A 3-year-old boy arrived at the emergency department of Dana Children’s Hospital at Ichilov on Saturday morning in septic shock, with a clinical suspicion of meningococcemia.
It should be noted that this was not meningitis.
Despite the staff’s efforts and resuscitation attempts, the medical team was forced to pronounce him dead.
In a separate incident, a 2-year-old child from Beersheba is suspected to have also died from meningococcemia at Soroka Hospital.
Meningococcus is a relatively rare but especially aggressive disease. In most cases, fever in children is caused by mild viral illnesses, but meningococcus can quickly lead to severe bloodstream infection, organ failure, and death. Alongside the need for early detection, pediatricians note that there is a vaccine against meningococcal B, intended to reduce the risk of serious disease from that strain.
What is meningococcemia?
Meningococcus, whose medical name is Neisseria meningitidis, is a bacterium that can cause a severe invasive disease. The two main forms are meningitis and severe bloodstream infection known as meningococcemia.
In meningococcemia, the bacterium enters the bloodstream, rapidly multiplies, and triggers an intense inflammatory response, a drop in blood pressure, coagulation disorders, and damage to vital organs. In some cases, a blood-colored rash also appears, red, purple, or bluish. The disease can develop very quickly, so any suspicion requires urgent treatment.
The bacterium spreads from person to person via respiratory and throat secretions, primarily through close, prolonged contact. Infection can occur through coughing, sneezing, kissing, prolonged exposure to crowded spaces, or exposure to saliva and other bodily fluids. In some people, the bacterium is present in the throat without causing any illness. This is called carriage. Carriers feel well, but in some cases the bacterium can pass to another person and, in rare cases, enter the bloodstream or the meninges and cause a life-threatening disease.
The disease can affect anyone, including completely healthy children. However, the risk is especially high in infants, toddlers, adolescents, and young adults living in crowded conditions.
Other risk groups include people without a spleen or with impaired spleen function, patients with a weakened immune system, people with complement deficiency, patients taking certain drugs that suppress the complement system, soldiers, boarding school and dormitory residents, and travelers to areas where the disease is more common.
What are the symptoms of meningococcemia?
The first signs may resemble a regular febrile illness: high fever, weakness, drowsiness, restlessness, vomiting, muscle aches, chills, cold hands and feet, or rapid breathing.
In infants and toddlers, the signs may be less clear: refusal to eat, unusual crying, apathy, lack of response, grayish skin, or a rapid deterioration in general condition. A significant warning sign is a pinpoint rash or small blood spots on the skin that do not disappear when pressed. However, even without a rash, the disease can be severe. Meningitis can present with severe headache, neck stiffness, sensitivity to light, confusion, and vomiting.
Diagnosis begins with clinical suspicion. A doctor who sees a child in poor general condition, with fever, signs of shock, a bloody rash, or suspected meningitis, does not always wait for laboratory results before starting treatment. In the hospital, blood tests, blood cultures, and sometimes a lumbar puncture to examine spinal fluid are performed, depending on the child’s condition and stability. In many cases, antibiotic treatment begins immediately, even before final laboratory confirmation.
Treatment is urgent and is carried out in the hospital. It includes intravenous antibiotics as quickly as possible, fluids, medications to support blood pressure, intensive care monitoring, and sometimes ventilation. At the same time, doctors treat coagulation disorders, kidney damage, low blood pressure, and other complications. The earlier treatment begins, the greater the chance of saving lives and reducing complications, but even rapid treatment does not always stop the course of the disease.
After a diagnosis or strong suspicion of the disease, the health bureau identifies the patient's close contacts.
In appropriate cases, they receive preventive antibiotic treatment, usually household members, children who were in close contact, and staff members exposed to respiratory secretions. Broader prevention includes vaccination, avoiding sharing bottles, pacifiers, and utensils, and maintaining basic hygiene. However, since the bacterium can also spread from healthy carriers, vaccination is a key tool in reducing the risk of severe disease.
Is there a vaccine against meningococcal bacteria?
Bexsero is a vaccine against meningococcal B, one of the bacterium’s important strains in young children. The vaccine does not protect against all meningococcal serogroups, but it is intended to reduce the risk of invasive disease caused by type B. In Israel, the vaccine is recommended for infants and toddlers by pediatric associations, and many pediatricians advise parents to consider it as part of protection against a rare but deadly disease.
The vaccine can be given starting at 2 months of age. According to the Health Ministry information sheets, an infant who begins vaccination at 2 months receives one dose at 2 months, another at 4 months, and a booster dose around age 1. Anyone who starts the vaccine series at an older age will receive a different number of doses depending on age and medical guidance. Parents should therefore consult their pediatrician about the number of doses and the intervals between them.
In Israel, parents need to see the pediatrician to obtain a prescription for the vaccine, with instructions for the nurse to administer it. The vaccine is then purchased at a health fund pharmacy or another pharmacy, depending on the health fund’s arrangements and supplemental insurance.
After purchase, the vaccine is brought to the clinic nurse, who gives it to the child according to the instructions. It is important to keep the vaccine refrigerated and to come for vaccination as soon as possible after purchase, according to the pharmacy’s and clinic’s instructions.
The vaccine against meningococcal B has not yet been included in the health basket, after being postponed in recent years, and therefore is not given as part of routine vaccinations. It is purchased separately and administered by a clinic nurse at the health fund. In some health funds, there is subsidization through supplemental insurance, depending on the child’s age and the insurance plan.
The vaccine is considered very safe and is used in many countries. The most common side effects are usually mild and pass within a day or two: fever, pain or redness at the injection site, restlessness, drowsiness, reduced appetite, or crying. In young infants, fever is more common, so sometimes doctors recommend separating it from some routine vaccines or using fever-reducing medicine under a doctor’s guidance. In Israel, it is recommended by pediatric associations, and globally, vaccination programs and recommendations vary by country according to local policy.
In any case of fever with unusual drowsiness, apathy, shortness of breath, grayish skin, repeated vomiting, a bloody rash that does not disappear when pressed, confusion, neck stiffness, or rapid deterioration in the child’s condition, medical help should be sought immediately in an emergency room, or emergency services should be called.
In cases of meningococcal disease, time is critical, and waiting at home can be dangerous.
It is important to note that there is a vaccine against meningococcus B, which is recommended by the Pediatric Association, and the association is calling on the public to vaccinate infants and toddlers and save lives.