Is meningitis airborne?

Is Meningitis Airborne?

Meningitis transmission depends on the causative organism: meningococcal meningitis (Neisseria meningitidis) spreads via respiratory droplets over short distances (not truly airborne), while most other bacterial causes like Streptococcus pneumoniae also spread through droplets, not airborne transmission. 1, 2

Transmission Mechanisms by Pathogen Type

Meningococcal Meningitis (N. meningitidis)

• Droplet transmission is the primary route, requiring close contact with respiratory secretions rather than airborne spread over long distances 1
• The organism spreads through direct contact with respiratory secretions from infected individuals, typically within a few feet 1, 3
• Droplet precautions (not airborne precautions) are required, including surgical masks for close contacts and single-room placement 1, 2
• Respiratory isolation must be maintained until the patient receives 24 hours of effective antibiotic therapy (ceftriaxone) or a single dose of ciprofloxacin 2

Pneumococcal Meningitis (S. pneumoniae)

• Spreads through airborne droplets via coughing and sneezing, but these are large droplets that do not remain suspended over long distances 1
• Requires close contact for transmission, similar to meningococcal disease 1

Key Distinction: Droplet vs. Airborne

• Droplet precautions apply to meningitis pathogens because they do not remain infectious over long distances when suspended in air 1
• True airborne precautions (requiring special air handling and N95 respirators) are reserved for organisms like Mycobacterium tuberculosis, varicella virus, and rubeola virus that remain infectious over long distances 1
• Standard surgical masks are sufficient for meningitis; fit-tested N95 respirators are not required 1, 2

Clinical Implications for Healthcare Settings

Isolation Requirements

• Place suspected meningococcal cases in respiratory isolation immediately until the diagnosis is excluded or 24 hours of appropriate antibiotics are completed 2
• Single-room placement with at least 3 feet spatial separation is adequate; specialized airborne isolation rooms (AIRs) are not necessary 1
• Discontinue droplet precautions after 24 hours of effective antibiotic therapy based on significant reduction in nasopharyngeal carriage 2

Healthcare Worker Protection

• Healthcare workers have approximately 25 times greater risk than the general population but still lower risk than household contacts 2, 4
• Antibiotic prophylaxis is indicated only for those with close contact to respiratory secretions of confirmed meningococcal cases 2
• Prophylaxis options include ciprofloxacin 500 mg single oral dose, ceftriaxone 250 mg IM single dose, or rifampin 600 mg twice daily for 2 days 2, 4

Common Pitfalls to Avoid

• Do not confuse droplet transmission with airborne transmission: meningitis does not require airborne isolation rooms or N95 respirators that tuberculosis requires 1
• Do not delay prophylaxis: administer antibiotics to close contacts as soon as possible, even up to 6 days after exposure 4
• Do not use rifampin as first-line during outbreaks: it may lead to resistant strain emergence 2
• Aircraft travel poses transmission risk only for flights lasting at least 8 hours with close contact to infected individuals 3