Deaths from a rare and dangerous bacterial infection could rise if fewer teenagers are vaccinated, doctors warn.
After the Centers for Disease Control and Prevention recommended that all adolescents get vaccinated against meningococcal disease in 2005, cases of the potentially deadly disease have plummeted in the United States by 90%.
However, cases have increased sharply since 2021, likely due to a combination of mutating bacteria and an overall decline in vaccination rates, particularly among adolescents receiving a booster dose for bacterial meningitis, doctors suggest.
Dr. Luis Ostrosky, an infectious disease specialist at UT Health in Houston, worries that as cases of bacterial meningitis increase in the United States, the Recent CDC revision of the childhood immunization schedule could lead to more deaths.
Under the leadership of Secretary of Health Robert F. Kennedy Jr., the CDC is no longer recommends a meningitis vaccine for all teenagers. The vaccine and booster protect against the most common types of infection in the United States, serogroups A, C, Y and W.
“We see many cases of meningitis every year,” Ostrosky said.
Under the new guidelines, vaccines will be recommended for “high-risk groups,” although parents can still ask doctors to vaccinate their children through a process called “shared clinical decision-making.”
Adolescents and college-aged adultswho often spend a lot of time in groups or common living spaces such as dormitories, and HIV-positive people are considered most at risk of infection, caused by a group of bacteria called Neisseria meningitidis.
Vaccination is important not because the disease is common — about 3,000 people are diagnosed with bacterial meningitis in the United States each year — but because the infection is both extremely dangerous and rapidly progressing.
Bacterial meningitis can progress rapidly, causing swelling of the brain and gangrene and sepsis in the limbs, and can kill within 24 hours.
Symptoms such as headache, neck stiffness, vomiting and fever appear suddenly and may be confused with other minor illnesses. It can be treated with antibiotics, but even with rapid diagnosis, about 15% of patients die.
“This is a truly devastating disease that keeps pediatricians up at night,” said Dr. Kevin Messacar, professor of pediatric infectious diseases at the University of Colorado Anschutz in Aurora, Colorado. “It’s difficult to recognize, and we often see patients that it’s too late to bring back.”
Rapid action and potentially fatalWe don’t really understand why some people are sensitive to it. Infection develops when usually harmless bacteria travel through the airways and infiltrate the membranes surrounding the brain and spinal cord, causing severe inflammation. These bacteria, which usually live in the back of the throat, can spread from person to person through close contact.
This can lead to a life-threatening infection in a person whose immune system is weakened – sometimes by a simple cold or flu virus – or who is not immune to these bacteria. Viruses and fungi can also cause meningitis, but bacterial meningitis is the most serious.
Of those patients who survive, up to 20% suffer lifelong disability or complications, including limb amputation, hearing loss, and neurological problems.
“You can die from brain herniation or sepsis,” Messacar said. “And if you survive a brain herniation, you will most likely have serious complications.”
In 2024, the The CDC has issued an alert on an increase in cases of a type of invasive meningococcal disease. More than 500 cases were reported, the highest number since 2013. Most infections were caused by a specific serogroup Y strain of the bacteria, included in the previously recommended vaccine. Cases were more common among adults aged 30 to 60, black people and people with HIV.
“It’s even more important now that we get the meningococcal vaccines out to people given that we’re seeing an increase in this Y strain,” Messacar said.
The Food and Drug Administration has approved three types of meningitis vaccines. In 2005, the The CDC has begun recommending that 11- and 12-year-olds be vaccinated against the most common meningococcal serotypes, A, C, Y and W. Due to waning immunity, the CDC added a booster recommendation for 16-year-olds in 2011 to protect them into adulthood. A meningitis B vaccine and combination injection are available for children or babies considered at high risk.
In a statement Monday, Kennedy said the CDC’s new childhood immunization schedule “aligns the United States’ childhood immunization schedule with international consensus.”
Dr. Peter Chin-Hong, an infectious disease physician at the UCSF School of Medicine in San Francisco, said the new approach to meningitis vaccination in the United States, which is based in Denmarkis imperfect.
“You can’t just look at another country’s vaccine approach and photocopy it. You really have to look at what’s happening in your own country,” Chin-Hong said. Given the safety of meningitis vaccines, “it makes sense to vaccinate.”
Alicia Stillman, who is part of a World Health Organization task force charged with eliminating meningitis, worries that by moving the vaccine through the shared decision-making process, the CDC could create obstacles for parents who want to protect their children.
Stillman’s daughter, Emily, died of meningitis B in 2013. Emily had been vaccinated against meningitis A, C, W, and Y, but the FDA did not approve a meningitis B vaccine until 2014.
Emily Stillman, seen here with her mother Alicia, was 19 when she died of meningitis B. Courtesy of Alicia StillmanBecause many types of bacteria can cause bacterial meningitis, different vaccines are needed. The meningitis B vaccine has not been recommended for all children, but it is available to those at high risk through the shared decision-making process.
“I have seen health professionals not provide [meningitis B vaccination] “I’ve observed parents who are maybe a little less educated and don’t know how to ask questions about it, or who go to a public clinic instead of a private clinic where they have less time with a provider.”
She thinks this could happen more widely with the new guidance.
What the research saysA CDC statement said the changes to the recommendation reflect the need for more data on certain vaccines, “including randomized, placebo-controlled trials and long-term observational studies to better characterize the benefits, risks, and outcomes of vaccines.”
Although there have been no placebo-controlled trials of meningitis vaccines – which would test the effectiveness of a vaccine either by deliberately infecting people with bacteria or by checking how they behave if infected in the real world – many randomized trials have been conducted. clinical trials and other studies that use decades of data collected from vaccinated and unvaccinated individuals in the real world.
Chin-Hong said placebo-controlled trials are neither realistic nor ethical for all drugs, especially for rare and life-threatening diseases.
“A well-designed observational study, particularly drawing on decades of experience, can be just as informative as a randomized controlled trial,” Chin-Hong said.
A CDC Report 2020 analyzed 20 clinical trials of meningococcal vaccines, including data from the Vaccine Adverse Event Reporting System (VAERS) and the Vaccine Safety Datalink (VS). The most commonly reported side effects were “mild to moderate” and included swelling, fever and headache.
According to the CDC, the meningococcal vaccines are safe.
“It’s pure hell.”In 2005, Katie Thompson, now 39, was infected with an antibiotic-resistant strain of bacterial meningitis while she was a college freshman, the same month the FDA approved the first MenACWY vaccine.
“I don’t know how to describe it other than it’s pure hell,” she said.
After five weeks in the hospital and almost dying, she returned home, but not without complications that will stay with her for life. Thompson, who lives outside of Charleston, South Carolina, still suffers from migraines and vestibular disorders that cause dizziness and nausea. The infection has been hard on her organs and she uses a bladder stimulator that helps regulate both her bladder and the nerves at the base of her spine.
“It’s just not a disease you want to take a chance on,” she said. “You don’t want to play with your child’s life.”
Two remaining vaccines universally recommended by the CDC – the Haemophilus influenzae type b, or Hib, vaccine and the pneumococcus vaccine – protect against certain causes of bacterial meningitis. However, these vaccines do not protect against meningitis A, C, W, Y or B.
Kaitlin Sullivan
Kaitlin Sullivan is an NBCNews.com contributor who has worked with NBC News Investigations. She reports on health, science and the environment and is a graduate of the Craig Newmark Graduate School of Journalism at the City University of New York.
