Meningitis: what you can do to safeguard your family

Virtually every year, there are reports of a meningitis ‘outbreak' - the South African Medical Association's chairman, Professor Denise White, says that meningitis, which surfaces every year at around the same time, is actually in decline: "According to the National Department of Health, there has been a steady decline in meningitis cases in the past few years with 35 cases reported countrywide this year, compared to 50 reported countrywide between January and March last year. In Gauteng, there were 31 cases last year. There had been 12 so far this year." But when there are news stories about deaths, an understandable panic ensues.

It is very often teenagers and children who die, as bacterial meningitis is more likely to strike them. So parents would be wise to read up on the disease and find out what to look out for and how to give their children the best chance of surviving the disease if he or she should be infected.

• What is meningitis?
Essentially, meningitis is an infection of the fluid that cushions the spinal cord and the brain (it is named for the meninges, the membranes which surround and enclose the central nervous system). There are in fact two kinds of meningitis: viral and bacterial. The viral sort is generally not too severe and will clear up without anything more than treatment of the symptoms. It's the bacterial meningitis, which can result in disability (such as hearing loss or brain damage) or even death. “It's important to realise that this is a very serious disease which has a death rate, everywhere in the world, irrespective of the quality of medical care, of between 6% and 10%,” says Dr Pete Vincent of Netcare Travel Clinics.

When doctors see a patient who has bacterial meningitis, the first thing they'll do is find out (by taking some of the spinal fluid) what kind of bacteria is causing this particular case; the more they know about the bacteria involved, the better they can tailor the treatment.

The commonest bacterium involved is Neisseria meningitidis, but it can be caused by Streptococcus pneumoniae as well. (There's another bacterium, Haemophilus influenzae, which usually causes meningitis, but most children are now vaccinated against it.)

Eighteen out of every hundred people you encounter have Neisseria meningitidis living in their nasal passages, and you can be infected by it if you come into contact with their nasal secretions (maybe through kissing or coughing). The bacteria are contagious (you have to have physical contact with the bodily fluids) rather than infectious (where the bacteria spread through air).

This begs the question: if so many people have the bacteria, how come meningitis is not much more common? Well, the development of bacterial meningitis does not automatically follow an infection. Infection is more likely to progress to become meningitis when certain risk factors are present:

- A pre-existing infection of the upper respiratory tract (so during the ‘meningitis season' in South Africa, it might be an idea to keep a child with a cough or cold at home until the infection has cleared up)
- Active and passive smoking (parents who smoke put their children at greater risk - a huge incentive to give up!)
- Crowded conditions, especially when people experience these conditions for the first time - so be on the alert when your child first starts at nursery school, for example, or a teenager heads for boarding school or a university residence
- Existing physical depletion, such as reduced immune function.

What are the signs and symptoms of meningitis?

“The noticeable thing about bacterial meningitis is how quickly it develops,” says Dr Vincent. “Symptoms appear and get worse within hours, or at most one to two days.” Symptoms could include:

- A really bad headache
- Joint and muscle pain
- Vomiting
- In young children, irritability is often a feature
- Light hurts the patient's eyes
- The neck is stiff
- There's a fever
- The patient may get a rash known as a petechial rash (red/purple blotches which don't go white under pressure)
- Seizures occur in 40% of children with meningitis, typically during the first few days.

Small children may not get the fever, headache, and neck stiffness; the baby may instead be irritable and fussy, lethargic and not feeding.

Do something!

“Meningitis is so serious that parents should not hesitate to take their child to a doctor or hospital and demand immediate treatment,” says Dr Vincent. “If treated early with antibiotics appropriate to the specific bacteria involved, your child has a very good chance of surviving unharmed.” The quicker the action, the better the outcome!

When there is an ‘outbreak' of meningitis in an area or in a school, as we've often seen in South Africa, people in the community quite understandably demand that the health authorities ‘do something!'

Proactive health departments do immediately start prophylactic antibiotic treatment for people who have been in what is called ‘close contact' with the patients. In school, that would be good friends who share eating utensils, for instance; at home, it will be people living in the same house, and anyone who might have been exposed to the patient's nasal secretions. But since the bacteria does not spread through the air or casual contact, it's not necessary to treat people who haven't been exposed to nasal fluids.

• What about vaccination?

South Africa will shortly start including a new vaccination in its routine vaccinations of babies which will protect against Streptococcus pneumoniae (this is not recommended for use in older children or grown-ups). There are vaccines available for certain of the Neisseria meningitides strains, but not all (serogroup B is not covered), and they don't work for children under the age of two.

There is as yet nothing that can fully protect people against all the kinds and all the strains of the bacteria that can cause this disease. So it remains important for all South Africans to be vigilant and get swift medical treatment when symptoms appear.

Your travel-health lifeline

Please do not hesitate to contact your nearest Netcare Travel Clinic should you have any queries or questions regarding travel-health related topics. You may also visit our website on www.travelclinic.co.za or email .

Netcare Travel Clinics

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Tel: +27 11 898 6509

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