Meningitis

Meningitis is an inflammation (usually from infection) of the covering layers (meninges) of the spinal cord or brain, and the cerebral spinal fluid.

Meningitis can be caused by different sources of infection:  virus, bacteria, or even fungus (in immune compromised individuals). 

Viral meningitis is usually considered to be less serious, not life-threatening, and is a complication of a virus infection. Treatment is supportive and observational.  

Bacterial meningitis is considered extremely serious, dangerous, rapidly progressing, and life-threatening.

Symptoms include:

-generalized feeling of being “unwell”

-high fever, chills

-headache

-neck ache or stiffness/achiness, can include the upper or lower back 

-over-sensitivity to light (photophobia)

-drowsiness (altered mental status)

-rash, “purple splotches”

-nausea and vomiting 

Bacterial meningitis can be contagious. Transmission can occur via inhalation of air-borne droplets, intimate contact (e.g. kissing), or contact with objects that are freshly soiled by an infected carrier’s nasal secretions.  The bacteria are spread through respiratory, nasal and/or throat secretions and airborne droplets (e.g., being within a couple of feet of a coughing patient). Fortunately, none of the bacteria that cause meningitis are as contagious as the virus that spreads the “common cold”.

 Three main causative bacteria of bacterial meningitis in adults are:

-Neisseria meningitidis, (causes Meningococcal meningitis)

-Haemophilus influenzae, type b (Hib)

-Streptococcal pneumoniae

Neisseria meningitidis has become a leading cause of bacterial meningitis in the United States after drastic reductions in the incidence of Streptococcus pneumonieae and Haemophilus influenzae type b (Hib), due to recent vaccination programs against the Streptococcus and Haemophilus bacteria.

Each year in the United States, about 2,400 cases of Meningococcal meningitis occur.  The annual rate of infection is about 1.1 cases/100,000 population.  10-14% of patients die.  11-19% suffers severe neurological damage or loss of a limb(s).

There are nine types (serogroups) of neisseria meningitidis that have been currently identified:  A, B, C, D, L, X, Y, Z, and W-135.

Serogroup A is the predominant cause of Meningococcal meningitis in travelers to Africa and Asia.  W-135 has also been identified in the “meningitis belt” of Africa.

Serogroups B and C together equally account for about 70% of all cases in the United States.

In January of 2005, a new tetravalent meningococcal conjugate vaccine (MCV4) was licensed for use for persons ages 11-55.  The vaccine (MCV4) provides protection against four serogroups, A, C, Y, and W-135.  This inactivated-bacteria vaccine is commercially available as Menomune.  It provides protection for 3-5 years.

A vaccine against serogroup B is not available.

CDC’s Advisory Committee on Immunization Practice (ACIP) now recommends routine vaccination with MCV4 for all adolescents (age 11 or 12) at the preadolescent health visit.

The CDC also recently [May 27, 2005 MMWR 54(RR-07);1-21] recommended routine vaccination with meningococcal vaccine for “college freshmen living in dormitories…and other populations at increased risk (i.e. military recruits, travelers to areas in which meningococcal disease is hyperendemic or epidemic, microbiologists, patients without a spleen or with a non-functioning spleen, and persons with complement deficiency.)  Other adolescents, college students, and persons with HIV who wish to decrease their risk for meningococcal disease may elect to receive the vaccine.”

Firefighters are at increased risk for coming into contact with patients with meningococcal meningitis in their duties as first responders and emergency medical technicians.  Many firefighters also work and sleep in close living quarters that are similar to college dormitories or military barracks.  The IAFF Department of Health, Safety and Medicine now recommends MCV4 (Menomune) for all professional fire fighters, under the age of 55.  It is anticipated that the implementation of the MCV4 vaccine will be a key addition to existing meningococcal disease prevention. 

As with any concern for occupational exposure to blood or body fluid, seek prompt evaluation and care from a healthcare professional.  If in doubt about any patient contact of an individual that is suspected of having bacterial meningitis or if a diagnosis has been established, consult a physician.   First responders, family members and other household members  who have been identified as being in close contact with a confirmed case of meningitis may be offered oral antibiotics to help prevent them from coming down with meningitis.   

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