Meningitis is an infection of the meninges, the thin lining that surrounds the brain and spinal cord. It is sometimes referred to as spinal meningitis.
The most common causes of meningitis are viral and bacterial; fungal and parasitic infections are much less frequent. Knowing whether meningitis is caused by a virus or bacterium is important because the severity of the disease and its treatment depend on the type of infection:
- Viral meningitis is generally benign and resolves without specific treatment.
- Bacterial meningitis is much more serious because its onset is rapid and the infection is associated with a significant risk of death. Bacterial meningitis may also result in mental retardation, deafness, epilepsy, or necrosis leading to limb amputation. It is important to know which type of bacteria is causing the meningitis because antibiotics can prevent some types from spreading and infecting other people.
Before the 1990s, Haemophilus influenzae type b (Hib) was the leading cause of bacterial meningitis, but new vaccines given to all children as part of their routine immunizations have reduced the occurrence of invasive disease due to H. influenzae. Today, Streptococcus pneumoniae and Neisseria meningitidis (meningococcus) are the leading causes of bacterial meningitis.
Meningitis (Meningococcal disease) is an inflammation of the membranes that cover the brain and spinal cord and may be caused by a variety of pathogens, including bacteria, viruses, fungi, environmental toxins like heavy metals and reactions to medications. Meningitis case fatality rates have been as high as 50% in endemic countries although now they hover between 10%-15%. Regardless, serious permanent side effects like deafness, mental retardation and amputation of limbs occur in 11%-19% of survivors. Although bacterial and fungal meningitis require extended hospitalization, viral meningitis is typically less severe and clears up without specific treatment.
Meningitis is an infection of the protective membranes that surround the brain and spinal cord (meninges).
It can affect anyone, but is most common in babies, young children, teenagers and young adults.
Meningitis can be very serious if not treated quickly. It can cause life-threatening blood poisoning (septicaemia) and result in permanent damage to the brain or nerves.
A number of vaccinations are available that offer some protection against meningitis.
How Do You Get Meningitis?
Meningitis is transmitted by air droplet, kissing, sharing of items, utensils that may have been infected and nasal secretions.
What Are the Symptoms of Meningitis?
Meningitis symptoms include high fever, headache and stiff neck in anyone over the age of 2 years. Other symptoms may include vomiting, nausea, confusion, sleepiness and discomfort looking into bright lights. In small infants and newborns, headache, fever and neck stiffness may be difficult to detect or completely absent. Infants with meningitis may be feeding poorly, be irritable, appear slow or inactive and have vomiting episodes. Meningitis symptoms can develop within hours or they may take 1 to 2 days. As the disease progresses, patients of any age may have seizures.
Where Does Meningitis occur?
Meningitis in North America most commonly occurs in dorms, schools or other areas where individuals will have long-term close contact with one another. Because of this, many high schools, colleges and universities throughout North America mandate meningitis vaccination in order to attend. The increased prevalence of meningitis among younger individuals has led the CDC to recommend meningitis vaccination to those in their teens and early 20’s as part of the routine vaccination schedule.
Outside of North America, meningitis can be prevalent. The disease is endemic throughout the sub-Saharan Meningitis Belt, which extends from Senegal to Ethiopia, travelers visiting the region during the dry season are advised to receive the meningitis vaccine especially if prolonged contact with the local population is likely. Thus, meningitis vaccine is recommended for travelers going to countries in the meningitis belt: Senegal, The Gambia, Mauritania, Mali, Guinea Bissau, Guinea, Sierra Leone, Cote D’Ivoire, Burkina Fasso, Ghana, Parts of Togo, Benin, Niger, Nigeria, Chad, Cameroon, Central African Republic, Sudan, Ethiopia, Parts of Kenya, Parts of Uganda and parts of Eritrea.
An outbreak of group W-135 meningococcal disease occurred in the year 2000 associated with the annual Hajj pilgrimage to Mecca and caused the Saudi Arabian government to mandate that all travelers receive the meningitis immunization prior to pilgrimages to Mecca.
What Is the Meningitis Vaccine?
There are two types of meningitis vaccinations available in the U.S. One protects against A, C, W and Y strains and other other against only B strains.
Serogroup B meningitis immunization is recommended for youth age 16 to 23 to provide short term protection against meningitis B. It is also recommended as a routine vaccination for some individuals over the age of 10 if: there has been an outbreak of meningitis B, they have a damaged or removed spleen, certain immune conditions among other similar indications.
The meningitis B vaccine comes in two brands:
- Bexsero: given as two doses at least one month apart
- Trumenba: given as three doses, with the second dose two months after the first and the third dose six months after the first.
