Officials with the North Dakota Department of Health over the weekend announced three cases of the rare but serious meningococcal meningitis.

The three cases — two of which have been confirmed by laboratory testing — are the first in the state since 2014, according to a news release from the health department.

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It’s not clear where the cases occurred, but “People in close contact with the individuals who tested positive have already been notified and placed on antibiotics to prevent them from getting the disease,” said Jenny Galbraith, immunization surveillance coordinator with the state health department, in a statement.

“Meningococcal meningitis is a form of meningitis caused by a specific bacterium known as Neisseria meningitidis," .per the National Organization for Rare Disorders. Meningitis is characterized by inflammation of the membranes (meninges) around the brain or spinal cord,”

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The disease is spread through sharing salvia, typically through coughing or kissing. Symptoms often include a severe headache, stiff neck and/or rash.

Meningococcal disease is primarily caused by five types of meningococcal bacteria — A, C, W, Y and B. The Centers for Disease Control and Prevention (CDC) recommends children between ages 11 and 12 receive a meningococcal conjugate vaccine and receive a booster at 16 to prevent against serogroups A, C, W and Y. In addition, those age 16 to 23 can also receive a serogroup B meningococcal vaccine, the agency added.