April 24, 2019- World Meningitis Day

A note from the author— Happy Spring NCP friends! The month of April is known for World Health Awarness, which means addressing health problems that are widespread/ have great impacts on populations all over the world, not just health problems common on a national or regional level. This month, I wanted to feature a global health awareness topic that is celebrated on April 24th each year, World Meningitis Day. Many people have heard of the disease “meningitis”, but the severity of the disease is not always well- understood. Meningitis can be found in all countries and kills millions. Celebrate with us this month by learning more and spreading the word about Meningitis. What is Meningitis? Meningitis is a relatively rare infection that affects the delicate membranes -- called meninges (men-in'-jeez) -- that cover the brain and spinal cord. Meningitis is the inflammation of the fluid and membranes that cover the brain and spinal cord.

There are three main types of meningitis infection: bacterial, viral, and fungal. Bacterial

meningitis can be contagious among people in close contact. Viral meningitis tends to be less severe, and most people recover completely. Fungal meningitis is a rare form of meningitis and generally occurs only in people with weakened immune systems.

Bacterial: Bacterial meningitis is aggressive, develops quickly and can lead to

permanent disability or death in a matter of hours. It is fatal in approximately 50% of cases and accounts for around 170,000 deaths around the world each year. Most cases of bacterial meningitis are caused by one of the following bacteria: meningococcus, pneumococcus, or Haemophilus Influenzae Type B (Hib).

Septicemia is a potentially life-threatening infection that occurs when the bacteria that cause meningitis get into the bloodstream. The infection may be seen alone or in addition to meningitis.

Other bacteria that can cause meningitis include E. coli, Group B Strep (common causes of neonatal meningitis) and Mycobacteria tuberculosis (TB).

It is believed that 10-20% of the population carries the meningitis bacteria

at any one time, but it will only develop into the disease in susceptible people. The infection spreads from person to person through respiratory droplets (kissing, coughing, sneezing, sharing food or utensils).

Children who attend day-care or preschool are at greater risk of contracting bacterial meningitis. There are vaccines available for many types of bacterial meningitis.

Viral: Viral meningitis is the most common but least severe type. Almost all

patients recover without any permanent damage, although full recovery can take many weeks. It is most often spread through respiratory droplets (kissing, coughing, sneezing, sharing food or utensils) or fecal contamination. Elderly people and those with conditions that affect their immune system are more at risk.

There are no vaccines available for viral meningitis, but washing hands thoroughly and keeping surfaces clean can help prevent the disease.

Fungal/ environmental:

Fungal meningitis causes severe infections but occurs much less frequently. It is not contagious and spreads by inhaling fungal spores from the environment.

Other It is also possible to contract meningitis from parasites or through non-

infectious means like cancers, lupus, certain drugs, head injuries, brain surgery, or an existing condition of the skull or spine.

Who can contract Meningitis? Anyone of any age can get meningitis or septicemia, but various factors can increase the risk. Geographical location - some countries have higher rates of meningitis and

septicemia than others. For example, many kinds of meningitis are much more common in developing countries than elsewhere. The only way to address this is through vaccination.

Environmental factors - exposure to smoke, for example, can make you more susceptible to infection.

Living in a community setting - College students living in dormitories, personnel on

military bases, and children in boarding schools and child care facilities are at increased risk of meningococcal meningitis. This increased risk likely occurs because the bacterium is spread by the respiratory route and tends to spread quickly wherever large groups congregate.

Medical conditions and immunodeficiencies- Factors that may compromise your immune system — including AIDS, alcoholism, diabetes and use of immunosuppressant drugs — also make you more susceptible to meningitis. Removal of your spleen, an important part of your immune system, also may increase your risk.

Pregnancy- if you are pregnant, you are at increased risk for contracting listeriosis, in infection caused by Listeria bacteria, which also may cause meningitis. If you have listeriosis, your unborn baby is at risk too.

Skipping vaccinations- If you or your child hasn't completed the recommended childhood or adult vaccination schedule, the risk of meningitis is higher.

Age is one of the main risk factors- most cases of viral meningitis occur in children younger than age 5. Bacterial meningitis commonly affects people under 20, especially those living in community settings.

o Infants Babies are at higher risk of bacterial meningitis than any other age

group. They can get all of the main types of meningitis and septicemia, including meningococcal pneumococcal and Hib.

