Meningitis, What?

To start off, what is meningitis? Well, according to the Centers for Disease Control and Prevention:

“Meningitis is an inflammation (swelling) of the protective membranes covering the brain and spinal cord known as the meninges. This inflammation is usually caused by an infection of the fluid surrounding the brain and spinal cord. Meningitis is usually caused by bacteria or viruses, but can be a result of injury, cancer, or certain drugs. It is important to know the specific cause of meningitis because the treatment differs depending on the cause.”

Sounds scary, right? But how do we know if we have meningitis? Here are the symptoms to look out for. They can appear in any order and some may not appear at all.

Early Symptoms:

  • Fever or fever with cold hands and feet
  • Vomiting
  • Severe headache
  • Severe muscle pain

Other Symptoms:

  • Drowsy, difficult to wake
  • Stiff neck
  • Pale, blotchy skin with spots or rash
  • Confusion and irritability
  • Convulsions or seizures
  • Dislikes bright lights

Reference: https://www.meningitisnow.org/meningitis-explained/ signs-and-symptoms/signs-and-symptoms-children-and-adults/

An individual who is down with meningitis could get worse very quickly, so it’s important to monitor their condition and get them timely medical help if necessary. But before you think this is an adult-only condition, meningitis could affect children due to a lack of prior immunity against the infecting agent. In fact, children who miss out on the recommended vaccinations have a higher risk of getting meningitis.

Prof. Lulu C. Bravo (Paediatric Infectious and Tropical Diseases, University of the Philippines Manila, Philippines), gives us the lowdown on the serious infection.

LWB: How common is meningitis amongst children?

PROF. LU LU: Meningitis can affect anyone, regardless of age - with infants, adolescents and young adults at greatest risk. According to a study done in the U.S., the peak infant age group at risk of bacterial meningitis – a common form of meningitis – is six to 12 months. Overall, as seen in a global study, about 50% of bacterial meningitis cases occur in children under five years old, with a second disease peak in adolescents and young adults between 15-24 years of age.1,2

A vaccine is currently available in Singapore for children older than 2 years of age, but what about younger children?

In Singapore, two types of vaccines are available – the polysaccharide vaccine is used for children aged two and above, while the conjugate vaccine is available for use in infants, children and adults. Compared to existing polysaccharide vaccines, the new meningococcal conjugate vaccine has several advantages:3

  • It is known to be more effective in protecting children under two years who do not respond to conventional polysaccharide vaccines.
  • It also offers a higher and more sustainable immune response against certain strains of the bacteria and its transmission.
  • The conjugate vaccine offers a longer-term protection and can potentially prevent transmission by reducing the carriage of bacteria in the throat. (10% to 20% of the population is believed to carry the bacteria in their throat at any given time.4 During dense gatherings such as the Hajj pilgrimage, it can rise to as high as 80%.5)

Aside from getting a vaccine, what other precautions can a parent take to protect their child from meningitis?

The most effective way to protect your child against meningitis is to complete the recommended vaccine schedule. Apart from vaccination, parents can take the following everyday preventative measures:

  • Avoid close contact with sick people and keep your child away from those suspected of meningitis infection as much as possible. Wearing a regular surgical mask can also prevent transmission of germs. I will generally recommend this for a newborn’s first six months, as their immunity is very low.
  • Keeping the child’s play and eating areas clean.
  • Washing your hands with soap and water or use alcohol rubs frequently after a cough or a sneeze.

Is it a must for children to get a vaccine for meningitis before they travel?

The disease is spread via direct transmission, such as respiratory droplets from an infected person. Transmission rate is increased in an overcrowded environment. For example, the bacteria that causes meningitis, Neisseria meningitides, can spread from person to person through coughing and sneezing or close and intimate contact such as kissing via throat secretions (saliva or spit).6

It can also spread through the sharing of food or drink or living in close quarters. Immediate family members and other persons sharing a household are considered at risk.7 Healthy people can also carry the bacteria that causes meningitis in their nose or throat with no signs or symptoms of disease and are termed as ‘a carrier’.

Although vaccination has indeed reduced vaccinepreventable diseases to low levels, some of them are still prevalent in other countries (beyond Singapore) causing travellers to unknowingly transmit diseases to people in the countries they visit. As such, regardless of travel plans, it is highly recommended that children are vaccinated to minimise the chance of being exposed to disease agents and contracting meningitis from inbound travellers.

Meningococcal meningitis is very serious and can be fatal. In fatal cases, deaths can occur in as little as a few hours. In non-fatal cases, permanent disabilities can include hearing loss and brain damage. Prevention is key1.

References:
1. Brouwer MC, Tunkel AR, van de Beek D. Epidemiology, diagnosis and antimicrobial treatment of acute bacterial meningitis. Clin Microbiol Reviews 2010;23:467-92
2. Edwards K, Clark A, Korczak VS, et al. Global and regional risk of sequelae from bacterial meningitis: a systematic review and meta-analysis. Lancet Infect Dis 2010;10:317- 28
3. Centers for Disease Control and Prevention, http://www.cdc.gov/meningitis/non-infectious.html
4. World Health Organisation, http://www.who.int/mediacentre/factsheets/fs141/en/
5. European Centre for Disease Prevention and Control (ECDC), http://www.eurosurveillance.org/ViewArticle.aspx?ArticleId=19671
6. Thompson MJ, et al. Clinical recognition of meningococcal disease in children and adolescents. Lancet 2006;367:397-403.
7. Centres for Disease Control and Prevention, USA. Meningococcal Disease. Available at http://www.cdc.gov/meningococcal/about/ Last accessed Feb 2016