I have given my talk on vaccinations on a number of occasions. One of the points I used to make was that “we are living in a kind of a post-apocalyptic world. The devastating effects of many diseases are not evident in society, so the fear surrounding certain vaccine-preventable diseases is far removed from our minds”.
The health of our youngsters had lulled us into a false sense of security until we became aware of the measles outbreaks in the UK and America in 2018 and 2019 respectively. COVID-19 has violently shaken us into an awareness of a world where there is no vaccine to protect us. The effects of a disease let loose on our society glare at us from all forms of media.
Amid this turmoil, 24 April has been declared “World Meningitis Day”. The theme is #Defeat Meningitis.
Meningitis may be caused by a number of organisms that are usually viral but might be as a result of various bacteria, parasites or fungal infections. The major focus of the awareness day is to highlight meningococcal meningitis in particular. This is bacterial meningitis that kills at least four out of every 10 cases. Those who survive will most certainly carry the physical scars. Thankfully, this is one of the organisms that can be controlled through vaccination programmes.
Before we begin looking at meningitis, I find myself needing to apologise. Meningitis can cause untold damage. The images of children afflicted by these infections are nothing short of horrific. There is no pleasant way of discussing these illnesses. The silver lining around this dark subject, however, is the availability of vaccinations.
What is meningitis?
Imagine a cross-section of your head. First, you would find your skin, then the lining of your skull, your skull bone, then the meninges and finally your brain. The meninges comprise three layers, and cerebral spinal fluid (CSF) is found between the inner two layers. Together the meninges and fluid form a cushion which plays a very big role in protecting the brain and spinal column from impact, trauma and infection.
If a virus, bacteria, fungus or parasite finds its way into the CSF, it causes swelling (inflammation) of the meninges. This swelling is known as meningitis.
“If your child’s vaccine schedule is up to date then you have done a huge amount to protect your child from getting meningitis.”
Why is meningitis of such a grave concern?
I think it is safe to say that we all understand how critical our brain is to normal functioning. Anything that threatens this functioning is a cause for concern.
- Viral infections. These are the most common causes of meningitis and are usually less severe. These viruses are also responsible for illnesses such as measles, mumps, chickenpox, herpes, gastroenteritis and flu. An antiviral agent may be necessary in cases with chickenpox or herpes meningitis as these are serious conditions. Children with other viral meningitis suffer severe headaches and do feel very ill, however, most individuals will recover fully from most viral meningitis infections.
- Bacterial infections. Bacterial meningitis can be deadly without urgent medical attention. The damage can occur within a few hours. If the patient survives, the effects usually last a lifetime. An individual who has had bacterial meningitis may suffer hearing loss, learning difficulties, brain damage and seizures.
- Neisseria meningitides (meningococcus). This is the bacteria that we are focusing on during World Meningitis day. These bacteria are carried in the nasal passages and throat and don’t often cause illness. If, however, the balance between the immune system and the ability of the bacteria to invade the body is disrupted, it can enter the bloodstream and cause a devastating type of meningitis, known as meningococcal meningitis. Neisseria meningitides (meningococcal) infections can be spread very easily and are deadly. A couple of hours is all that is required for these bacteria to wreak havoc in the body.
An individual with this infection deteriorates rapidly. Typically, the patient will develop a rash (petechial rash). The septicaemia (bloodstream infection) leads to broken vessels in the skin which appear like brown or purple pinpricks but can eventually result in chunks of the flesh dying off in those areas. If it enters the CSF, the patient is likely to suffer brain damage. Forty per cent of patients will not survive meningococcal meningitis.
It is a highly contagious bacteria which mainly affects teenagers and young adults. Those at boarding school, camps, university or college are most at risk. Infants between the ages of six months and three years are also susceptible to this bacterial infection. The good news is that we have a vaccine that can help prevent the illness. Please be aware that this vaccine is not part of the State EPI Vaccine Schedule yet (download here). Should you opt to do this vaccine for your child you would have to purchase it at a private health facility.
Since the introduction of the vaccine in the USA, the number of cases has reduced dramatically. If one looks at the statistics, it is incredible to note that in the 1970s there were around 15 000 cases annually in America alone. By 2018 this number had dropped to 330 cases.