The introduction of vaccines against some of these infections has

decreased the risk to babies, but there are still types of meningitis and septicemia for which there is no vaccine. So it is important to know the symptoms in babies and to protect your baby as much as possible through immunization. In the UK and Ireland, every routine injection offered to babies in the immunization schedule protects against meningitis. Newborn babies are also particularly susceptible to meningitis caused by other types of bacteria such as GBS, E. coli and Listeria.

o Toddlers Toddlers are also at increased risk of meningitis, although the risk is not

as high as in babies. Baby and toddler immune systems are still developing and this is why they are more likely to be infected than older children and adults when they encounter the bacteria.

o Young adults Teenagers and young adults are at risk mainly from meningococcal

disease. The introduction of the MenC vaccine has dramatically reduced cases of Group C meningococcal meningitis and septicemia.

However, Group B and other rarer types of meningococcal disease continue to cause cases in teenagers. If you are going off to college and have not already had the MenC vaccine, make sure you get vaccinated.

Complications of Meningitis The complications of meningitis can be severe. The longer you or your child has the disease without treatment, the greater the risk of seizures and permanent neurological damage, including: Hearing loss Memory difficulty Learning disabilities Brain damage Gait problems Seizures Kidney failure Shock Death

Symptoms of Meningitis Meningitis can be hard to recognize in the early stages. Symptoms can be similar to those of the common flu and can develop quickly, over a matter of hours.

The main symptoms to look out for are: fever, vomiting, headache, stiff neck, sensitivity to light, and drowsiness or altered consciousness. The signs and symptoms do not appear in a definite order and some may not appear at all. Most common symptoms of meningitis include: Arching of the back (infants) Behavioral changes Blank, staring expression Bulging fontanelle (infants) Cold hands and feet Diarrhea Dislike of being handled (infants) Drowsy or difficult to wake Fever Irritability Listless, less responsive Loss of appetite, refusing food (infants) Muscle, leg or joint pain Neck retraction with arching of the back (infants) Pale or blotchy skin Rash or spots that don’t fade with pressure (also called purpure orpetechiae)* Rapid breathing Seizures, fits or convulsions

Sensitivity to light Severe headache Stiff neck Unusual high-pitched cry (infants) Vomiting

Other common signs of meningitis in infants: Irritable when picked up, with a high pitched or moaning cry A stiff body with jerky movements, or else floppy and lifeless Fever is often absent in babies less than three months of age

Septicemia can occur with or without meningitis. Not everyone gets all the symptoms and they can appear in any order. This symptoms list does not include every possible sign and symptom of meningitis. Contact your local healthcare professional to ask about the most common symptoms in your country. Speak to your local healthcare professional also about the vaccines available in your country to prevent some forms of meningitis. It’s important to know the warning signs and to get medical treatment fast. Until the cause of meningitis is known, it should be regarded as a medical emergency.

When to see a doctor Seek medical care right away if you or someone in your family has signs or symptoms of meningitis, such as: Fever Severe, unrelenting headache Confusion Vomiting Stiff neck

Viral meningitis may improve without treatment, but bacterial meningitis is serious, can come on very quickly and requires prompt antibiotic treatment to improve the chances of a recovery. Delaying treatment for bacterial meningitis increases the risk of permanent brain damage or death. In addition, bacterial meningitis can prove fatal in a matter of days. There's no way to know what kind of meningitis you or your child has without seeing your doctor and undergoing spinal fluid testing. It's also important to talk to your doctor if a family member or someone you work with has meningitis. You may need to take medications to prevent an infection.

Preparing for your appointment Depending on the cause, meningitis can be life-threatening. If you've been exposed to someone with bacterial meningitis and you develop symptoms, go to an emergency room and let medical staff know you may have meningitis. If you're not sure what you have and call your doctor for an appointment, here's how to prepare for your visit.

What you can do Be aware of any pre- or post-appointment restrictions. At the time you make the

appointment, be sure to ask if there's anything you need to do in advance, such as restrict your diet. Also ask if you may need to stay at your doctor's office for observation following your tests.

Write down symptoms you're having, including changes in your mood, thinking or behavior. Note when you developed each symptom and whether you had cold or flu-like symptoms.

