Following the recent deaths from a meningitis-related disease of two Ohio teens, parents across the country have become increasingly concerned about meningitis and how it is spread. And with good reason. About 5,800 cases of bacterial meningitis occur annually in the United States, involving very young children as well as high school and college students, according to the Meningitis Foundation of America (MFA).
"Meningitis is an illness that strikes fear and worry in all pediatricians," says Christine Curtis, M.D., a pediatrician in Manhattan Beach, Calif. "It is a rare illness, but the pain, suffering and serious consequences to patients and families are so high."
Fortunately, vaccines -- including a new one released in the United States less than two years ago -- have been tremendously helpful in preventing meningitis. Here are the facts.
What Is Meningitis?
Meningitis is a serious infection that causes inflammation of the membranes that cover the brain and spinal cord. Except in rare cases, it is caused by either viruses or bacteria.
Approximately 20 percent of pneumococcal meningitis and 3 percent of meningococcal meningitis cases end in death, the MFA reports. And about 16 percent of all bacterial meningitis cases result in lasting effects such as those mentioned above.
Symptoms of both viral and bacterial meningitis include fever, headache and neck stiffness. Nausea, vomiting, drowsiness and general malaise also may occur. With viral meningitis, symptoms are generally milder and flu-like. With bacterial meningitis, symptoms develop quickly, sometimes over a few hours, and may be followed by drowsiness or loss of consciousness. With meningococcal meningitis, a deep-red or purple rash can appear, which may signal blood poisoning.
Anyone who spends a great deal of time in group settings, such as children in day care, students living in dormitories and even nursing-home residents, may be at increased risk for meningitis. Young children are more susceptible to bacterial meningitis than any other group, according to the MFA.
The bacteria and viruses that cause meningitis are spread through coughing, sneezing, kissing, sharing drinking glasses, etc. The bacteria can’t be transmitted through the air or by casual contact.
Of course, babies and toddlers in a group setting will always share a certain amount of saliva. And teens and young adults will always be interested in kissing. But parents can help educate their children, from an early age, about covering coughs and sneezes and about not sharing drinking cups, utensils, etc.
Diagnosis and Treatment
Early diagnosis and treatment are crucial. A lumbar puncture (also known as a spinal tap) is the only definitive way to diagnose meningitis, according to the MFA. No specific treatments exist for viral meningitis except for supportive care in treating symptoms, notes Curtis. But recovery is usually rapid and without side effects. Bacterial meningitis can be treated with antibiotics, but treatment must be started as soon as possible to prevent permanent damage or death.
Pneumococcal meningitis is becoming more and more difficult to treat because many strains of pneumococcus are becoming increasingly antibiotic-resistant. This is yet another reason for all of us to make sure we take antibiotics only when needed.
For several decades, Haemophilus influenza type b (Hib) was the leading cause of bacterial meningitis in the United States, according to the MFA. Since the introduction of the Hib vaccine about a decade ago, however, Hib-related meningitis has decreased by 94 percent.
Now, the leading cause of bacterial meningitis is Streptococcus pneumoniae, or pneumococcus. Prevnar, which was approved by the U.S. Food and Drug Administration in February 2000, is the first vaccine designed to prevent infants and young children from getting invasive pneumococcal disease. For older children who are at high risk, there is a different vaccine, called 23 valent pneumococcal vaccine, that can be given. Your doctor can tell you which vaccine is appropriate for your child.
The American Academy of Pediatrics (AAP) recommends that all children 23 months of age and younger be immunized with Prevnar. It should be given at 2, 4, 6 and 12 to 15 months. (It can be given along with other recommended childhood vaccines.) The number of doses required will change if vaccination begins after a child is 2 months old. Ask your child’s doctor for the appropriate immunization schedule.
The AAP also notes that children ages 24 through 59 months who are at increased risk for infection also should be immunized. This includes children whose immune systems may be compromised. The MFA also recommends Prevnar for children in group-care settings such as day care and preschool. Approximately 60 percent of all U.S. children under age 6 are in some form of group child care, according to the National Child Care Association, which also recommends the vaccine. If Prevnar is first given between ages 24 months and 59 months, only one vaccination is recommended, says Curtis.
The Prevnar vaccine, which costs about $85 per dose, is generally covered by insurance for children ages 2 months through 59 months, according to Curtis. After that age, parents may still request the vaccine for their child, but they must pay the full cost. If your child is older than 59 months, talk with her doctor to determine if he or she should receive the vaccine.
Currently, no booster shot is recommended after the initial vaccination series (or single vaccination, for children over age 2), says Curtis. But researchers will continue testing the original 36,000 children who were involved in the clinical trials that began nine years ago to ensure that they remain protected, she notes.
In the United States, more than 1,400 children age 5 and younger are infected with pneumococcal meningitis each year, according to the MFA. "Children are among those at highest risk for invasive pneumococcal disease," says Carla Newby, the MFA’s general manager.
Newby’s personal experience with the infection ended in tragedy. "I lost my son Jacob to meningitis less than two years ago," she says. Jacob was 6 years old. "This vaccine can help protect children and their families from a disease that can cause tremendous pain and suffering."
Because it has been less than two years since the Prevnar vaccine was approved, some parents are, understandably, concerned about its track record.
"The vaccine has been tested for over nine years, with 36,000 children, and has been found safe," says Curtis. In clinical trials, Prevnar was associated with only mild reactions, according to the U.S. Centers for Disease Control and Prevention. Up to 30 percent of the children had redness, tenderness or swelling at the injection site. About one in 10 had a mild fever.
The risk of the vaccine causing serious harm is extremely small, according to the CDC, which notes that any vaccine can potentially cause a serious allergic reaction. If your child exhibits an allergic reaction, high fever or unusual behavior after vaccination, contact your doctor.
Vaccination for Older Teens & Adults
Another significant cause of bacterial meningitis is meningococcus. The MFA recommends that all young adults, ages 18 to 22, receive the Menomune vaccine, which protects against several strains of meningococcal meningitis. This is the vaccine that currently is being offered to high school and college students at many campus health centers across the country.
The Menomune vaccine is especially important for those students entering college and living in dormitory settings, says Curtis. It also may be recommended for travelers to Africa and other high-risk areas. Protection lasts three to five years.
Young children are susceptible to meningococcal meningitis, too, according to the MFA. But currently the only meningococcal vaccine available in the United States, the Menomune vaccine, isn’t very effective in children younger than age 2. Technically, the vaccine can be given to a child over 2 years old, Curtis notes. But it is not currently given to children this age because a young child’s risk for this type of meningitis is too low, she says.