Meningitis is an inflammation of the membranes surrounding the brain and spinal cord. Its bacterial forms can turn into a life-threatening condition within hours. The recent increase in cases caused by Neisseria meningitidis serogroup B on university campuses in the UK has brought the risk gap among unvaccinated young adults back to the agenda.
Causative Agents and Types
Bacterial meningitis — requires emergency intervention
Three main causative agents stand out, varying according to age and immune status:
Neisseria meningitidis (A, B, C, W, Y)
Streptococcus pneumoniae
Haemophilus influenzae type b
Listeria monocytogenes (≥50 years, immunosuppressed)
Viral Meningitis
Generally milder course with spontaneous recovery. Enterovirus is the most common causative agent. Due to clinical overlap with herpetic encephalitis, empirical acyclovir initiation may be required.
Others
Fungal, tuberculosis, aseptic meningitis (drug-induced, autoimmune)
Clinical Findings
The classic meningitis triad (fever, neck stiffness, altered consciousness) is fully met in only 44% of adults. Severe headache alone is sufficient to trigger clinical suspicion.
High fever
Neck stiffness (Kernig/Brudzinski +)
Altered consciousness
Severe headache
Light sensitivity (photophobia)
Nausea / vomiting
Petechial/purpuric rash
Emergency alarm sign
A purple/red rash that does not fade with pressure is a sign of meningococcemia and requires immediate emergency intervention. Parenteral antibiotics should be started without waiting for diagnosis.
Vaccination Strategies
Meningitis B Vaccine: History and Turkey
Since the serogroup B capsule resembles human tissue, the classic polysaccharide vaccine strategy could not be applied. The solution came with reverse vaccinology and outer membrane vesicle technology. Bexsero (GSK) was licensed in Europe in 2013, and Trumenba (Pfizer) in the USA in 2014.
The UK became the first country in the world to start routine national implementation by including MenB in the infant vaccination program in 2015. Following this decision, a decline of up to 75% in MenB cases among infants was documented in the UK.
Situation in Turkey
Current Status — Republic of Turkey Ministry of Health
The MenB vaccine (Bexsero, Trumenba) is not included in Turkey’s routine national vaccination schedule. It can be administered for a fee at private healthcare facilities upon physician evaluation and parent/patient request. This situation leads to many children and young adults remaining unprotected against N. meningitidis serogroup B.
Current Situation in the UK: Why Young People?
The UK’s 2015 vaccination program covers those born after 2005. Today’s university student population (born 2000–2005) consists of a generation that did not catch up with the routine vaccination period. When this demographic gap combines with the transmission opportunity created by crowded dormitory and campus environments, cases increase.
UK Health Security Agency (UKHSA) reported a significant increase in cases in the 2023–2024 academic year compared to previous years; MenACWY and MenB vaccines are recommended for unvaccinated students starting university.
Transmission Routes
Respiratory droplets, close/prolonged contact, kissing / sharing items, crowded indoor environments
The carriage rate in the general population is 10–35%, while it can reach up to 25% in adolescents and young adults; asymptomatic carriers constitute the main source of transmission.
Post-Exposure Prophylaxis
Chemoprophylaxis initiated within the first 24 hours is critical in preventing secondary cases after close contact.
Antibiotic prophylaxis (in order of preference)
Ciprofloxacin 500 mg single dose (PO)
Rifampicin 600 mg × 2/day × 2 days (PO)
Ceftriaxone 250 mg single dose (IM)
Ceftriaxone is preferred in pregnancy and in the presence of contraindications. It should be verified whether the antibiotic to be administered to the index case starting treatment provides prophylaxis.
Active Immunization
Post-exposure MenB and MenACWY vaccines are administered by decision of the public health authority to provide long-term protection; they do not replace chemoprophylaxis.
Clinical Summary
Although meningitis is largely preventable with early diagnosis and appropriate treatment, it remains an emergency condition with high mortality and morbidity burden.
The absence of MenB vaccine in the routine program in Turkey creates a significant immunity gap. The UK experience clearly demonstrates how this gap can turn into an outbreak in unvaccinated young adult cohorts.
Early diagnosis + prophylaxis + vaccination = saves lives.
References:
1-van de Beek D, et al. Community-acquired bacterial meningitis in adults. N Engl J Med. 2006;354:44–53.
2-Pace D, Pollard AJ. Meningococcal disease: clinical presentation and sequelae. Vaccine. 2012;30 Suppl 2:B3–9.
3-Maiden MC, et al. MLST revisited: the gene-by-gene approach to bacterial genomics. Nat Rev Microbiol. 2013;11:728–36.
4-Giuliani MM, et al. A universal vaccine for serogroup B meningococcus. Science. 2006;312:1060–4.
5-Ladhani SN, et al. MenB vaccination impact, England. N Engl J Med. 2020;382:447–57.
6-UK Health Security Agency (UKHSA). Meningococcal disease: guidance, data and analysis. 2024.
7-Republic of Turkey Ministry of Health. Expanded Immunization Program Circular. 2024.
8-European Centre for Disease Prevention and Control (ECDC). Meningococcal disease — annual epidemiological report. 2023.
Prof. Dr. Elif Aksoy
ENT Head and Neck Surgery Specialist
