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Travel health – Meningitis

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Travel health – Meningitis



Introduction 

Meningitis is an infection of the protective membranes that surround the brain and spinal cord.

This infection causes these membranes (the meninges) to become inflamed, which in some cases can damage the nerves and brain.

Signs and symptoms of meningitis

Anyone can get meningitis, but babies and young children under five years of age are most at risk. A baby or young child with meningitis may:


have a high fever, with cold hands and feet

vomit and refuse to feed 

feel agitated and not want to be picked up

become drowsy, floppy and unresponsive

grunt or breathe rapidly

have an unusual high-pitched or moaning cry

have pale, blotchy skin, and a red rash that doesn't fade when a glass is rolled over it

have a tense, bulging soft spot on their head (fontanelle)

have a stiff neck and dislike bright lights

have convulsions or seizures


The above symptoms can appear in any order, and some may not appear at all.

Don't wait for a rash to develop. If your child is unwell and getting worse, seek medical help immediately.

In older children, teenagers and adults, the symptoms of meningitis can include:


a fever, with cold hands and feet

vomiting

drowsiness and difficulty waking up

confusion and irritability

severe muscle pain

pale, blotchy skin, and a distinctive rash (although not everyone will have this)   

a severe headache

stiff neck

sensitivity to light (photophobia)

convulsion or seizures


Again, these symptoms can appear in any order, and not everyone will get all of them.

Don't wait for a rash to develop. Seek immediate medical help if someone is unwell and displays the symptoms of meningitis.

The glass test

If you press the side of a clear glass firmly against the skin and the rash doesn't fade, it's a sign of meningococcal septicaemia.

A person with septicaemia may have a rash of tiny "pin pricks" that later develops into purple bruising.

A fever with a rash that doesn't fade under pressure is a medical emergency, and you should seek immediate medical help.

Types of meningitis

There are two types of meningitis. They are:


bacterial meningitis – caused by bacteria such as Neisseria meningitidis or Streptococcus pneumoniae and through close contact

viral meningitis – caused by viruses that can be spread through coughing, sneezing and poor hygiene 


Bacterial meningitis

Bacterial meningitis is very serious and should be treated as a medical emergency. If the bacterial infection is left untreated, it can cause severe brain damage and infect the blood (septicaemia).

In 2011-12, there were around 2,350 cases of bacterial meningitis and septicaemia in the UK. The number of cases has dropped since the introduction of vaccines that protect against many of the bacteria that can cause meningitis, including the meningitis C vaccine, MMR vaccine and pneumococcal vaccine.

It's essential to know the signs and symptoms, and to get medical help if you're worried.

Bacterial meningitis most commonly affects children under five years of age, particularly babies under the age of one. It's also common among teenagers aged 15 to 19. 

Viral meningitis

Viral meningitis is the most common, and less serious, type of meningitis. It's difficult to estimate the number of viral meningitis cases, because symptoms are often so mild that they're mistaken for flu.

Viral meningitis is most common in children and more widespread during the summer.

Diagnosing meningitis

Diagnosing meningitis can be difficult because it often comes on quickly and can be easily mistaken for flu, as many of the symptoms are the same.

However, it's very important to seek immediate medical help if you notice any of the symptoms of meningitis, particularly in a young child.

This may mean going to the accident and emergency (A&E) department of your local hospital in the middle of the night. 

Don't wait for a purple rash to appear, because not everyone with meningitis gets one.

If meningitis is suspected, treatment will usually be started before the diagnosis is confirmed. This is because some of the tests can take several hours to complete, and it could be dangerous to delay treatment.

The doctors will carry out a physical examination to look for signs of meningitis (see above) or signs of septicaemia, such as a rash. They will also carry out a number of other tests to confirm the diagnosis.

Treating meningitis

Viral meningitis usually gets better within a couple of weeks, with plenty of rest, painkillers for the headache and anti-sickness medication for the vomiting.

Bacterial meningitis is treated with intravenous antibiotics (delivered through a vein in the arm). Admission to hospital will be needed, with severe cases treated in intensive care, so the body's vital functions can be monitored and supported.

If antibiotics don't work, you will need to be in hospital for a week or less. If the infection is more severe, you may need to stay in for longer. 

Outlook

Several decades ago, the outlook for bacterial meningitis wasn't good, and almost everyone who had the condition would die.

Nowadays, most deaths are caused by septicaemia (blood poisoning) rather than meningitis. Meningococcal disease, meningitis or septicaemia caused by Neisseria meningitidis bacteria results in about 1 death in every 10 cases.

