Meningitis

Meningitis: The word may stimulate fear and anxiety. And it should--although it is a relatively uncommon condition, meningitis can have very serious consequences, and childcare providers should be informed about it.

The meninges are membranes around the brain and spinal cord that contain the spinal (or cerebrospinal) fluid, bathing the brain and cord. Inflammation of the meninges and of the spinal fluid is called meningitis. If the brain also is involved, it is called "meningoencephalitis." The inflammation may be severe, even life-threatening, or it might only cause a severe headache and fever.

Children from infancy through age five are most commonly affected by meningitis. Child caregivers should be aware of the signs of meningitis: first, the child usually acts sick. Fever is present and can be moderate to high. The child may complain of a bad headache and, in rare cases, that his neck is stiff and hurts when he tries to put his chin to his chest. The child also may be lethargic (sluggish or droopy), even to the point of semi-consciousness. Seizures occasionally occur.

Most cases of meningitis are caused by bacteria or viruses. Bacterial meningitis generally is more serious. In the days before antibiotics, nine out of 10 children with bacterial meningitis died, with most of the survivors being permanently brain damaged. Now, almost all children with bacterial meningitis survive, if they are diagnosed and treated early. Some children are left with damage to the brain that may cause problems such as learning disabilities and hearing loss.

There are three major causes of bacterial meningitis. The most feared is meningococcal meningitis, which races through the child's body, sometimes causing death within a day or two unless treated early. One of the hallmarks of meningococcal meningitis is the appearance of innumerable petechiae, which are tiny hemorrhages beneath the skin, each only about the size of a pinhead.

A second bacterial cause is pneumococcal meningitis, which is the leading cause of meningitis in young children. Penicillin no longer can treat it as before because some strains have become drug resistant. However, we have additional antibiotics to treat this form of disease. Pneumococcal vaccine is recommended for children up to age five in childcare.

The last bacterial cause of meningitis is H. influenzae, Type b, sometimes called Hib or H. flu. In an astounding way, the cases of and the deaths from H. flu meningitis have dropped drastically because of the effectiveness of the Hib immunization given to most children beginning when they are about two months old.

In addition, there are several viral causes of meningitis. Many viruses cause meningoencephalitis, as well. Some viral cases of meningitis can cause serious problems, but most cases are of mild to moderate severity. Unfortunately, there are very few medications effective against any of these viral infections, but most children (and adults) recover well without them.

Transmission of meningitis depends upon the infecting organism. All forms of bacterial meningitis are contagious from person to person. Also, each of the three organisms occasionally can be found in the throats and noses of children, even when no symptoms are present. It is not known why at times these germs change from silent, harmless occupants of the respiratory tract into life-endangering infections in the spinal fluid. For this reason, the local public health department or the health consultant for the childcare program will likely recommend that children in the facility take prophylactic (preventive) antibiotics to protect against the possibility that a child may have acquired the bacteria from the ill child, but not yet show symptoms.

Prevention of illness always is easier than treatment. For example, the widespread use of Hib immunization has been startlingly effective and the new pneumoccal vaccine may be equally effective. For certain high-risk children there is a second pneumococcal vaccine. Likewise, a meningococcal vaccine is available for particular children who are at-risk. These vaccines are available for high risk children (and adults) and not recommended for general use.

For viral forms of meningitis there is no effective medical preventive measure. Practicing good hygiene such as regular and thorough hand washing is the first prevention measure. Also, pay close attention to even minor illnesses and be alert for signs of more serious complications. Many cases of viral meningitis are not transmitted from person to person, but rather are passed on by tick and mosquito bites so appropriate precautions should be taken when children are outdoors, such as wearing long pants and socks, and checking for ticks when you go inside.

If a child is diagnosed with meningitis, the childcare provider should be informed of the specific cause of the disease in order to adequately protect the rest of the children, and to effectively communicate with parents.

By Don Palmer, MD
American Academy of Pediatrics Committee on Early Childhood, Adoption, and Dependent Care

RESOURCES

The Meningitis Foundation of America (MFA), 7155 Shadeland Station, Suite 190, Indianapolis, Indiana 46256-3922; 800-668-1129; www.musa.org

INTERNET RESOURCES

For the following websites, type "meningitis" in the home page's search window:

The American Academy of Pediatrics Medical Library, www.medem.com

The Centers for Disease Control & Prevention (CDC), www.cdc.gov/ncidod/dbmd/diseaseinfo