Meningitis – What You Need to Know
Meningitis is a particularly aggressive and rapidly progressive disease that can lead to life-changing disability and can be fatal. However, there is a lot of confusion about what meningitis is, who it affects and how to spot it.
What is Meningitis?
Meningitis is inflammation of the thin membrane that surrounds the brain and spinal cord. This inflammation can be caused by different organisms – bacteria, viruses and occasionally even fungi. Most usually however, meningitis is caused by either a bacteria or a virus.
Viral meningitis is rarely life-threatening but it can lead to life-altering after effects such as headaches and memory problems.
Bacterial meningitis can be rapidly life-threatening and needs urgent medical attention. In the UK, bacterial meningitis is most commonly caused by the bacteria meningococcus. There are 5 different types of meningococcus – A, B, C, W and Y.
The bacteria that cause meningitis can also cause septicaemia. This is ‘blood poisoning.’
Who Does Meningitis Affect?
The bacteria meningococcus lives harmlessly in the nose and throat of up to 1 in 4 people. This ‘carriage’ of the bacterial may help to boost the natural immunity of the person who has the bacteria in their nose or throat. The bacteria cannot survive outside the body so it requires intimate contact such as kissing of sneezing on someone to pass the bacteria to another person.
Occasionally, the meningitis bacteria can overcome the body’s immune system and infect the blood of lining of the brain.
Babies, toddlers and children under 5 are most at risk of meningitis as their immune systems have not yet fully developed.
Teenagers and young people are the next most at risk group. Young adults have the highest rate of carriage of the meningitis bacteria. First year university students are at particular risk. This is because Fresher’s Week is an enormous gathering of people from different areas in relatively confined housing or Halls of Residence. Initially, the symptoms of meningitis can seem like a hangover or ‘Fresher’s Flu.” With no more parental supervision and health being at the bottom of a long list of priorities meningitis can be easily missed.
Previously, Meningitis W was a rare cause of meningitis. Since 2009 there has been a rapid increase in the number of this very dangerous and aggressive form of the disease. Young adults are at particular risk of this form of meningitis.
People who take the Pilgrimage to Hajj or Umrah are also at risk of meningitis. This is because so many people from all over the world travel come together and the high density of people leads to increased risk. For this reason, pilgrims need to have received the Meningitis ACWY vaccine and have a valid certificate provided by a doctor before a visa can be issued by the Embassy of the Kingdom of Saudi Arabia.
How To Spot Meningitis
Meningitis can start off with non-specific symptoms that are similar to having flu. It tends to cause different symptoms in different age groups. The symptoms can occur in any order and some may not appear at all.
Fever with cold hands and feet.
Pale, mottled skin
Bluish tinge around the mouth.
Fussing and irritability may occur. The baby may be difficult to soothe and settle and may not like being cuddled.
Excessive crying. The cry may have a higher pitch to usual.
Poor feeding and not having as many wet nappies.
Bulging of the fontanelle, the soft spot on the top of the head.
Drowsiness at times when you would not expect if and difficulty in waking.
A non-blanching rash. This is a rash that does not fade on pressure.
In Children and Adults:
Fever with cold hands or feet
Pain in the arms or legs
Pale mottled skin
Sensitivity to light
Difficulty in lifting the head from the pillow
Confusion or irritability.
DO NOT WAIT FOR A RASH TO OCCUR. The characteristic rash of meningitis occurs after 13-22 hours. Early features of meningitis include:
Leg pain. It is unusual for a child with a fever to complain of leg pain so if they do seek medical help immediately.
Cold hands and feet
Abnormal skin colour
How to Prevent Meningitis
There is no single vaccine to prevent all forms of meningitis but thankfully there are now several available to prevent many of the forms of meningitis. HiB (haemophilus influenza B) was the most common form of meningitis in children under 5 until the introduction of the HiB vaccine in 1999 to the routine NHS immunisation schedule for babies. Now it is a rare cause of meningitis.
Preventing Meningitis C
The meningitis C vaccine was recently removed from the NHS primary series of immunisations at 12 weeks of age because “there are now very few cases of meningitis C.” The Meningtis B vaccine (Bexsero), given at 8 and 16 weeks does offer protection against one of the most severe strains of meningitis C. Also, a vaccination for meningitis ACWY was begun in adolescents in 2015. It was thought by the Joint Committee on Vaccination and Immunisation (JCVI) that the herd immunity provided to the population by the vaccine for teenagers would reduce the risk to babies. However, the JCVI did note that “the decision on the timing of removal of the infant MenC dose should be made primarily from an operational, rather than scientific viewpoint”. Sadly, the uptake of this vaccine amongst teenagers has been low.
For this reason, at Coyne Medical, we continue to offer the Meningitis C vaccine to children in the primary immunisation schedule.
Preventing Meningitis B
Meningitis B is the most common type of bacterial meningitis in the UK. The vaccine is on the routine UK immunisation schedule and is offered to babies at 2 and then 4 months of age. A booster dose is then given at 12 months of age.
The peak age of incidence of meningococcal disease is 4-5 months. The risk for older children is much less. However, as meningococcal disease is potentially deadly and disabling many parents choose to vaccinate older children who have missed out on the vaccine in the routine immunisation schedule. Children over 2 years of age require 2 dose of Bexsero separated by a minimum of 8 weeks.
From the age of 12 years the incidence of meningococcal disease increases to another peak at 18 years of age. A new vaccine for Meningitis B, Trumenba, has recently been introduced to the UK to protect adolescents and young adults from meningococcal disease. We are pleased to be able to offer Trumenba at Coyne Medical. Trumenba can be given to children of 10 years of age and older. It is a two-dose course with each dose separated by 6 months.
Preventing Meningitis ACWY
The Meningitis ACWY vaccine has been offered to children aged 14 on the routine immunisation programme since 2015. There has also been a catch-up programme to immunise children aged 14-18. However, uptake of this vaccine has been low. We would recommend that anyone in this age group who has not received the Meningitis ACWY vaccine previously to have it. It is also very important for pilgrims on Hajj or Umrah to have this vaccination. The vaccination is given as a single dose.
Other Forms of Meningitis
The Pneumoccocal, HiB and MMR vaccines all prevent different types of meningitis so it is important for your child to have the full routine immunisation schedule.
However, no all forms of meningitis are preventable by vaccine. This is why being able to recognise the signs and symptoms of meningitis is so important.
Dr Hugh Coyne