Up to a quarter of people may experience complications of meningitis, such as hearing loss, after having bacterial meningitis.

Vaccination

The best way to prevent meningitis is by ensuring vaccinations are up-to-date. Children in the UK should receive the available vaccines as part of the childhood vaccination programme.

It's also important to check your travel vaccinations are up-to-date before travelling in certain parts of the world.

Symptoms of meningitis 

Every suspected case of meningitis should be treated as a medical emergency.

Bacterial meningitis can lead to septicaemia (blood poisoning), which can be fatal.

Bacterial meningitis

Bacterial meningitis is more serious than viral meningitis. The symptoms usually begin suddenly and get worse rapidly.

If you suspect bacterial meningitis, dial 999 immediately and ask for an ambulance.

Babies and young children

Babies and young children under five years of age are most at risk of developing bacterial meningitis.

A baby or young child with meningitis may:


have a high fever, with cold hands and feet

vomit and refuse to feed

feel agitated and not want to be picked up

become drowsy, floppy and unresponsive

grunt or breathe rapidly

have an unusual high-pitched or moaning cry

have pale, blotchy skin, and a red rash that doesn't fade when a glass is rolled over it (see below)

have a tense, bulging soft spot on their head (fontanelle)

have a stiff neck and dislike bright lights
have convulsions or seizures


The above symptoms can appear in any order, and some may not appear at all.

Don't wait for a rash to develop. If your child is unwell and getting worse, seek medical help immediately.

In older children, teenagers and adults, the symptoms of meningitis can include:


a fever, with cold hands and feet 

vomiting

drowsiness and difficulty waking up

confusion and irritability

severe muscle pain

pale, blotchy skin, and a distinctive rash (although not everyone will have this)    

a severe headache

stiff neck

sensitivity to light (photophobia)

convulsion or seizures


Again, these symptoms can appear in any order, and not everyone will get all of them.

Don't wait for a rash to develop. If someone is unwell and has symptoms of meningitis, seek medical help immediately.

The glass test

If you press the side of a clear glass firmly against the skin and the rash doesn't fade, it's a sign of meningococcal septicaemia.

A person with septicaemia may have a rash of tiny "pin pricks" that later develops into purple bruising.

A fever with a rash that doesn't fade under pressure is a medical emergency, and you should seek immediate medical help.

Viral meningitis

Most people with viral meningitis will have mild flu-like symptoms, such as:


headaches

fever (see above)

generally not feeling very well


In more severe cases of viral meningitis, your symptoms may include:


neck stiffness

muscle or joint pain

nausea and vomiting

diarrhoea

sensitivity to light (photophobia) 


Unlike bacterial meningitis, viral meningitis doesn't usually lead to septicaemia (blood poisoning).



A blotchy red rash that doesn't fade or change colour when a glass is pressed against it is a possible symptom of bacterial meningitis 

Bacterial or viral meningitis?

It's not possible to tell the difference between bacterial and viral meningitis from the symptoms alone.

Clinical tests are needed to distinguish between the two types of meningitis. Therefore, every case of suspected meningitis should be treated as a medical emergency.

Causes of meningitis 

Meningitis can be caused by bacteria or a virus.

Bacterial meningitis

Vaccination programmes have helped reduce the number of different types of bacteria that can cause meningitis.

However, there are currently a number of bacteria for which there currently aren't effective vaccines. Some bacterial causes are described below.

Neisseria meningitidis bacteria

Neisseria meningitidis bacteria are often referred to as meningococcal bacteria. There are several different types of meningococcal bacteria, called groups A, B, C, W, X, Y and Z.

There's a vaccination that protects against group C meningococcal bacteria

In the UK, most cases of meningococcal meningitis are caused by the group B bacteria. A vaccine for group B bacteria has recently been developed and approved for use, but it isn't currently available on the ..

Streptococcus pneumoniae bacteria

Streptococcus pneumoniae bacteria are often referred to as pneumococcal bacteria.

Pneumococcal bacteria tend to affect babies and young children because their immune systems (the body's natural defence) haven't built up immunity (protection) to these bacteria.

Spreading the bacteria

The meningococcal bacteria that cause meningitis can't survive for long outside the body, so they're usually only spread through prolonged, close contact. Possible ways the bacteria are spread include:


sneezing

coughing

kissing

sharing utensils, such as cutlery

sharing personal possessions, such as a toothbrush or cigarette


As most people, particularly adults aged over 25, have a natural immunity to the meningococcal bacteria, most cases of bacterial meningitis are isolated, single incidents.

