Young people aged 15–24 are among the most at risk of meningococcal disease, and first-year university students are particularly vulnerable to the often deadly infection.

This is because close living conditions in residence, social habits that bring students into frequent contact with others and exposure to new strains of the bacteria from across the country all make it easier for the infection to spread. This can lead to occasional cases and small outbreaks, particularly in shared accommodation.

The findings come from a recent article in the Public Health Bulletin of South Africa, Protect our future leaders: Advocating for meningococcal vaccination to prevent meningococcal disease among tertiary students in South Africa, led by Dr Susan Meiring of the National Institute for Communicable Diseases (NICD).

South Africa is among the 15 African countries with a high burden of meningitis, although it does not experience the large epidemics seen in the African meningitis belt. As in other middle- and high-income countries, the number of meningococcal disease cases has been rising steadily since 2022, following a dip during the Covid-19 pandemic years.

The devastation of the disease was starkly illustrated when Chris Scheffers, a second-year theology student at Stellenbosch University, died suddenly from meningococcal meningitis in August.

Rare but devastating disease

Meiring describes meningococcal disease as rare but devastating, capable of causing rapid death or severe long-term complications in otherwise healthy young adults.

Meningococcal disease is a serious infection caused by the meningococcus bacteria. It can lead to meningitis – swelling and inflammation of the membranes around the brain and spinal cord, or septicaemia (blood poisoning), or both. Meningitis itself can also be caused by other germs, including viruses, fungi and different types of bacteria.

Despite the risk, meningococcal vaccination is not included in South Africa’s national immunisation programme and remains out of reach for most students. Introducing vaccination for high-risk groups, such as tertiary students, could help protect them and strengthen broader vaccine access, Meiring notes.

Despite the availability of vaccines in the private sector, uptake remains alarmingly low – with less than 1% of South Africans vaccinated.

Meiring, who has tracked the disease in South Africa for many years through the GERMS-SA surveillance programme, says each case underlines the devastation the disease brings to families and communities.

Prevention strategy proposed

The authors say preventing meningococcal disease is a public health imperative and a moral responsibility.

They say vaccination is the only reliable means of primary prevention, and global experience has demonstrated its effectiveness in reducing both carriage (when the bacteria live harmlessly in the nose/throat) and active disease.

The policy brief makes three recommendations:

• On-campus education campaigns to improve awareness and promote meningococcal vaccine uptake.
• Vaccinating all first-year tertiary students during the first month of registration.
• Vaccinating only first-year students staying in institutional residences within the first month following registration.

How is meningitis spread?

According to the NICD, most bacterial and viral causes of meningitis are spread from person to person through close contact with respiratory secretions or saliva (such as coughing, sneezing and intimate kissing).

Sharing eating utensils, glasses, food or sleeping together in the same room or hostel can also spread these bacteria and viruses.

Enteroviral meningitis is spread through the faecal-oral route – for example, if people don’t wash their hands properly after using the toilet, or if food, water or surfaces become contaminated.

Signs and symptoms of meningitis

Meningitis often starts like the flu, but symptoms can worsen rapidly, leading to severe illness or even death.

The NICD says if you or someone you know develops these symptoms, seek medical help immediately:

• A high fever
• A very bad headache
• Stiff neck
• Dislike of bright lights
• Stomach upset, including vomiting, diarrhoea or pain
• Painful joints
• A purple-red skin rash that does not disappear when pressed (this is a medical emergency)
• Cold hands and feet
• Seizures
• Drowsiness that can turn into a coma

Long-term effects

While a full recovery is possible, the NICD says around one in five people have long-term effects, which could include:

• Chronic fatigue
• Concentration problems
• Recurring headaches
• Varying degrees of deafness or blindness
• Seizures

Early treatment is vital to minimise the disease’s severity and possible long-term effects. If you suspect meningitis, do not wait for all these symptoms to appear.

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