What is meningitis?

Meningitis is an inflammation of the meninges (the covering of the brain and spinal
cord). Meningitis can be caused by infection from viruses and bacteria (germs).
These germs usually cause everyday illness, such as an ear infection or pneumonia.
It is not known why one person gets meningitis when others exposed to the same
germs do not get as sick, or don't get sick at all. Sometimes funguses, cancers,
head injuries or other factors can cause meningitis, but cases from these sources
are rare. In general, meningitis caused by a virus is less serious than meningitis
caused by bacteria.
What is meningitis?
Meningitis is an inflammation of the fluid and membranes that cover the brain and
spinal cord.
There are three main types of meningitis infection:

Bacterial
Viral
Fungal / environmental

What to look for

Meningitis can be hard to recognize in the early stages. Symptoms can be similar to
those of the common flu, including: fever, vomiting, headache, stiff neck, sensitivity
to light, drowsiness, and muscle and leg pain.
If someone close to you shows signs of meningitis, seek medical help immediately.
Anyone, anywhere, any time
Did you know that:
Meningitis kills or disables around 1.2 million people worldwide each year.
Bacterial meningitis, which is the most severe and common form of meningitis,
causes around 120,000 deaths globally every year.
Even with prompt diagnosis and treatment, approximately 10% of patients will die
within 24 to 48 hours after the onset of symptoms, and up to 20% or more will
sustain permanent damage and disability.
Infants and children under five years old and adolescents between 15 and 19 years
of age are most at risk. But anyone in the world can get meningitis at any time.
Cases are more frequent in developing countries due to poverty, overcrowding and
lack of access to vaccines.

Those surviving meningitis can have their lives devastated as a result of long-term
effects, such as deafness, brain damage, learning difficulties, seizures, difficulties
with physical activities and when septicemia is involved loss of limbs.
Many people dont know the warning signs or that many types of meningitis are
vaccine-preventable.
Bacterial Meningitis
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 meningococcus , pneumococcus

and Haemophilus Influenzae Type B (Hib) .

There are different types of meningococcus (called serogroups ), of which

serogroups A, B, C, Y and W135 are responsible for over 95% of meningitis and
septicaemia cases.

Septicaemia (blood poisoning) 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 and 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 Meningitis
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 faecal 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 Meningitis
Fungal meningitis causes severe infections but occurs much less frequently. It is not
contagious and spreads by inhaling fungal spores from the environment.
Other Types of Meningitis
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.

Meningitis Symptoms
Meningitis can be hard to recognise 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.

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.

Its 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.
Know the Symptoms

Arching of the back (infants)

Behavioural changes
Blank, staring expression
Bulging fontanelle (infants)
Cold hands and feet
Diarrhoea
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 dont fade with pressure (also called purpure or
petechiae)*
Rapid breathing
Seizures, fits or convulsions
Sensitivity to light
Severe headache
Stiff neck
Unusual high-pitched cry (infants)
Vomiting

*Not everyone who contracts meningitis will get a rash. Dont wait for a rash to
appear before getting help.
Preventing Bacterial Meningitis
The best way to prevent bacterial meningitis is through vaccination.
Vaccines prepare the immune system by exposing the body to a germ so that it is
better able to fight an infection when it occurs. Vaccines contain either parts of a
germ, live but weakened germs, or inactivated (dead) germs.

The vaccines available protect against the three major causes of bacterial
meningitis, meningococcal disease, pneumococcal meningitis and Haemophilus
Influenzae Type b.
Meningococcal vaccines
Meningococcal vaccines exist to protect against meningococcal disease
Polysaccharide vaccines are available to protect older children, adolescents and
adults, outbreaks or situations of increased risk (military recruits, university
students, travelers). May be used in conjunction with antibiotics. These include:
Combined groups A and C vaccine
Combined groups A-C-Y-W135 vaccine
Conjugated vaccines exist for routine immunisation of infants, children and
adolescents. These include:
Conjugate group C vaccine
Conjugate groups A-C-Y-W135 vaccine
A conjugate Group A vaccine for use in Africa has been developed by the Meningitis
Vaccine Project. This vaccine is being used to reduce and control epidemic
meningococcal meningitis in the Sub-Saharan meningitis belt.
Vaccines will start to be available for Meningococcal B from 2013.

Pneumococcal vaccines
Pneumococcal vaccines exist to protect against pneumococcal meningitis
A number of polysaccharide vaccines exist for routine immunisation of people over
65 years of age and children over 5 years of age with underlying medical conditions.
These include:
Combined polysaccharide vaccine against the 23 most common serotypes causing
pneumococcal disease in those aged 5 and older.
Conjugated vaccine against the 7 most common serotypes causing disease in
children aged 5 and younger.
Conjugated vaccine against the 10 most common serotypes causing disease in
children aged 5 and younger.
Conjugated vaccine against the 13 most common serotypes causing disease in
children aged 5 and younger (including serotype 19A). Because a large proportion of

type 19A strains are resistant to penicillin, treatment of pneumococcal meningitis

can require the use of other antibiotics, which may have more side effects.
Haemophilus Influenzae Type b (Hib) vaccines
Hib vaccines to protect against Haemophilus Influenzae Type b
The first Hib vaccine was a polysaccharide-only vaccine. Although it provided
protection in children between 2 and 5 years of age, it was not effective in infants
less than 18 months old.
Conjugated Hib vaccines are highly effective in preventing Hib disease and are
recommended for routine use in all infants.
Vaccine Safety
Meningitis-preventing vaccines have proven to be extremely safe. Because they are
composed of purified polysaccharide and protein, there is no possibility of
contracting meningitis or any other infection from these vaccines.

