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Meningitis / Meningococcal disease

"Meningitis" is an infection of the meninges, the membranes that surround the brain and spinal cord.  Bacteria, viruses, and parasites alike can cause meningitis with varying degrees of severity, and indeed, when one has viral meningitis, the illness generally is mild and self-limited and usually causes nothing more than a bad headache and a somewhat stiff neck.  Bacterial meningitis, however, is much more severe and can lead to brain damage and even death.  Several bacteria are known to cause bacterial meningitis, including pneumococcus, Haemophilus influenzae type B, and meningococcus.  All three bacteria, in fact, cause not just meningitis but also blood infections, pneumonia, and many other "invasive" infections.  Fortunately we immunize against the first two bacteria with the Prevnar and Hib vaccines, which is why we generally do not see bacterial meningitis and invasive bacterial disease any more in childhood.

Nowadays when we hear about "meningitis" in the news, it is usually meningococcal disease.  Meningococcal disease is extremely rare--the incidence is 0.8 to 1.3 /100,000 people, some of which will be meningitis and some of which may be "meningococcemia", a blood infection.  However, when meningococcal disease occurs, it is fulminant and may be very rapidly fatal, sometimes under 24 hours.  Currently the death rate is 10%, with a significant portion of the survivors (11-19%) having permanent disabilities.  Meningococcal disease is most prevalent under one year of age, then rises again for 15-24 year olds.

Bacterial meningitis, whether it is caused by meningococcus or another bacteria, presents with a fever, headache, stiff neck, and irritability.  Vomiting is frequently present as well.  Keep in mind that meningococcus disease may not present as meningitis, however; if it presents as a blood infection (meningococcemia), the initial signs will be fever and extreme irritability, but may be very nonspecific.  Meningococcal disease can be treated with antibiotics as long as it is diagnosed quickly, which can be difficult.  A child who is seriously ill will not drink, will not smile, and cannot be comforted.  If your child is drinking and smiling when the fever is brought down with Tylenol or Motrin, your child is extremely unlikely to have meningococcal disease.

Meningococcal disease tends to present in clusters, including the military, colleges, families, and child care settings.  Close contacts of a person with meningococcal disease will receive antibiotics to prevent the illness.  The illness is passed through close contact with a person's respiratory passages--you have to be next to an infected person's face to be at risk.  Meningococcal disease is a reportable illness and public health officials make recommendations for treating close contacts with any illness.  If your child is at school with a child who comes down with meningococcal disease, your child would receive antibiotics if he or she was in the same classroom with the infected child; if your child is in another class--even if it is next door--your child is not at any increased risk for becoming sick.

There is one vaccine for meningococcus , Menactra, that protects against four of the five serotypes of meningococcus that cause disease and thus overall reduce the disease incidence about 80%. Menactra was licensed by the FDA in 2005 and is now recommended by the Centers for Disease Control (CDC) and the American Academy of Pediatrics (AAP). Menactra is now recommended for all adolescents starting at the 11-12 year age range. There is also a booster recommended for all adolescents at age 16.  The vaccine is also currently approved for children two and older who have a damaged spleen or have had their spleen removed as well as those children with an immune deficiency.  Vaccine side effects are minor and include low grade fever and soreness at the injection site.

American Academy of Pediatrics meningococcus vaccine recommendation

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