Write down key personal information, including any recent moves, vacations or interactions with animals. If you're a college student, your doctor likely will ask questions about any similar signs or symptoms in your roommates and dorm mates. Your doctor will also want to know your vaccination history.

Make a list of all medications, vitamins or supplements you're taking. Take a family member or friend along. Meningitis can be a medical emergency.

Take someone who can help remember all the information your doctor provides and who can stay with you if you need immediate treatment.

Write down questions to ask your doctor.

For meningitis, some basic questions to ask your doctor include: What kinds of tests do I need? What treatment do you recommend? Am I at risk of long-term complications? If my condition is not treatable with antibiotics, what can I do to help my body

recover? Am I contagious? Do I need to be isolated? What is the risk to my family? Should they take preventive medication? Is there a generic alternative to the prescription medicine you're recommending? Do you have any printed information I can have? What websites do you

recommend?

What to expect from your doctor Your doctor is likely to ask you a number of questions, such as: When did you begin experiencing symptoms? How severe are your symptoms? Do they seem to be getting worse? Does anything seem to improve your symptoms? Have you been exposed to anyone with meningitis? Does anyone in your household have similar symptoms? What is your vaccination history? Do you take any immunosuppressant medications? Do you have other health problems, including allergies to any medications?

What you can do in the meantime When you call your doctor's office for an appointment, describe the type and severity of your symptoms. If your doctor says you don't need to come in immediately, rest as much as possible while you're waiting for your appointment. Drink plenty of fluids and take acetaminophen (Tylenol, others) to reduce your fever and body aches. Avoid aspirin and drugs called nonsteroidal anti-inflammatory medications, which may not be safe for people with untreated meningitis. Also avoid any medications that may make you less alert. Don't go to work or school.

Diagnosing Meningitis Your family doctor or pediatrician can diagnose meningitis based on a medical history, a physical exam and certain diagnostic tests. During the exam, your doctor may check for signs of infection around the head, ears, throat and the skin along the spine. You or your child may undergo the following diagnostic tests: Blood cultures. Blood drawn from a vein is sent to a laboratory and placed in a

special dish to see if it grows microorganisms, particularly bacteria. A sample may also be placed on a slide to which stains are added (Gram's stain), then examined under a microscope for bacteria.

Imaging. X-rays and computerized tomography (CT) scans of the head, chest or sinuses may reveal swelling or inflammation. These tests can also help your doctor look for infection in other areas of the body that may be associated with meningitis.

Spinal tap (lumbar puncture). The definitive diagnosis of meningitis requires an analysis of your cerebrospinal fluid (CSF), which is collected during a procedure known as a spinal tap. In people with meningitis, the CSF fluid often shows a low sugar (glucose) level along with an increased white blood cell count and increased protein. CSF analysis may also help your doctor identify the exact bacterium that's causing the illness. If your doctor suspects viral meningitis, he or she may order a DNA-based test known as a polymerase chain reaction (PCR) amplification or a test to check for antibodies against certain viruses to check for the specific causes of meningitis. This helps to determine proper treatment and prognosis.

Treatment for Meningitis The treatment depends on the type of meningitis contracted.

Bacterial meningitis Acute bacterial meningitis requires prompt treatment with intravenous antibiotics and, more recently, cortisone medications, to ensure recovery and reduce the risk of complications, such as brain swelling and seizures. The antibiotic or combination of antibiotics that your doctor may choose depends on the type of bacteria causing the infection. Your doctor may recommend a broad-spectrum antibiotic until he or she can determine the exact cause of the meningitis. Infected sinuses or mastoids — the bones behind the outer ear that connect to the middle ear — may need to be drained.

Viral meningitis Antibiotics can't cure viral meningitis, and most cases improve on their own in several weeks. Treatment of mild cases of viral meningitis usually includes: Bed rest Plenty of fluids Over-the-counter pain medications to help reduce fever and relieve body aches

If the cause of your meningitis is a herpes virus, an antiviral medication is available.

Other types of meningitis If the cause of your meningitis is unclear, your doctor may start antiviral and antibiotic treatment while a cause is being determined. Fungal meningitis is treated with antifungal medications. However, these medications can have serious side effects, so treatment may be deferred until a laboratory can confirm that the cause is fungal. Chronic meningitis is treated based on the underlying cause, which is often fungal. Noninfectious meningitis due to allergic reaction or autoimmune disease may be treated with cortisone medications. In some cases, no treatment may be required, because the condition can resolve on its own. Cancer-related meningitis requires therapy for the individual cancer.

