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Childhood Illnesses
and Conditions
: Meningitis in Children
Important Facts About Meningitis in Children:
What is meningitis?
The term meningitis means the infection of the covering
of the brain (or the meninges). Although there are multiple causes,
the two major germ categories are bacterial and viral. Viral meningitis,
which occurs mostly during the summer months, goes away on its
own, and usually causes no significant complications. This article
will discuss bacterial meningitis in children.
What are the causes of bacterial meningitis?
In children over 3 to 4 months, the main bacteria that cause meningitis
are:
- Streptococcus pneumoniae (the most common)
- Hemophilus Influenzae
- Neisseria meningitidis (or meningococcus)
The first 2 bacteria, Streptococcus pneumoniae and Hemophilus
influenzae are also the main bacterial causes of ear and other
respiratory infections including pneumonia and sinusitis. Menigococcus
has been the cause of the recent outbreaks of "meningitis". This
particular infection is discussed below in greater detail.
What are the symptoms of meningitis?
In general children with meningitis look very ill and the specific
signs and symptoms vary with age. In older children, the symptoms
may include:
- fever
- stiff neck
- headache
- vomiting
In younger children, especially babies less than 3 months, the
symptoms are very non-specific. For example, irritability, poor
feeding, increased sleepiness with or even without fever. It is
therefore usually difficult to determine just by symptoms whether
a baby has meningitis or not. When examining an older child the
doctor can look for signs of meningitis by bending the neck and
the knees. In babies, these specific signs are usually absent.
How is meningitis confirmed?
In children with suspected meningitis, the only way the diagnosis
can be definitively confirmed is by a procedure called a lumbar
puncture (or spinal tap). This relatively safe procedure involves
placing a (hollow) needle between the spinal bones in the middle
lower back after the area is frozen. Spinal fluid is then collected
into small test tubes which are sent for analysis. A positive
spinal tap means that a child has meningitis, and the liquid will
then be tested to see which bacteria is the cause. If no bacteria
are found, but the spinal fluid is abnormal, the liquid may be
tested for viruses or other causes.
What are the consequences of bacterial meningitis?
Bacterial meningitis is an extremely dangerous infection. The
associated problems or complications, range from brain related
infection/damage (such as deafness, paralysis, seizures and even
mental retardation), to spread of infection through the blood,
to tragically, even death.
How is meningitis treated?
Bacterial meningitis is treated by intravenous antibiotics which
fortunately have been able to decrease and/or prevent the associated
potential complications. However, even despite antibiotic use
the death rate from bacterial meningitis is about 10%.
What if a child comes into contact with a person who develops
meningitis?
The answer depends on which bacteria are causing the meningitis.
If the meningitis is caused by Hemophilus influenza or meningococcus,
preventative antibiotics (usually rifampin), taken by mouth, are
given to close contacts (household, barrack, dorm, school or day
care). In the case of outbreaks or mini-epidemics of meningococcus,
which occurred in the early 1990's and more recently during the
winter season of 2000-2001, mass vaccination may be recommended
by public health authorities (see details below).
Is there a single meningitis vaccine?
Because there are several bacteria that cause meningitis there
is no single "Meningitis" vaccine protecting against all of the
possible bacterial causes. However, what has had a big impact
on decreasing meningitis is the introduction of the Hemophilus
Influenzae vaccine which is now given routinely to all children
from 2 month of age. Hemophilus meningitis and other related infections
have decreased significantly since the vaccination was given universally.
Unfortunately, this vaccination does not protect children from
the other 2 bacteria. Recently a new Streptococcus pneumoniae
vaccine has been developed and recommended for all children as
part of their routine immunization. This (heptavalent pneumococcal)
vaccination is good news as children can now be protected from
this bacteria too.
Meningococcal infection: The cause of recent "meningitis" outbreaks
Meningococcus is the bacteria that has caused outbreaks across
North America over the last 8 - 10 years including most recently.
Understandably the presence of a meningitis epidemic in a community
is very scary to parents. The following section specifically on
meningococcal infection has been created in an attempt to answer
the most common questions parents have about this bacteria.
Why is meningococcal infection so dangerous?
