What we know about meningococcal disease amid outbreak in Toronto

As Canada’s health care system struggles amid health-care worker shortages and burnout while Canadians continue to deal with the threat of COVID-19 and monkeypox, the news of another disease forming a potential threat has sparked questions and concerns among Canadians.

On Thursday, the City of Toronto declared an outbreak of meningococcal disease after one person has died and two others remain infected.

But what is this life-threatening disease and what tools do we have to face it? Here’s what we know about the infection.

WHAT IS IT?

Meningococcal disease refers broadly to illnesses caused by a specific bacterium called Neisseria meningitidis, sometimes just referred to as the meningococcal bacterium.

These illnesses can include meningitis, an inflammation of the fluid around the brain and spinal cord. It can also result in septicemia, a serious form of sepsis in which the blood is infected.

Not all types of meningitis are caused by meningococcal disease, as it can be caused by several different types of bacterial infection, viral infections or even a fungal infection, in rare cases.

The presentation of invasive meningococcal disease can vary depending on if it progresses to meningitis or septicemia, but all forms of meningococcal disease are an emergency, and require immediate medical attention.

Around one in 10 people who contract meningococcal disease will die, and up to a fifth of survivors may have long-term disabilities, including brain damage, deafness or loss of limbs, according to the U.S. Centers for Disease Control (CDC).

Meningococcal disease is endemic in Canada, which means that outbreaks do occur from time to time, although they are rare, with the incidence rate varying across the country.

Between 2012 and 2019, the average incidence rate nationally was 1 case per 290,000 people. According to Health Canada, the most recent documented outbreak was in 2017 among five adolescents in B.C. 

HOW DOES IT SPREAD AND HOW INFECTIOUS IS IT?

Meningococcal disease is spread through close contact with the saliva of others through activities such as kissing, coughing or sneezing as well as sharing items that are inserted into the mouth such as toothbrushes, cigarettes, mouth guards, chapstick or lipstick or musical instruments performed using the mouth.

Around one in ten people are carriers of the meningococcal bacterium, meaning they unknowingly have it in their nose and throat without becoming ill themselves.

The meningococcal bacterium is far less transmissible than the virus than causes COVID-19 — you cannot contract meningococcal disease purely from breathing the same air as someone carrying the bacteria.

It also is more difficult to transmit than the common cold or flu, according to the CDC, and a person generally needs close and lengthy contact with a patient to contract it.

When a person contracts the disease, their family members, roommates and romantic partners are more at risk of also contracting it.

HOW DO YOU KNOW IF YOU HAVE IT?

A person who has contracted the disease will begin experiencing symptoms in two to 10 days after exposure, with most symptoms appearing within three to four days, according to Health Canada.

Common symptoms include a sudden fever, headache and a stiff neck for those with meningococcal meningitis, potentially accompanied by vomiting, light sensitivity and confusion.

For those with septicemia caused by meningococcal disease, symptoms can include fever and chills, vomiting, fatigue, cold hands and feet, muscle aches and diarrhea.

In later stages, meningococcal septicemia can be accompanied by a fast spreading skin rash that starts as purplish spots.

Because many of the early symptoms are so similar to other illnesses, the disease has to be diagnosed through laboratory testing, making it important to seek medical attention as soon as you suspect you may have the disease.

Without treatment, a patient could end up hallucinating, falling into a coma, or even dying.

HOW IS IT TREATED?

Those with invasive meningococcal disease are treated with antibiotics for three to seven days. Doctors will issue antibiotics as soon as a person says they suspect they have the disease, even before confirmation, in order to reduce the risk of the illness progressing to fatal.

If the disease was only caught in the later stages, a person might hospitalization for breathing support, care for skin damaged by a rash or surgery for dead tissue.

IS THERE A VACCINE?

There are several vaccines approved for use in Canada which target well-known serogroups of meningococcal disease. The Men-C vaccine protects against type C, the meningococcal quadrivalent vaccine protects against types A, C, Y and W-135, and the Men-B vaccine protects against type B.

According to the City of Toronto, all three individuals confirmed Thursday to have contracted meningococcal disease had the “same rare strain of serogroup C meningococcal disease.”

Infants in Canada are able to receive the Men-C vaccine as part of routine immunizations as two doses at 2 months and 12 months.

Either the Men-C or the quadrivalent vaccine is offered through school immunization programs in all of the provinces and territories in Canada, although the grade at which the vaccine is offered varies from grade 6-12 depending on the region.

In Ontario and New Brunswick, proof of vaccination against meningococcal disease is required for all school-attending children.

While many people in Canada will have received vaccination against meningococcal disease through these routine immunizations given to children, large immunization programs to vaccinate against meningococcal disease only became widespread in Canada the early 2000s, although there were several immunization campaigns that launched in the 90s in response to outbreaks in certain provinces.

This means many adults may have never received a vaccine.

The City of Toronto on Thursday urged residents to find out if they’ve received the meningococcal vaccine.

“Adults between 20 and 36 years old who have not received a meningococcal disease vaccine are strongly recommended to contact their health care provider to receive a meningococcal disease vaccine as soon as possible,” the statement reads. “TPH will monitor vaccine demand and is actively exploring additional vaccination channels.”