However, there's a chance of a small outbreak of cases occurring in environments where many young people live in close proximity. For example:


boarding schools

university campuses

military bases

student housing


Pneumococcal bacteria are more easily spread than meningococcal bacteria, and are passed on through coughing and sneezing. However, in most cases, they only cause mild infections, such as a middle ear infection (otitis media).

Viral meningitis

As in the case of bacterial meningitis, vaccination programmes have successfully eliminated the threat from many viruses that used to cause viral meningitis.

For example, the measles, mumps and rubella (MMR) vaccine provides children with immunity against mumps, which was once a leading cause of viral meningitis in children.

However, there are still a number of viruses that can cause viral meningitis. These include:


enteroviruses – a group of viruses that usually only cause a mild stomach infection, and can be spread through coughing, sneezing or not washing your hands after touching a contaminated surface

herpes simplex virus – which can cause genital herpes and cold sores


During a meningitis infection

In most meningitis infections, bacteria or viruses spread through the blood. An infection can begin in one part of the body, such as your throat or lungs, before moving through the tissue and into the blood.

The brain is usually protected from infection by the blood-brain barrier, which is a thick membrane that filters out impurities from the blood before allowing it into the brain. However, in some people, the infection is able to pass through the blood-brain barrier and infect the meninges (brain membrane).

The immune system responds to the infection by causing the meninges to swell in an attempt to stop the spread of infection. The swollen meninges may then damage the brain and the rest of the nervous system (nerves and spinal cord).

Bacteria or viruses can also infect the cerebrospinal fluid (CSF) that surrounds and supports the brain and spinal cord. If the CSF becomes infected, it can cause the meninges to become more swollen, leading to increased pressure in the skull and pressing on the brain. This is known as intracranial pressure.

Diagnosing meningitis 

Meningitis can be difficult to diagnose.

It usually comes on suddenly and can be confused with flu because many of the symptoms are the same.

Seek immediate medical help if you notice any of the signs and symptoms of meningitis, particularly in a young child.

This may mean going to your local accident and emergency (A&E) department in the middle of the night. Don't wait for the purple rash to appear, because not everyone gets a rash.

A suspected case of meningitis should always be treated seriously. If you're not sure whether it's meningitis, you can get more advice by calling:


your GP, practice nurse or health visitor

111

the Meningitis Research Foundation on 080 8800 3344 FREE

Meningitis Now on 0808 80 10 388 FREE


Both of the above charities run a 24-hour freephone helpline. The Meningitis Trust also have a free meningitis signs and symptoms iPhone app that you can download.

Confirming the diagnosis

If meningitis is suspected, treatment will usually begin before the diagnosis has been confirmed. This is because some of the tests can take several hours to complete, and it could be dangerous to delay treatment.

The doctors will carry out a physical examination to look for signs of meningitis or septicaemia (blood poisoning), such as a rash. They will also carry out tests to confirm the diagnosis.

Diagnostic tests for meningitis may include:


a blood test – to check for the presence of bacteria or viruses that can cause meningitis

a lumbar puncture – where a sample of cerebrospinal fluid (CSF) is taken from the base of the spine under local anaesthetic and checked for the presence of bacteria or viruses

a computerised tomography (CT) scan – if there are any other suspected problems, such as brain damage

a chest X-ray – to look for signs of infection


Treating meningitis  

Immediate hospital admission is required in cases of suspected meningitis or septicaemia (blood poisoning).

Bacterial meningitis

Someone with bacterial meningitis will require urgent treatment in hospital. If they have severe meningitis, they may need to be treated in an intensive care unit (ICU).

Antibiotics will be used to treat the underlying infection. These can be given intravenously (through a vein in your arm). At the same time, you may also be given:


oxygen

intravenous fluids

steroids or other medication to help reduce the swelling around your brain


If the antibiotics are effective, you'll need to be in hospital for about a week. However, if you're severely ill, you may need to stay in hospital for several weeks or even months.

Meningococcal disease (either meningitis or septicaemia due to Neissaria meningitidis) can cause some long-term complications. 

Viral meningitis

Viral meningitis can either be mild or severe. The treatment for both severities is described below.

Mild viral meningitis

Most people with viral meningitis won't require hospital treatment. Viral meningitis is usually mild and can be treated at home with:


plenty of rest

painkillers for the headache

anti-emetics (anti-sickness) medicine for the vomiting


Most people take between 5 and 14 days to recover.