Vaccination against serogroups A, C, W and Y is considered a routine vaccination and is recommended for adolescents 11 to 18 years old. Generally, the first dose is given at 11 or 12 with a booster at 16. If the first dose is given after an individual is 16, a booster is not needed. There are two types of A, C, W and Y vaccines:
- Meningococcal polysaccharide vaccine (MPSV4): licensed for individuals 55 and older
- Meningococcal conjugate vaccine (MCV4): the preferred vaccine for people under 55
Both provide equal levels of protection against potential meningitis contact in the United States and other regions of the world an individual may travel to.
The meningitis vaccines are available at all Passport Health travel clinic locations.
Who Should Get a Meningitis Vaccine?
Adolescents are most at risk for contracting meningitis. The CDC recommends all teens 11 through 18 receive the meningitis A, C, W and Y vaccine and between 16 and 23 receive the meningitis B vaccine. Many high schools and colleges now require proof of meningitis vaccination before starting the school year. Additionally, the Advisory Committee on Immunization Practices (ACIP) suggests that teens receive the vaccine less than 5 years before starting school.
The CDC recommends adults with the following risk factors be vaccinated as well:
- Military recruits
- College freshmen living in a dormitory
- People with a damaged spleen or a spleen that has been removed
- Microbiologists who are routinely exposed to Neisseria meningitidis (the bacterial pathogen)
- People with a terminal complement deficiency
- People who have had close or prolonged contact with a patient with meningitis caused by Neisseria meningitidis
- People who are traveling or to areas where the dissease is common
- People who reside in countries in which the disease is common or endemic
What is Meningococcal Disease?
Meningococcal disease is caused by the bacterium Neisseria meningitidis, also called meningococcus. Some people carry these bacteria in the back of their nose and throat with no signs or symptoms of disease. But sometimes these bacteria can invade the body causing certain illnesses, which collectively are known as meningococcal disease.
Neisseria meningitidis are spread from person-to-person through the exchange of respiratory and throat secretions (saliva or spit) during close (for example, coughing or kissing) or lengthy contact, especially if living in the same household. The bacteria are not spread by casual contact or by simply breathing the air where a person with meningococcal disease has been.
The two most severe and common illnesses caused by Neisseria meningitidis include infections of the lining of the brain and spinal cord (meningitis) and bloodstream infections (bacteremia or septicemia). Meningococcal disease can be deadly and should always be viewed as a medical emergency. About 10 to 15 percent of meningococcal disease cases are fatal. Of patients who recover, up to 1 in 5 experience long-term disabilities, such as loss of limbs, deafness, nervous system problems, or brain damage.
A common outcome of meningococcus infection is meningitis. When caused by Neisseria meningitidis, it is known as meningococcal meningitis or bacterial meningitis. When someone has meningococcal meningitis, the protective membranes covering their brain and spinal cord, known as the meninges, become infected and swell. This is characterized by a sudden onset of fever, headache, and stiff neck. It is often accompanied by other symptoms, such as:
- Photophobia (sensitivity to light)
- Altered mental status (confusion)
The symptoms of meningococcal meningitis can appear quickly or over several days. Typically they develop within three to seven days after exposure.
In newborns and infants, the classic symptoms of fever, headache, and neck stiffness may be absent or difficult to detect. Infants with meningitis may appear slow or inactive, have vomiting, be irritable, or be feeding poorly. As the disease progresses, patients of any age may have seizures.
Meningococcal Bacteremia or Septicemia
Another common outcome of meningococcus infection is meningococcemia, also known as meningococcal septicemia or bacteremia. This is the more dangerous and deadly of illnesses caused by Neisseria meningitidis. When Neisseria meningitidis bacteria enter the bloodstream and multiply, they damage the walls of the blood vessels and cause bleeding into the skin and organs.
Symptoms may include:
- Cold hands and feet
- Severe aches or pain in the muscles, joints, chest or abdomen
- Rapid breathing
- A dark purple rash (puerperal or petechial rash), in later stages
Who gets Meningococcal Disease?
Anyone can get meningococcal disease, but it is most common in infants younger than one year old and people with certain medical conditions. Teenagers and young adults 16 through 23 years old are also at increased risk of getting meningococcal disease.
Can Meningococcal Disease be Treated?
Early diagnosis and treatment are very important. If symptoms occur, the patient should see a doctor immediately. Meningococcal disease can be treated with a number of effective antibiotics. Antibiotic treatment should reduce the risk of dying, but sometimes the infection has caused too much damage to the body for antibiotics to prevent death or serious long-term problems.