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Tuesday, May 10, 2016

Meningitis Risks and Preventions

Meningitis is thankfully uncommon, but when it happens it can be deadly. Meningitis is an inflammation in the membranes around the brain and spinal cord (meninges). It is usually caused by a virus, but many bacteria and fungi can also infect the meninges. Symptoms include headache, fever, and stiff neck and may include other symptoms depending on the organism causing the infection.

I wanted to write about meningitis because with the newest vaccine against meningitis, I am concerned that parents don't recognize what exactly their children are protected against and what risks remain after vaccination. I will break down meningitis by type of organism causing the inflammation, and include any vaccines and treatments available for that type within that grouping.

Bacterial Meningitis

Bacterial meningitis is a medical emergency. Even with early treatment with antibiotics, it can be devastating. If a person survives, many of the bacteria can cause permanent brain damage, hearing loss, learning disabilities, and loss of limbs. Anne Geddes, a photographer famous for her pictures of infants and children, has worked with Novartis Vaccines and the Confederation of Meningitis Organizations (CoMo) to create Protecting Our Tomorrows: Portraits of Meningococcal Disease, a book that is available for a free download on iTunes that shows people who have survived meningitis.

Photo by Mikael Häggström


The type of bacteria causing meningitis varies by age group. Fortunately the bacteria that cause meningitis are not as contagious as things we more commonly see, such as the common cold, but whenever there's a case of bacterial meningitis the health department will identify risks and help treat contacts at risk. The bacteria don't always lead to meningitis, but may be found in healthy people or cause other types of infections as well, such as ear infections, pneumonia, and urinary tract infections. 
  • Newborns tend to be infected with bacteria that can be a part of the mother's urogenital tract. Group B Streptoccous (GBS), Escherichia coli, and Listeria monocytogenes are most common. Pregnant women are screened for GBS and treated with antibiotics prior to delivery if possible. Pregnant women should handle foods properly and avoid certain foods to protect against Listeria.
  • Infants and children are most at risk from Streptococcus pneumoniae (pneumococcus), Neisseria meningitidis (meningococcal), Haemophilus influenzae type b (Hib). Thankfully starting at two months of age infants can get vaccines against Hib since 1985. A vaccine against 7 strains of pneumococcus became available in the year 2000, and it was improved to protect against 13 strains of pneumococcus since 2010. There are over 90 known strains of pneumococcus, but the vaccine covers the majority of strains that cause severe illnesses. Vaccination against N. meningitidis is not routinely given to infants at this time.
  • Teens and young adults are at risk from Neisseria meningitidis and Streptococcus pneumoniae. Younger teens who are up to date on vaccines have been vaccinated against S pneumoniae, but since the vaccine was introduced in 2000, older teens might have missed this vaccine and it is not recommended to do catch up unless they are in a high risk group, such as if they are immune compromised or missing a spleen. 
  • Meningococcal conjugate vaccine (Menactra®- which covers A, C, W, Y subtypes, Menveo®- which covers A, C, W, Y subtypes and MenHibrix®- which covers C, Y, and Hib) is recommended as part of the routine vaccine schedule at 11-12 years of age with a booster at 16 years. It is also recommended at younger ages for high risk people (immune compromise, spleen issues, and certain travel).
  • Serogroup B meningococcal vaccine (Bexsero® and Trumenba®- both cover subtypeB). This is only recommended with a permissive use status, meaning it is not highly recommended for any age group, but it is allowed to be given to anyone over 16 years of age and is encouraged for high risk people, sometimes down to 10 years of age, depending on the risk. High risk people are those with known immune problems, specific chronic diseases, or who have no working spleen. High risk might include when there is a known outbreak, so if your college student hears of meningitis on campus don't let them think they don't need it due to vaccination with one of the vaccines that covers A, C, W, and Y. Some colleges require vaccination against meningitis B in addition to A, C, W and Y. 

Viral Meningitis

Viral meningitis is much more common but less deadly than bacterial meningitis. There are many types of viruses that cause meningitis, and usually there is no specific treatment for viral meningitis, just like other viral illnesses. Most people who get viral meningitis completely recover on their own within 7 to 10 days. People with meningitis caused by certain viruses such as herpesvirus and influenza may benefit from treatment with an antiviral medication. If there are symptoms of meningitis, it is important to quickly get the proper testing done to determine if treatment is needed or not. Prevention with standard hand washing and other measures to prevent the spread of viruses is important. Some vaccinations can protect against diseases that can cause meningitis, such as measles, mumps, chickenpox, and influenza. Since mosquitoes, other insects, and rodents can spread disease, avoiding bites can help prevent infection.

Fungal Meningitis 

Fungal meningitis is very rare and does not spread from person to person. It occurs when a person with a weak immune system is infected with a fungus that spreads to the brain or spinal cord.