This particular bacteria is quite dangerous because in addition
to causing meningitis, it can enter the blood stream (called meningococcemia)
and cause the body to go into shock, resulting in kidney failure
and, unfortunately, possibly death. Tragically, the risk of dying
from menigococcemia is about 17%. Therefore, not only can meningococcal
infection result in meningitis, which itself is bad enough, it
can cause significant damage to the rest of the body. One of the
difficulties with treating meningococcemia is that it can spread
so quickly and cause such an overwhelming infection that even
antibiotics and other supportive treatments can't always stop
the infection, explaining why the mortality or death rate is so
high.
Which bacteria cause meningococcal infections?
The bacteria are called Neisseria meningitidis or meningococcus
and there are 3 main types that cause infection in humans: A,
B and C. Type B accounts for most meningococcal infections.
How is meningococcus spread?
The spread is usually from direct person-to-person contact through
respiratory secretions. This is why outbreaks of infection occur
more frequently in crowded conditions such as in the army, schools
or dormitories. People most prone to getting the infection from
someone already infected are those who have had close prolonged
contact. More than 50% of infections occur in children less than
5 years old. There is also a higher incidence of this infection
in 15 to 24 year olds. The infections most frequently occur during
the winter and spring months.
What are the symptoms of meningococcal infection?
If the child only gets meningitis, then the signs and symptoms
are as described above for meningitis. However, if the infection
spreads beyond meningitis into the blood, one of the main signs
specific to menigococcemia, is the development of little blue
spots on the skin called "petechiae" which rapidly grow and spread
all over the body eventually looking like large bruises. If a
child ever develops such a rash, especially in the context of
an outbreak of meningococcal infection, medical attention should
be sought immediately. Not all petechiae are due to meningococcemia,
but this should be ruled out immediately, because if menigococcemia
is either suspected or confirmed, immediate treatment and monitoring
are absolutely necessary.
How is meningococcal infection treated?
People with full-blown meningococcemia are very ill because of
this potentially deadly infection and therefore require intensive
medical therapy, support and monitoring in addition to intravenous
antibiotics.
What happens to contacts of a person with meningococcal infection?
The most important thing to do is to treat the close contacts
with antibiotics taken by mouth. When given promptly, preventative
antibiotics have been shown to prevent infection very effectively.
What about vaccination against meningococcus? Why is this not
routine?
There is no clear-cut answer. Firstly, the vaccine that is available
is only effective against type A and C and not Type B which is
the type most frequently associated with severe infection and
outbreaks. The vaccination, however, is effective against type
A and C, but this protection wears off within a 3 -5 year period.
The problem is that there currently is no effective vaccine against
Type B. So vaccinating children against type A and C will not
protect against B. However, if Type A or C is the cause of a specific
epidemic, the local public health authorities may recommend mass
vaccination as this has been shown to be able to stop outbreaks.
It must be noted that it takes several weeks for the vaccination
to protect a person, and therefore household or close contacts
with people with active meningococcal infection should receive
antibiotics preventatively, even if vaccinated as part of a public
health campaign.
Is the meningococcal vaccine safe?
Yes, this vaccination has been used for years in the army without
any significant problems. The reactions any are minor, such as
local swelling or redness at the injection site (less than 2%)
and irritability in younger children.
What else can parents do to protect their children?
The main thing that parents can do is be on the lookout for any
petechiae or other signs of meningitis described above, especially
under conditions of a local or community outbreak of infection.
If parents are not sure, they should not take a chance but seek
medical attention just to be on the safe side.
Is there hope for developing effective vaccines against meningococcus?
Good news... yes. Because the disease is so dangerous once it
starts, the key is to prevent infection in the first place by
vaccination. A number of vaccines have been developed and tested
that protect against all three major meningococcal types or strains
A, B and C. These vaccines have been shown to be effective in
protecting children against meningococcal infection in trials
and hopefully will soon be approved for use in North America and
become part of the routine immunization program. Once this is
achieved, there will be effective vaccinations for all
three major bacterial causes of meningitis in children!
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The information provided in this site is
designed to be an educational aid only. It is not intended to
replace the advice and care of your child's physician, nor is
it intended to be used for medical diagnosis or treatment. If
you suspect that your child has a medical condition, always
consult a physician.
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