Why Kids Should Be Vaccinated Against Bacterial Meningitis
Dr. Pia Fenimore
Dr. Joan Thode
In early January, the U.S. Department of Health and Human Services removed the recommendation for universal vaccination against bacterial meningitis. The federal agency instead has moved this vaccine to the “shared decision-making” category, leaving parents to question if their child should receive this vaccine.
For pediatricians, it is an easy answer: Based on the devastation and loss that bacterial meningitis causes, vaccinating your child is the best thing you can do for them.
The neurons, or nerve cells, of our brain and spinal cord are understandably some of the most complex cells of our body, communicating with each other through a complex language of specific chemicals called neurotransmitters. The neurons connect in elaborate and specific groupings, passing information one to another to achieve millions of various functions that allow our bodies to think, adapt, move, feel and remember.
While there are millions of neurons in the brain, there are also additional neurons in the spine that allow the brain to communicate reciprocally with the rest of the body. Suffice it to say that these cells are delicate, specialized and very hard to repair once damaged. It therefore makes sense that the body protects these neurons from damage with hard bone (skull and spine), as well as a fluid cushion called cerebrospinal fluid between the bone and neurons.
While this closed system works well to allow humans to run, jump and ride roller coasters without causing stress to our neurons, it also offers protection from substances in the bloodstream.
The blood vessels that line this system to bring nutrients to, and waste away from, the brain have a unique wall design that is very selective and specific with what can cross into the delicate balance that’s maintained around our neurons. This is called the “blood-brain barrier.”
In bacterial meningitis, however, the delicate balance of fluid and pressure is disrupted, causing acute stress to the neurons. While the central neurons of the brain and spine are ultimately what get damaged when meningitis becomes severe, it’s the cells of the system’s lining (the “meninges”) just inside the bones that experience the inflammation (the “itis”). Meningitis is the inflammation of the meninges, typically from infection of the cerebrospinal fluid through the bloodstream.
Bacterial meningitis
The most common bacterial causes of acute meningitis in kids and teens are Neisseria meningitidis bacteria and streptococcus pneumoniae bacteria.
Once in the cerebrospinal fluid, the bacteria multiply, creating two major initial issues: a need for a massive immune response to combat the bacteria, and a decrease in the sugar that neurons require to function. The white blood cells that patrol the cerebrospinal fluid will detect the bacteria and signal for additional fighter cell backup, resulting in a massive influx of fighter cells from the bloodstream into the cerebrospinal fluid. This helps to fight the infection but increases the pressure within that fixed space.
The damage then cascades from there as the body’s support systems for our neurons become disrupted, leading to neuron damage and death. And neurons are irreplaceable. They are not actively dividing cells, so unlike skin or other cells, they will not be replaced or self-repaired once damaged. Damaged neurons not only function more poorly, but can also malfunction, creating secondary problems such as seizures, blindness, hearing loss and cognitive impairments. As many as 50% of bacterial meningitis survivors will live on with some form of neurological deficit, and emerging research strongly suggests a connection between meningitis and a later high risk for various forms of dementia.
Neisseria meningitidis makes an outer coating that disguises it from the immune system; it rapidly reproduces; and it makes toxins that relax the blood-brain barrier, allowing proteins and chemicals from the bloodstream to leak into the brain without the typical regulation. This increases stress and damage to the neurons, worsens the inflammatory cycle, disrupts the delicate brain cellular ecosystem and contributes to the danger of this illness.
Why vaccinate against meningitis?
One reason cited for the change in recommendations for the meningococcal vaccine by federal health officials is the relatively rare occurrence of bacterial meningitis.
However, as pediatricians and parents, we are tasked to evaluate not just risk but outcome when it comes to making decisions for our children.
Electrocution from an outlet is rare, but we put outlet protectors in our homes. Abduction is rare, but we don’t let our children out of sight in crowded places. Spina bifida is rare, but we take prenatal vitamins to prevent it. We take these actions because while the occurrences are rare, the potential outcomes are devastating.
