidis, also commonly called meningococcus
• A large proportion of the population are healthy, asymptomatic carriers of meningococcal bacteria in their nasopharynx and oropharynx
• Invasive meningococcal disease (IMD) is a rare but serious disease, presenting as
  • severe sepsis complicated by disseminated intravascular coagulation (DIC), with rapidly progressive non-blanching petechial/purpuric rash (higher mortality)
  • meningitis with or without a rash
  • more rarely, septic arthritis, pneumonia, pharyngitis, conjunctivitis, occult bacteraemia
• Most cases in Australia are caused by 6 serogroups (A, B, C, W, X and Y)
  • Serogroup B accounts for the majority of IMD cases in Australia
• Vaccines for serogroups A, C, W and Y, and for B are available in Australia. Serogroup B vaccine is not funded in all states
• Despite prompt treatment, IMD is associated with a mortality rate of up to 10%. 10-20% have long-term morbidity, including deafness, neurological deficits, and partial or full amputations

Assessment

Signs and symptoms of acute meningococcal disease can present as sepsis or meningitis

History

• Specific symptoms can include
  • Rapid onset (<12 hours) of headache, loss of appetite, nausea, vomiting, sore throat and coryza
  • Fever
  • Leg pain or myalgia
  • Infants can present with non-specific symptoms such as poor feeding, irritability, lethargy, mottling, and/or a high-pitched moaning cry. See Recognition of the seriously unwell neonate and young infant
• Vaccination status, including Men B

Risk factors

• Aboriginal and Torres Strait Islander
• Immunodeficiency such as asplenia, immunoglobulin deficiencies, complement deficiencies, sickle cell disease, haematopoietic stem cell transplant, HIV
• Exposure to cigarette smoke
• Crowded housing or living in 'close quarters' eg student dormitory
• Prolonged contact with a person carrying meningococcal bacteria

Examination

• Abnormal skin colour (pallor or mottling) and/or cool peripheries
• Altered conscious state
• Neck stiffness, headache, photophobia, bulging fontanelle
• Non-blanching rash: petechiae/purpura

Note: a blanching rash does not exclude meningococcal disease; the rash can initially be a macular or maculopapular rash that blanches

Examples of rash: Click to see additional full size pictures

Management

Investigations

Investigations should NOT delay antibiotic administration

• Blood from IV or intraosseous
  • Culture: should be obtained prior to antibiotic administration if possible
  • PCR (separate EDTA tube)
• CSF, once initially stabilised and no contraindication to lumbar puncture
  • Gram stain (Gram negative diplococci), cell count, biochemistry, culture +/- meningococcal PCR

Initial treatment

• If meningococcal infection is not yet confirmed, treat as per Sepsis
• Resuscitate as appropriate, see Sepsis

Antibiotics

Antimicrobial recommendations may vary according to local antimicrobial susceptibility patterns; please refer to local guidelines

• Initial empiric treatment in suspected meningococcal disease is a third-generation cephalosporin

Ceftriaxone 100 mg/kg (max 4 g) IV daily or >4 weeks of life

           OR

Cefotaxime 50 mg/kg (max 2 g) IV

Week 1 of life: 12 hourly

Week 2-4 of life: 6-8 hourly

>Week 4 of life: 6 hourly

• If no IV/intraosseous access, give IM  
  • May need two injections due to volume/muscle size and repeat the dose once IV access available
• If ceftriaxone/cefotaxime is unavailable

Benzylpenicillin 60 mg/kg (max 2.4 g) IV

Week 1 of life: 12 hourly

Week 2-4 of life: 6 hourly

>Week 4 of life: 4 hourly

• Children treated with benzylpenicillin require concurrent treatment with contact prophylaxis antibiotics to eradicate meningococcal carriage

Resuscitation

• Anticipate rapid deterioration with close monitoring and repeated assessments. see Sepsis
• Fluid resuscitation as needed with early consideration of inotropes

For additional management see Sepsis and Meningitis and encephalitis

Ongoing management

Antibiotics

Antimicrobial recommendations may vary according to local antimicrobial susceptibility patterns. Refer to local guidelines

• Confirmed meningococcal disease requires 5 days of IV treatment
• Continue a third-generation cephalosporin until sensitivities confirmed:
  
  Ceftriaxone 100 mg/kg (max 4 g) IV daily for >4 weeks of life 

OR

Cefotaxime 50 mg/kg (max 2 g) IV

Week 1 of life: 12 hourly 

Week 2-4 of life: 6-8 hourly 

>Week 4 of life: 6 hourly  

• If susceptibility of N meningitidis to benzylpenicillin is confirmed, de-escalate treatment:

Benzylpenicillin 60 mg/kg (max 2.4 g) IV

Week 1 of life: 12 hourly

Week 2-4 of life: 6 hourly

>Week 4 of life: 4 hourly

Isolation
N meningitidis is spread person-to-person by respiratory droplets. Children should be isolated with droplet precautions according to local hospital infection control guidelines

Notification
Acute meningococcal disease is a notifiable disease with all cases (presumed or confirmed) requiring immediate notification to the local state authority. See additional notes

Steroids

If dexamethasone has been given for empiric meningitis management, this can be ceased once N meningitidis infection is confirmed as there is no clearly demonstrated benefit

Contact prophylaxis
Contact prophylaxis involves the treatment of at-risk contacts to prevent further disease and should be given as soon as possible

Vaccination

• Three meningococcal vaccines are available
  • MenB
  • MenC
  • MenACWY
• Meningococcal B and ACWY immunisations are recommended as per the Australian Immunisation handbook
• The MenACWY vaccine is on the National Immunisation Program Schedule
• Some states include MenB vaccine as part of the standard immunisation schedule; others include only certain groups of children. The vaccine is also available for private purchase

Cases

• Vaccination is not recommended unless the case has underlying risk factors (See above)

Contacts

• Secondary prevention vaccination may be offered to non-immunised contacts to reduce secondary cases for serogroups A, C, W or Y
• A single (first) dose of MenB vaccine is unlikely to confer protection to the contact during the period of disease risk

Consider consultation with local paediatric team when

All children with suspected meningococcal disease

Consider transfer when

• All children with acute meningococcal disease should be managed in a facility with the capacity to provide intensive care
• If these facilities are unavailable, the child should be stabilised and transferred as appropriate

For emergency advice and paediatric or neonatal ICU transfers, see Retrieval Services

Consider discharge when

• Children can complete IV treatment through HITH services if available, once haemodynamically stable and afebrile
• Contact prophylaxis has been considered

Parent information

Kids Health Info: Meningococcal infection

Additional notes

• ACT: Communicable Disease Control phone 02 5124 9213 and complete the notification form
• NSW: Public Health Units of local Hospital & Health Service phone 1300 066 055 and PHU form
• NT: Centre for Disease Control by phone. After hours: Royal Darwin Hospital phone 08 8922 8888.
• QLD: Public Health Units of local Hospital & Health Service by telephone (list of PHUs)
• SA: Communicable Disease Control Branch phone 1300 232 272
• TAS: Public health hotline phone 1800 671 738
• VIC: Department of Human Services phone 1300 651 160 (DHHS notification procedure)
• WA: Public Health Units of local Hospital & Health Service (list of PHUs) and PHU notification form for metropolitan residents or regional residents

Last updated May 2026