MENINGITIS

• Notifiable

Inflammation of the meninges, the protective membranes covering the brain and spinal cord. May be viral or bacterial.

Viral meningitis can cause a person to feel very unwell but they usually make a full recovery within 2 weeks; treatment is rest and analgesics. Most viruses that cause meningitis are enteroviruses that are normally harmless, and passed on as a result of poor hygiene.

Bacterial meningitis can kill a healthy person of any age within 4 hours of first symptoms, or cause permanent disability (loss of limbs, blindness, deafness, brain damage).

Hib meningitis is caused by Haemophilus influenzae type b; most common in babies and children

Meningococcal meningitis is caused by the meningococcus Neisseria meningitides; most prevalent in children

Pneumococcal meningitis, second most common form of bacterial meningitis in UK, is caused by Streptococcus pneumoniae, which can also cause ear infections and pneumonia. Less common than meningococcal meningitis, but much more life threatening. Both types of bacteria can cause, separately or together:

• meningitis (infection of the meninges/spinal cord) and
• septicaemia (blood poisoning).

Septicaemia is more dangerous, causing blood vessels to haemorrhage.

Symptoms Some of the symptoms for meningitis and meningococcal septicaemia are the same, others differ. Not everyone gets them all, and they can develop in any order. In the early stages both diseases can appear flu-like. Meningococcal septicaemia

• fever
• rigors
• severe muscle and joint aches
• isolated, severe limb pain
• gastrointestinal symptoms: abdominal pain, vomiting, diarrhoea.
• weakness, may be profound.
• rash: parents may not recognise the purpura/bruises or petechiae of septicaemia as a ‘rash’. The spots do not fade under pressure, i.e., they remain visible through the side of a clear drinking glass pressed firmly against the skin.

Meningitis

• fever
• headache
• vomiting
• drowsiness/confusion
• fits
• photophobia
• neck stiffness.

• Encourage parents to trust their instincts, and seek medical advice again if child’s condition deteriorates
• Give information about symptoms of serious illness, including how to identify a non-blanching rash
• Give a specific follow-up time
• Advise how to liaise directly with other health professional if concerned.

Vaccination Childhood vaccination protects against meningitis C, pneumoccoccal meningitis and Hib meningitis. A new vaccine against meningitis B is due to be introduced later in 2014 which is thought to offer around 88% protection against this, the most common form of meningitis, which affects around 1,200 people a year – both adults, babies and young children – and which has a high risk of limb amputations, brain injury and death. Uptake levels of MenC vaccine since introduction in 1999 is close to 90%; cases have reduced by 90% in under-20-year-olds, the target group. Young adults aged 20–24 remain at risk and all first-year college and university students who have not already received the Men C vaccine should do so, ideally before starting their course.