Meningitis is an inflammatory disease of the leptomeninges, the tissues surrounding the brain and spinal cord, and is defined by an abnormal number of white cells in the cerebrospinal fluid (CSF). The meninges consist of three parts: the pia, arachnoid, and dura maters. Bacterial meningitis reflects infection of the arachnoid mater and the CSF in both the subarachnoid space and the cerebral ventricles. Approximately 1.2 million cases of bacterial meningitis occur annually worldwide. Meningitis is among the 10 most common infectious causes of death and is responsible for approximately 135,000 deaths throughout the world each year. Neurologic sequelae are common among survivors.

Bacterial meningitis can be community acquired or healthcare associated. Patients with bacterial meningitis are usually quite ill and often present soon after symptom onset.

The classic triad of acute bacterial meningitis consists of fever, nuchal rigidity, and a change in mental status, although an appreciable number of patients do not have all three features. Most patients have high fevers, often greater than 38 C, but a small percentage have hypothermia. Almost no patients have a normal temperature. Headache is also common. The headache is typically described as severe and generalized. It is not easily confused with a normal headache. Neurologic complications such as seizures, cranial nerve palsies, and papilledema may be present early or occur later in the course. Certain bacteria, particularly N. meningitides, can cause characteristic skin manifestations, such as petechaiae and palpable purpura. Arthritis also occurs in some patients with bacterial meningitis.

Students entering grade 7 will be required to receive one dose of meningococcal conjugate vaccine (MenACWY: sometimes abbreviated as MCV4; brand names Menactra or Menveo). The only exceptions to this requirement will be for students who have documented medical or religious exemptions to MenACWY vaccine.

In addition, students entering grade 12 will be required to receive two doses of MenACWY vaccine, with the second dose received on or after the student’s 16th birthday. However, if the first dose was received at age 16 years or older, then only one dose will be required, in accordance with Advisory Committee in Immunization Practices (ACIP) recommendations. Students entering grade 12 this fall who have not yet received a dose of MenACWY vaccine on or after their 16th birthday will be required to receive an additional dose of MenACWY vaccine, unless they have a medical or religious exemption to MenACWY vaccine or have a medical condition that puts them at high risk of meningococcal disease which necessitates use of the high risk meningococcal vaccine schedule. Doses of vaccine against meningococcal serogroup B (MenB vaccine; brand names Bexsero or Trumenba) will not satisfy the grade 1