| Meningitis: Making Sense of a Mysterious Illness
How to recognize and prevent this dangerous disease By Rachel Rabkin Peachman Meningitis can be caused by a variety of bacteria, viruses, fungi and even medications -- which can make the disease seem complicated and confusing. But it doesn’t have to be a mystery. Read on to learn about the disease and how to protect your family. What Is Meningitis? The term meningitis refers to an inflammation of the meninges, the membranes that cover the brain and spinal cord. It can be caused by bacteria, such as Neisseria meningitidis (also known as meningococcus), Streptococcus pneumoniae (pneumococcus), Haemophilus influenzae type b (Hib) or group B Streptococcus (GBS or group B strep). Viruses, such as measles, enteroviruses and coxsackieviruses, can also cause meningitis. Less commonly, fungi or medications can cause the disease. Viral meningitis is the most common form, but almost everyone fully recovers from it. “What people fear the most is bacterial meningitis, because it can be far more deadly,” says Mary Anne Jackson, M.D., chief of pediatric infectious diseases at Children’s Mercy Hospitals and Clinics in Kansas City, Mo.
Those who contract a bacterial form of meningitis called meningococcal meningitis have a 20 percent risk of death, says Dr. Jackson, while pneumococcal meningitis, another bacterial form of the illness, is fatal in an estimated 5 percent of cases. Among people who survive bacterial meningitis, an estimated 15 to 20 percent are left with side effects such as permanent hearing loss or brain damage.
Who’s at Risk? In the United States, the people who are most at risk for meningococcal meningitis include adolescents and members of the military, who tend to live in close quarters in college dorms and barracks (making transmission easier), and travelers to places where meningitis may be regularly present, including sub-Saharan Africa and Saudi Arabia during the annual religious pilgrimage to Mecca called the hajj. Infants are most at risk for pneumococcal meningitis, due to their low immunity and the fact that babies are not yet fully vaccinated against most diseases.
While both forms of bacterial meningitis can be scary and severe, cases are relatively rare in this country. Meningococcal meningitis affects about 500 people each year, and pneumococcal meningitis affects an estimated 2,000 people annually, according to the Centers for Disease Control and Prevention (CDC). How Can You Prevent It? Even more good news: You can protect your family. “The best way to prevent meningitis is vaccination,” says Amanda Cohn, M.D., medical epidemiologist for the CDC. Several vaccines can help guard against multiple causes of meningitis. Vaccines That Help Protect Against Viral Meningitis - All vaccines that guard against viruses, such as the MMR and chicken pox vaccines. Typically, it is difficult to determine how you got viral meningitis or what organism caused it. To reduce the likelihood of getting viral meningitis, your best bet is to get yourself and your family vaccinated against any vaccine-preventable viruses such as measles, mumps, rubella and chicken pox.
Vaccines That Help Prevent Bacterial Meningitis - Meningococcal conjugate vaccines (MCV4), which protect against meningococcal meningitis and other forms of meningococcal disease, such as a bloodstream infection. The vaccines are routinely given to children ages 11 through 18. The first dose should be given at 11 or 12 years. The second dose (a booster) should be given at 16 years. “But it’s never too late to get the first shot, especially if your child is getting ready to go off to college,” says Dr. Cohn.
- Pneumococcal conjugate vaccine (PCV13),which prevents pneumococcal meningitis and other forms of pneumococcal disease, such as pneumonia. Your child should get four doses: at 2 months, 4 months, 6 months and 12 to 15 months.
- Hib vaccine,which protects against Hib meningitis, among other things. Your child should get two to three doses before 6 months (the number of doses depends on which vaccine product your doctor uses), and a booster between 12 and 15 months.
Also keep in mind that people of any age with compromised immunity, other chronic health issues and adults 65 and older may need one or more of these vaccinations to protect themselves against meningitis. Ask your doctor about vaccination if you think you are at increased risk. What Are the Symptoms? Even if you’ve been vaccinated, it is still possible to get meningitis, because no vaccine protects against all strains that cause the disease. “No intervention is 100 percent effective,” says Dr. Cohn. The pathogen can invade the bloodstream and then the meninges within a matter of hours, making the first 24 hours of the onset of symptoms the most crucial window for treatment. It’s important to go to the doctor or hospital immediately if you notice a sudden onset of these telltale signs of meningitis: - Fever
- Stiff neck
- Headache
- Nausea
- Vomiting
- Increased sensitivity to light
- Loss of appetite
- Altered mental status (confusion)
- Lack of alertness (in infants)
- Difficulty arousing
- Dark purple rash that can damage limbs (if you develop a bloodstream infection from the meningococcus bacteria)
What’s the Treatment? At the hospital, doctors will do a spinal tap to collect cerebrospinal fluid and identify the cause of the meningitis. If it is bacterial, antibiotics and IV fluids will be given. Recovery time will vary greatly depending on the severity of the case. There is no specific treatment for viral meningitis, but the hospital will probably recommend IV fluids. Most people recover in a week or two. If you or a member of your household has been in close contact with someone diagnosed with meningitis, ask your doctor about antibiotics to prevent the disease. | 
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