Meningitis describes an infection of the meninges. The meninges are the protective membranes surrounding the brain and spinal cord. The infection can be viral or bacterial.
Viral infections, whilst very scary, are usually not life threatening. Hospital tests are often required to differentiate between bacterial and viral menigitis and it’s extremely important to seek medical attention if meningitis is suspected as urgent antibiotic treatment is needed for the bacterial form of the disease. Examples of viruses which can cause meningitis are enteroviruses and the herpes simplex virus.
There are many different types of bacteria which cause meningitis but the main ones are Neisseria meningitidis (meningococcal) bacteria and pneumococcal bacteria. Pneumococcal bacteria are more easily spread but less likely to cause severe infections. Meningococcal bacteria are usually only spread through prolonged close contact and consist of several groups including A,B,C,W, X, Y and Z. They are a human only pathogen and are carried in the nasopharynx (upper throat and behind the nose).
I must be clear that bacterial meningitis is not very common but can be extremely serious, even fatal, when experienced so prompt action is always recommended. Approximately 10% of the population are thought to carry the bacteria responsible but becuase many adults have developed natural resistance it is not common to actually suffer from invasive infection. This means that many people may be carrying the infection without realising it as they have no symptoms. The highest incidence of invasive infection is in infants followed by the under 5’s. In Ireland the majority of infections occur in winter and early spring. In Ireland, the case-fatality rate is less than 5%.
Possible ways the bacteria are spread include:
- sharing utensils, such as cutlery
- sharing personal possessions, such as a toothbrush or cigarette
In most cases a meningitis infection occurs when the infection spreads through the blood from one part of the body, such as the throat or lungs, through the blood brain barrier to the meninges. The blood brain barrier is a thick membrane which normally protects our brains membrane from infection. The infection causes an immune response which causes the meninge to swell. Infection can also occur in the cerebrospinal fluid, which is the fluid surrounding the spine, and also cause inflammation. This swelling can then lead to damage of the brain and nervous system.
The symptoms of meningitis
Meningitis is often accompanied with septicaemia. Septicaemia is when bacteria release toxins into the blood which break down the walls of the blood vessels allowing blood to leak out under the skin. This can cause the characteristic rash which is associated with meningitis but it is important to remember that this rash does not have to be present!
The best summary of the symptoms that I have seen comes from www.actformeningitis.ie This awareness card also includes information on how to perform the ‘tumbler test’.
Vaccinating against meningitis
Meningococcal Group C Bacteria
MenC vaccine is included in the national childhood schedule – your child will receive this vaccine at four months and thirteen months of age. They will also receive it in the first year of their second level school. The introduction of this vaccine has reduced the number of confirmed cases of this group of bacteria from 130 in the year 2000 to only 6 in the year of 2014. Brands of this vaccine include Menjugate, Meningitec, and NeisVac C.
Meningococcal Group B bacteria
This is not included in the current national childhood schedule. It is currently only given under the health service to “cases and all previously unimmunised close contacts of a case of any age and to control outbreaks of meningococcal disease as agreed by the Department of Public Health and the Health Protection Surveillance Centre.” (HSE National Immunisation Office 20/10/2015). However the MenB vaccine will be included in the ‘new’ immunisation programme which will be offered to all babies who are born on or after the 1st October 2016.
Group B meningococcal bacteria accounts for almost 80% of all cases of meningitis in Ireland according to the Health Protective Surveillance Centre. In 2014, out of a total of 82 notifications of all meningococcal disease notifications, 64 (78%) cases were caused by serogroup B.
Bexsero is suitable from two months of age and involves two doses two months apart in the primary series and a booster as described in the product SPC (http://www.medicines.ie/medicine/15903/SPC/Bexsero+Meningococcal+Group+B+vaccine+suspension+for+injection+in+pre-filled+syringe/)
You can sign a petition with the charity ACT for meningitis to try to get this vaccine included in the childhood vaccination schedule here : http://www.actformeningitis.ie/campaigns/meningitis-b-petition/
Meningococcal Group A,C,W and Y bacteria
There’s also a quadruple vaccine that provides protection against group A, C, W and Y meningococcal bacteria. This is not routinely offered in Ireland as cases from groups A, W and Y are rare in Ireland. Brands include Menveo and Nimenrix
Treatment of meningitis
You should always see a doctor if you suspect your child has meningitis. Seek medical attention immediately. Your baby may need tests to find out if it is bacterial or viral meningitis and their treatment choices will result from the diagnosis.
As www.actformeningitis.ie say – Trust your insticts and ACT now!
I hope you have found this article helpful and if you have any questions at all please don’t hesitate to contact me by sending a private message to the WonderBaba facebook page (www.facebook.com/wonderbabacare) or by calling me (Sheena) at Milltown totalhealth Pharmacy in Dublin 6 on 012600262. I’m always happy to help!