- Streptococcus pneumoniae (pneumococcus). These bacteria are a major cause of ear infections, sinusitis and pneumonia. If these infections are left untreated, the bacteria may find their way into the bloodstream resulting in septicaemia. If it enters the CSF, meningitis is highly probable. Infants and young children are most susceptible to this type of meningitis. Again, there is a vaccine that can help prevent this illness. The vaccination prevents nearly 80% from severe disease and about 60% from ear infections associated with Streptococcus.
- Haemophilus influenzae (haemophilus). These bacteria used to be the most common cause of meningitis in children (80%). The bacteria caused major damage to infants as a result of meningitis, sepsis and pneumonia. To put the illness in perspective, prior to the vaccine there were approximately 2.2 million cases each year resulting in around 400 000 deaths worldwide. Today the Hib vaccine has made huge inroads into preventing this illness altogether.
Listeria monocytogenes (listeria). In 2017 to 2018 we had an outbreak of listeria in South Africa which originated in factories producing processed meats such as polony and hotdogs. A total number of 978 cases were reported and of the 674 cases that were followed up, 183 people died. Forty-two per cent of the deaths were neonates who were infected either during pregnancy or delivery. Unfortunately, there is no vaccine to prevent listeria. A patient would require antibiotic treatment.
How can we protect children from meningitis?
As mentioned above, meningitis may be caused by a number of different organisms. A complication of many childhood illnesses is meningitis. If your child’s vaccine schedule is up to date then you have done a huge amount to protect your child from getting meningitis. Let’s consider the vaccine schedule and see exactly when the vaccines are given and how they protect your child. (Schedules may vary depending on whether you are following the Government schedule. I am basing my table on the schedule followed in private practice).
|VACCINATION||AGES GIVEN||TYPE OF MENINGITIS|
|Tuberculosis||At birth||Complication of tuberculosis|
(as part of the 4 in 1 or 6 in 1 vaccination)
Neisseria meningitides (meningococcus)
(Not part of the State EPI)
* This is the illness being highlighted on 24 April 2020
(Not part of the State EPI)
|Viral meningitis as a complication of chickenpox. If the child gets secondary infections then bacterial meningitis is possible.|
|Measles, Mumps and Rubella (MMR)
(Not part of the State EPI)
A separate measles vaccine may be given
6 years6 months
Viral meningitis as a complication of one of these illnesses. If the child gets secondary infections then bacterial meningitis is possible.
If your child did not receive the meningococcal vaccine as part of the early schedule then this vaccine may be given between 11 and 12 years of age with a booster at 16 years of age.
Since there are types of meningitis that can pass easily between people, the standard hygiene practices that have been emphasised during COVID-19 are also very important. Teach your child:
- not to share food, drinks or eating utensils.
- that washing their hands often with soap and running water is always the best way to keep safe from germs, especially before eating and after using the bathroom.
- coughing and sneezing into the crook of their elbow, rather than into their hands.
- staying home when they are sick is to protect them and their friends.
What are the signs of meningitis in an infant?
- High fever
- Constant crying which may be made worse by holding the baby
- Stiffness in a baby’s body and neck
- A bulge in the soft spot on top of a baby’s head (fontanel)
- Arching of the body
- Excessive sleepiness or irritability
- Inactivity or sluggishness. May even be difficult to wake.
- Poor feeding
- Light sensitivity
We live in a world of information overload and also a huge amount of choice. There are very strong groups that advocate against vaccines. In my years as a paediatrician, I can honestly say that I am grateful not to have had to walk the meningitis path with many little children. Of those that I have had to treat, only a few children made it through without permanent damage. The other children suffered and their lives will never be the same again – nor will their parents’.
They will care for a mentally retarded child or a child who has lost the sense of sight or hearing. These are harsh realities when there is an alternative to most of the infections that cause meningitis. The work done to #DefeatMeningitis is vital. There are still strains of illnesses that cause meningitis for which we have no vaccine. The awareness and ongoing research will hopefully allow us to find new ways of eliminating this devastating illness completely.
Meningitis references available on request. This article was written for BabyYumYum by our partner paediatrician, Dr Maraschin.