Prevention of Meningitis Meningitis typically results from contagious infections. Common bacteria or viruses that can cause meningitis can spread through coughing, sneezing, kissing, or sharing eating utensils, a toothbrush or a cigarette. You're also at increased risk if you live or work with someone who has the disease. These steps can help prevent meningitis: Wash your hands. Careful hand-washing is important to avoiding exposure to

infectious agents. Teach your children to wash their hands often, especially before they eat and after using the toilet, spending time in a crowded public place or petting animals. Show them how to wash their hands vigorously, covering both the front and back of each hand with soap and rinsing thoroughly under running water.

Practice good hygiene. Don't share drinks, foods, straws, eating utensils, lip balms or toothbrushes with anyone else. Teach children and teens to avoid sharing these items too.

Stay healthy. Maintain your immune system by getting enough rest, exercising regularly, and eating a healthy diet with plenty of fresh fruits, vegetables and whole grains.

Cover your mouth. When you need to cough or sneeze, be sure to cover your mouth and nose.

If you're pregnant, take care with food. Reduce your risk of listeriosis if you're pregnant by cooking meat, including hot dogs and deli meat, to 165 F (74 C), and avoiding soft cheeses made from unpasteurized milk, including feta, queso, Brie and Camembert. Don't eat these types of cheeses unless they're clearly labeled that they were made with pasteurized milk.

Immunizations—THE KEY TO PREVENTION Since bacterial meningitis is the most deadly and debilitating form of meningitis, it is important to vaccinate those at high risk for contracting this disease (i.e. children under 5, adolescents) Some forms of bacterial meningitis are preventable with the following vaccinations: Haemophilus influenzae type b (Hib) vaccine. Children in the United States

routinely receive this vaccine as part of the recommended schedule of vaccines, starting at about 2 months of age. The vaccine is also recommended for some adults, including those who have sickle cell disease or AIDS and those who don't have a spleen.

Pneumococcal conjugate vaccine (PCV7). This vaccine also is part of the regular immunization schedule for children younger than 2 years in the United States. In addition, it's recommended for children between the ages of 2 and 5 who are at high risk of pneumococcal disease, including children who have chronic heart or lung disease or cancer.

Haemophilus influenzae type b and Neisseria meningitidis serogroups C and Y vaccine (Hib-MenCY). This vaccine is recommended for children younger than 19 months, but not younger than 6 weeks, who are at high risk of meningococcal disease. This includes children with an improperly functioning spleen and sickle cell anemia. The vaccine is given in four doses, at age 2 months, 4 months, 6 months, and between ages 12 months and 15 months.

Pneumococcal polysaccharide vaccine (PPSV). Older children and adults who need protection from pneumococcal bacteria may receive this vaccine. The Centers for Disease Control and Prevention recommends the PPSV vaccine for all adults older than 65, for younger adults and children who have weak immune systems or chronic illnesses such as heart disease, diabetes or sickle cell anemia, and for those who don't have a spleen.

Meningococcal conjugate vaccine (MCV4). The Centers for Disease Control and Prevention recommends that a single dose of MCV4 be given to children ages 11 to 12, with a booster shot given at age 16. If the vaccine is first given between ages 13

and 15, the booster shot is recommended between 16 and 18. If the first shot is given at 16 or older, no booster is necessary.

This vaccine can also be given to younger children who are at high risk of bacterial meningitis or who have been exposed to someone with the disease. It's approved for use in children as young as 9 months old. It's also used to vaccinate healthy people who have been exposed in outbreaks but have not been previously vaccinated.

Resources https://www.healthline.com/health/meningitis http://www.comomeningitis.org/facts-about-meningitis/types-of-meningitis/ https://medicomhealth.com/health-observance/world-meningitis-day/

http://www.who.int/campaigns/immunization-week/2015/en/ http://www.realhealthmag.com/calendar/index.shtml http://www.meningitis.org/ http://www.mayoclinic.org/diseases-conditions/meningitis/basics/symptoms/con-20019713 http://www.webmd.com/a-to-z-guides/understanding-meningitis-basics