Severe viral meningitis

If the symptoms of viral meningitis are severe enough to require hospital admission, antibiotics will be given until the cause of the symptoms is known.

However, once a diagnosis of viral meningitis has been confirmed, the antibiotics will be stopped, as they have no effect on viruses. However, intravenous fluids will be given to help the body recover.

In very severe cases, where someone is in hospital with viral meningitis, anti-viral medicines may be given.

Infection control

Most cases of meningitis are isolated, and the risk of the infection spreading is low.

However, if someone is thought to be at high risk of infection, they may be given a dose of antibiotics as a precautionary measure.

This could be, for example, a young child who has been in close contact with another child who has developed bacterial meningitis.

Complications of meningitis 

Bacterial meningitis can place tremendous strain on the body and the brain.

It's estimated that a quarter of people with meningococcal disease (meningitis or blood poisoning caused by Neisseria meningitidis) will have complications.

Complications can vary in severity from person to person, and can be temporary or permanent.

The more severe a meningitis infection is, the greater the likelihood of complications. Complications are more common after bacterial meningitis and rare after viral meningitis.

Possible complications include:


hearing loss – which may be partial or total

problems with memory and concentration

co-ordination and balance problems

learning difficulties and behavioural problems – which may be temporary or permanent

epilepsy – a condition that causes repeated seizures (fits)

cerebral palsy – a general term for a number of neurological conditions that affect movement and co-ordination

speech problems

vision loss – which may be partial or total


Hearing loss

As hearing loss is the most common complication of meningitis, people recovering from the condition will usually have a hearing test. The test should be carried out before you're discharged, or within four weeks of being well enough to have the test.

Children and young people should discuss the results of their hearing test with a paediatrician (a doctor who specialises in treating children). This should take place between four and six weeks after being discharged from hospital. In cases where hearing is severely affected, cochlear implants (small devices inserted into the ears to improve hearing) may be needed.

Gangrene

If bacteria have entered the blood, they can produce toxins that kill healthy tissue. If the tissue damage is severe, it will die and become gangrenous.

Gangrenous tissue will need to be surgically removed in a procedure called debridement. In the most severe cases, it may be necessary to amputate a whole body part such as a finger, toe or a limb (arm or leg).

Intensive care

Being treated in intensive care for several weeks can sometimes cause complications. Some common problems people have reported after leaving an intensive care unit include:


feeling weak and tired

having a weak voice

feeling depressed


Psychological effects

Having meningitis can be a traumatic experience, particularly for young children. People often experience psychological effects and behavioural changes.

Possible psychological effects include:


becoming "clingy" and needing to be near a loved one – for example, a child may feel anxious when they're not with a parent

bedwetting

disturbed sleep

nightmares

moodiness

aggression or irritability

feeling dejected or hopeless

temper tantrums

developing a fear of doctors and hospitals


These effects should improve with time as you or your child recover, but some people may need additional therapy to cope.

Talk to your GP if you're anxious about your child's behaviour, or if you're having psychological problems.

They may be able to refer you to mental health services for treatment, such as counselling, or they may refer your child to a child psychologist (a specialist in assessing and treating mental health conditions in children).

Getting support

If you or your family has been affected by meningitis, further information and support is available from charities such as the Meningitis Research Foundation – 080 8800 3344 FREE – and Meningitis Now – 0808 80 10 388 FREE. Both charities run a 24-hour freephone helpline.

Meningitis vaccination 

There are a number of vaccines that can prevent many types of viral and bacterial meningitis.

The vaccines available include:


the MMR vaccine (which protects against measles, mumps and rubella) 

the meningitis C vaccine

the 5-in-1 vaccine – which provides protection against diphtheria, tetanus, whooping cough (pertussis), polio and Hib (Haemophilus influenzae type b)

the pneumococcal vaccine


Children should receive these vaccines as part of the  vaccination schedule. Speak to your GP if you're not sure whether your vaccinations are up-to-date.

Meningitis B vaccine

In 2013, a new meningitis B vaccine called Bexsero was approved for use by the European Medicines Agency (EMA).

In March 2014, the government's Joint Committee on Vaccination and Immunisation (JCVI), recommended routine use of the meningitis B vaccine in the UK.

The JCVI has said that the vaccine should be offered to babies at 2, 4 and 12 months of age. However, a number of issues, such as cost and supply, still need to be addressed, so it's likely to be a number of months before the vaccine is introduced.

Meningitis research

The Meningitis Research Foundation and Meningitis Now (formed when the Meningitis Trust and Meningitis UK merged) are charities that fund research into developing meningitis vaccines.