Bacterial meningitis causes overwhelming infection quickly, with a 50% to 70% death rate if untreated and a 10% to 15% death rate even if treatment is initiated. This is a risk we should not take with our children’s lives.
When should kids be vaccinated?
The American Academy of Pediatrics recommends that all children receive the meningitis vaccine between the ages of 11 to 12 years and then a booster dose at age 16 years.
Pennsylvania requires children to get the first dose of the meningococcal conjugate vaccine by the first day of seventh grade and the second dose by the first day of 12th grade.
The vaccine is licensed down to age 2 months and may be recommended for younger children if they will be traveling to areas, such as sub-Saharan Africa, where meningococcal disease is more common.
We vaccinate kids when they’re in middle school and high school because adolescents and young adults are at a higher risk for contracting meningitis due to their habits and lifestyles. During this period of life, they are more likely to experience crowded situations such as dorms, camp cabins or barracks. They also tend to engage in more close contact than other age groups as they form social peer groups, participate in clubs and sports, and romantically share food and drinks, kisses and closeness.
Explaining the vaccine
The meningitis vaccine is an inactivated conjugate vaccine, which means that a noninfectious part of the outer coat of the bacteria is bound to a protein that carries this unique molecule through the bloodstream.
The white blood cells of the body immediately respond to this new substance, and produce an antibody response, meaning that our white blood cell army becomes familiar with the Neisseria-specific molecules and will remain primed to attack a similar molecule in the future. The immediacy of this attack from primed white blood cells makes all the difference between life and death from overwhelming infection.
This type of vaccine is a scientific marvel because it produces a very specific immune response to only the bacteria that is presented to the cell and induces a response that is strong enough for the disease-fighting cells to retain the ability to recognize the disease for years beyond the vaccination.
Why do kids need booster shots?
The booster vaccine is recommended at age 16 because the effectiveness of the first shot can wane after about five years. Since the risky time for meningitis is middle school through college, this ensures that kids retain antibodies to keep them safe during their high-risk time.
Potential side effects?
The most common side effects are pain at the injection site, fever and muscle aches. These are typically very mild and do not last more than 24 to 48 hours. The teenage population has a higher incidence of fainting with vaccines, so that is also part of the warning for this shot, though this is more specific to the age group and not the vaccine. If your child is prone to fainting or dizziness, it is recommended they be given the vaccine lying down and then observed for 15 minutes afterward.
The vaccine first became widely available in 2005. Despite claims to the contrary, research has proven that there is no link between the meningococcal vaccine and Guillain-Barré syndrome.
Does the vaccine work?
The two-dose series of meningitis vaccine has been shown to be 80% to 90% effective in preventing disease. According to the Centers for Disease Control and Prevention, there has been a significant decline in cases since widespread vaccination became available. And a recent increase in cases in 2024 mostly affected adults ages 30 to 60 years; this has triggered research into the need for vaccination in other potentially vulnerable populations.
A teen’s heartbreaking death
As pediatricians, we both have witnessed the devastation caused by bacterial meningitis in patients, and one experience in particular shaped Dr. Fenimore’s career.
While managing a child on a ventilator suffering from meningitis, she met her family and learned about the life of this previously healthy, vibrant teenager. The day prior to her admission into the hospital, she had taken a photo with her siblings at the mall with the Easter Bunny. Forty-eight hours later, she was dead from meningitis.
The poignant photo was a reminder of how quickly this bacterium can overcome the immune system, despite intensive care. This devastating loss occurred three years before universal vaccination started, and since then, Dr. Fenimore thankfully has not personally seen another case.
Memories of children like this are what stoke the flame within us as medical providers to prevent that tragic outcome for others. Meningitis vaccination is the best defense against the aggressive and often deadly Neisseria meningitidis bacteria and therefore is universally recommended for children, teens and young adults.
Pia Fenimore, M.D., is a pediatrician at Lancaster Pediatric Associates and vice chair of pediatrics at Penn Medicine Lancaster General Health. Dr. Joan Thode, M.D., is a pediatrician at Penn Medicine Lancaster General Health Roseville Pediatrics. Both are fellows of the American Academy of Pediatrics.