Other things to remember include:

Smoking can increase the risk of being a carrier of meningitis bacteria.
Seasonal factors can also affect the incidence of bacterial meningitis. In temperate
regions, the disease in the winter and early spring. In Sub-Saharan Africa, outbreaks
occur in the dry season.
Cases are more frequent in developing countries due to poverty, overcrowding and
lack of access to vaccines.
Anyone who has been in close contact with a meningitis patient within seven days
before the onset of the disease is at increased risk of contracting it themselves.
With meningococcal and Hib infections, preventative antibiotics are usually offered
to close contacts. These reduce, but cannot eliminate, the risk of family members or
other close contacts becoming ill.
SAFE, EFFECTIVE VACCINES ARE NOW AVAILABLE FOR MANY COMMON TYPES OF
MENINGITIS AND NEW VACCINES ARE IN DEVELOPMENT ALL THE TIME.
Preventing Viral Meningitis
There are no vaccines available for the common kinds of viral meningitis, but
washing hands thoroughly and keeping surfaces clean can help prevent the disease.
People should also avoid sharing anything that has been in their mouth.

Measles Mumps and Rubella (MMR) vaccine and chickenpox) vaccine protect
children against meningitis and encephalitis (inflammation of the brain) caused by
these viruses.
Preventing Fungal Meningitis
Vaccines are not available for fungal meningitis. The risk of contracting fungal
meningitis can be minimised by avoiding exposure to environments likely to contain
fungal elements (for example, bird droppings and dust).
Meningitis is a medical emergency. It can develop quickly, over a matter of hours.

Diagnosis and treatment of meningitis varies from country to country, depending on

access to medical care, availability of antibiotics and local antibiotic resistance
patterns.

Wherever you are, its important to know the signs and symptoms and to get
medical treatment fast.

Diagnosis
In order to diagnose meningitis, doctors may do a blood test and take a sample of
cerebrospinal fluid (CSF), the watery fluid that flows in and around the brain and
spinal cord.
CSF is collected through a lumbar puncture and examined for the presence of white
blood cells and bacteria. Blood and CSF samples will be cultured for the presence of
bacteria.
Treatment should not be delayed for more than 1-2 hours while diagnostic tests are
taking place.

Treatment
Bacterial meningitis requires injectable antibiotics and fluid replacement. Transfer to
a hospital with an intensive care department may be necessary.
If signs of septicaemia are present, treatment should be started as soon as possible.
Diagnostic tests should be deferred until antibiotics have been given.

The choice of antibiotic will be based on the susceptibilities of the meningitis

bacteria in each patients area. Because of the worldwide prevalence of penicillinresistant pneumococci, ampicillin-resistant Hib and sulfonamide-resistant
meningococci, treatment with a third generation cephalosporin (such as cefotaxime
or ceftriaxone) is the current standard of care.
In areas with high-level penicillin-resistant pneumococci, vancomycin is usually
added until the susceptibility of the infecting bacteria is known. If patients are
allergic to these antibiotics, chloramphenicol may be used as an alternative.
Antibiotics do not kill viruses. Although viral meningitis is more common than
bacterial meningitis, treatment with injectable antibiotics should be started until a
bacterial cause can be excluded. Treatment for viral meningitis is generally rest and
pain relievers.

Recovery
Survivors of bacterial meningitis may require ongoing treatment or therapy after
their recovery. Almost all patients with viral meningitis recover without any
permanent damage, although full recovery may take weeks to months.
Most people who have meningitis make a full recovery, but it can take time.
Some may experience a range of different after-effects, which can range from mild
to more serious and disabling. Many children and adults with meningitis recover
without experiencing after-effects at all.
Bacterial Meningitis
After-effects and complications are more common with bacterial meningitis. Around
15% of patients are left with serious impairments that require on-going support.
Many more survivors will experience a range of short-term or less serious problems.
Possible after-effects of bacterial meningitis include:

Aggressive behaviour
Acquired brain injury
Balance problems
Cerebral palsy
Behavioural changes
Blindness / vision loss
(temporary or permanent)
Clumsiness
Concentration problems
Deafness / hearing loss

Depression
Exhaustion
Developmental delay (children)
Emotional changes
Epilepsy
Headaches
Joint soreness / stiffness
Learning difficulties
Memory lapses
Mood swings

Temper tantrums

Tinnitus (ringing in ears)

Viral Meningitis
Although it is rarely life threatening, viral meningitis can make people very
unwell. It is usually a mild illness characterized by fever, severe headache,
aches and pains. After-effects of viral meningitis occur more often in newborn
infants or in the elderly than in children, adolescents, or adults.
Possible after-effects of viral meningitis include:
Balance problems
Concentration problems
Depression
Exhaustion
Headaches
Memory lapses
Mood swings

Septicaemia

Possible after-effects of septicaemia include:

Amputation
Diminished blood supply to the face, feet, toes, hands and fingers
Limb loss
Long rehabilitation and recovery period
Organ failure
Skin grafts