September 2014 ISSUE

 

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Right Jab
It only hurts for a second. The consequences of meningitis aren’t quite so benign. Why many health experts advocate vaccinating adolescents and young adults against this terrifying disease.

Should you vaccinate your kids against meningitis?

Both the Advisory Committee on Immunization Practices (ACIP) for the Centers for Disease Control and Prevention (CDC) in the US and the American College Health Association recommend that all first-year college students living in dormitories be vaccinated against meningococcal disease, which can lead to meningitis.


The ACIP also suggests vaccinating students entering high school and pre-adolescents, aged 11 to 12.

“Few diagnoses are as frightening to the patient, his or her family, the clinician, and the community as the diagnosis of bacterial meningitis,” comments Dr. Allan R. Tunkel, chair of the Department of Medicine at Monmouth Medical Center in Long Branch, New Jersey.

“Especially given that the disease may strike healthy patients of all ages and can occur in epidemics. However, it is important for the public to recognize that despite these issues, bacterial meningitis is a disease in which the incidence is decreasing relative to the availability of effective vaccines.”

A vaccine for the most common cause of bacterial meningitis, Haemophilus influenzae type b, was licensed for use in the United States in the early 1990s, and has virtually eliminated this strain among those vaccinated.

In 2000, a vaccine was introduced for use against Streptococcus pneumoniae; currently the most common cause of bacterial meningitis, and just last year a vaccine was licensed to combat Neisseria meningitidis.

Unfortunately there is no vaccine for one of the serious strains of Neisseria meningitidis (serogroup B) that causes meningococcal meningitis, which afflicts children and adults with such devastating consequences.

“I am a strong advocate of vaccination,” declares Dr. Tunkel. “Haemophilus influenzae type b conjugate vaccine is administered at two, four and six months of age with a booster at 12-15 months; Streptococcus pneumoniae conjugate vaccine (Prevnar) is a heptavalent vaccine given in the same manner; and Neisseria meningitidis conjugate vaccine, effective against four of the five major serogroups of this organism, is administered as early as 11-12 years of age.”

The specter of bacterial meningitis calls for vigilance, not fear.

Lives can be saved if people know how to respond when signs of this menacing syndrome appear. Protocols for the diagnosis and treatment of bacterial meningitis are firmly established, so the odds favor survival.

The one variable in the equation is time—the faster therapy gets started, the better the likely result.

“Antibiotics should be administered even before a CAT scan is done,” says Dr. Tunkel.

“If you wait for the results and delay antibiotics the outcome is likely to be worse. Even before obtaining the results from the lumbar puncture, I advise giving antibiotics.”

The organism responsible for bacterial meningitis is ubiquitous, but generally harmless.

For Neisseria meningitidis, Dr. Tunkel reports that an estimated 30 per cent of all teenagers and 10 per cent of the adult population carry the organism in their upper respiratory tract at any one point in time. For reasons not entirely understood, particularly virulent strains of the organism are acquired and invade the blood stream and central nervous system.

Lumbar puncture, the extraction of fluid that surrounds the spinal cord is used to diagnose bacterial meningitis. A culture is then performed to determine the type of bacteria responsible for the infection so that the appropriate antibiotics can be administered.

There are some risks associated with a lumbar puncture, which often arouses as much fear in people as meningitis.

“Lumbar puncture is critically important in establishing the diagnosis, and is the only way to do so definitively,” explains Dr. Tunkel. “When performing a lumbar puncture, the spinal needle is inserted between the third and fourth lumbar vertebrae, below the level of the spinal cord, so there is not a risk of paralysis in performance of lumbar puncture. The main side effect is headache (about 10-25 per cent of patients), which is usually self-limited. Sometimes patients may develop persistent pain or numbness, local bleeding, or local infection but these are rare. The most important side effect to be concerned about is the possibility of brain herniation, which is very rare, but can be fatal. This can be avoided by carefully evaluating the patient for certain risk factors and physical exam findings. However, despite these concerns, it is important to establish the diagnosis because if bacterial meningitis is present, antibiotics need to be administered at higher doses than for other types of infections and other adjunctive therapies may need to be administered.”

The organism responsible for some virulent cases of meningitis is Neisseria meningitidis, which is commonly associated with outbreaks of the disease on college campuses and schools and is the main cause of bacterial meningitis among adolescents and young adults in the US.

It’s important to know that an infected person with this type of meningitis poses risk to others, but only through direct contact. Anyone who has had intimate contact with a person diagnosed with a strain of Neisseria meningitides should receive antimicrobial therapy.

An estimated 1,400 to 3,000 cases occur each year among Americans, accounting for approximately 150 to 300 deaths.

“The concern with bacterial meningitis,” comments Dr. Tunkel, “is that it attacks healthy people. You don’t have to have a compromised immune system. It’s an infection that can kill.”

Bugaboo:

Close attention should always be given to any flu-like symptoms, which are very similar to bacterial meningitis, at least in the beginning phase of the ailment. Here’s what you can expect with the onset of bacterial meningitis:
  • Fever and headache.
  • Stiff neck, which is a critical indicator.
  • Fatigue and lethargy.
  • Altered mentation or thinking.
  • Leg rash.
  • On a sobering note, bacterial meningitis can unfold so rapidly that not all of symptoms listed above may even appear.
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