1. What exactly is meningitis?
Meningitis is inflammation of the meninges, the lining which surrounds the brain. The disease should not be confused with encephalitis which is inflammation of the brain itself. Click here for more details.
2. How many types of meningitis are there?
Essentially, there are two distinct types of meningitis; aseptic (usually caused by viral infections) and bacterial. Bacterial meningitis, while it is comparatively rare, is by far the most dangerous and is sometimes fatal. As such, it gets the most media attention, but the Foundation is acutely aware of the effects of the more common viral meningitis. Most of the current vaccine efforts are directed toward preventing bacterial meningitis cases, since these so often lead to death or disability in survivors.
3. Just how common is each type?
There are not exact figures available on a month-to-month basis. In the 2004 Final Reports of Notifiable Diseases, the Morbidity and Mortality Weekly Report (MMWR) of the CDC reported 131 cases of encephalitis meningitis, 19 cases of Hib, 1,361 cases of meningococcal disease, and 1,162 of streptococcal pneumonaie. It's important to note that not all cases of meningococcal disease or streptococcal pneumonaie progress to meningitis, but 15% of cases that do become meningitis end fatally.
Viral meningitis is much more common but it is impossible to quote accurate figures because many mild cases may not even be reported by the sufferer to his/her doctor, and testing is much less accurate in identifying the specific cause of these cases of meningitis.
4. What causes Meningitis?
The bacteria which cause bacterial meningitis live in the back of the nose and throat region and are carried at any given time by between 10% and 25% of the population. It causes meningitis when it gets into the bloodstream and travels to the meninges. What triggers this movement in a small number of unfortunate people remains the subject of research. With viral meningitis, the viruses responsible can be picked up through poor hygiene or polluted water.
5. How are the bacteria and virus spread?
Both are spread by coughing, sneezing and kissing but they should not be regarded as either water-borne or air-borne. It is a mistake to assume that the viruses and bacteria can be blown in the wind and float in water because they CANNOT live for very long outside the human body. Also see question 4 above.
6. Can anyone get meningitis?
Yes, although research shows that certain age groups are more susceptible than others. These are the under 5's, the 16-25's and the over-55's.
7. Is meningitis seasonal?
Either form can occur at ANY time but elsewhere in the world there is a pattern which shows that bacterial meningitis occurs more in the winter months (November-March inclusive) while viral meningitis sees most cases occurring during the summer months.
8. What are the after effects of meningitis?
With both forms there will be a wide variation in exactly how the disease affects a sufferer in the long term. Tiredness, recurring headaches, short-term memory difficulties and concentration problems are often reported, as are temper tantrums, forgetting recently-learned skills and babyish behavior in children.
Mood swings, aggression, balance problems and clumsiness can all make daily life difficult both for the sufferer and his/her family and friends but these should pass in time.
Deafness (permanent or temporary) is a more serious outcome, while epilepsy/seizures, sight problems and brain damage have been known but are relatively rare.
9. What are the main symptoms?
Again, with both forms there is a wide range which can onset in different 'combinations'. In adults and older children vomiting, high temperature, severe headaches, neck stiffness, a dislike of bright lights, drowsiness, other joint pains and fits may be present. In babies and infants watch for fever with hands and feet feeling cold, vomiting, refusing feeds, high pitched crying, a dislike of handling, neck retraction, a staring expression, difficulty in waking and a pale or blotchy complexion.
10. Isn't there a rash to watch for too?
Yes, and it is VERY important. It can occur in anyone of ANY age and can begin on ANY part of the body. It looks like small clusters of tiny pin pricks at the beginning, which can quickly develop into areas of skin damage. They are purple in color and will NOT turn white when pressed.
11. Why is the rash so important?
The development of the rash in the way described in question 10 is a key indicator of septicemia (blood poisoning). If it is seen, it is ABSOLUTELY VITAL that the sufferer is taken to the nearest ER WITHOUT DELAY. Septicemia develops when the bacterium which causes meningitis multiples while it is in the bloodstream and if not treated quickly can be fatal or mean the loss of limbs or fingers/toes.
12. Do all the symptoms appear at once?
No. Some will appear while others may not appear at all. This can cause difficulties in diagnosing meningitis, complicated by the fact that many symptoms are like the common cold. However, over and above the symptoms themselves, it will become obvious to anyone close to the sufferer that he/she is becoming VERY ill VERY quickly.
13. What should I do if I see anyone showing these symptoms?
Act quickly. Firstly, describe the symptoms as accurately as possible to the doctor. If you cannot reach him/her or if they cannot come immediately, get the person to the nearest ER and be prepared to insist on immediate attention.
14. Wouldn't it be quicker to by-pass the family doctor?
We believe this is not advisable unless he cannot attend immediately. Diagnosing the form of meningitis is complicated and the family doctor is best person able to advise the right course of action. These days, he/she is much more likely to carry a supply of benzyl penicillin which can be administered to the sufferer immediately. This action can "buy valuable time" and should the case turn out to be the bacterial form, could make a major difference. Should the case ultimately turn out to be the viral form, no harm will have been done.
15. Is it true there are different types of bacterial meningitis?
Yes, they are called strains and there are several worth mentioning; meningococcal, pneumococcal, Hib, TB and neonatal meningitis. TB and neonatal are very rare, and Hib (which almost exclusively affects under 4's) has become rarer since the introduction of a vaccine for all under 4's. More information on all these forms is available on this site.
16. So meningococcal and pneumococcal are the most common strains?
Yes, pneumococcal meningitis tends to affect children, older people and anyone who has already had a chronic illness such as heart disease, liver disease or diabetes. Meningococcal is the most common strain and can be further sub-divided into three groups, commonly referred to as A, B, C.
17. What is the position on available vaccines?
Firstly, as stated above, the Hib vaccine has been successfully introduced but it is important to point out that it is ONLY effective against the Hib strain. The under 4's REMAIN SUSCEPTIBLE to all the other strains. Currently there is one vaccine which combats both Group A and C meningococcal meningitis but it is not very effective in young children and of limited effectiveness in adults. There is no vaccine against the most common strain B.
18. What of the future of vaccines?
It is universally agreed that vaccine development is the route to take in fighting meningitis. Some new vaccines are currently being tested and the scientific community remains hopeful that further studies will be made in the next several years. While this research is highly complex, technological advances continue to be made.
19. Why do people fear meningitis?
Because of the number of cases and the fact that very little has been explained to the public. Until the Meningitis Foundation of America began in 1997, the US had no national organization working in this area offering advice and support to the general public.
We believe that the public and opinion-formers, such as the media, will become more aware of the facts in the months ahead. These are that meningitis cases are normally isolated and unconnected and that speed is of the essence if the disease is suspected.
20. What would be your final message concerning meningitis?
When fighting meningitis there are two sides involved; human beings who are by nature are all different and viruses/bacteria which are the most ancient organisms about which we have much to learn. As such, it is impossible to draft "golden rules" about any aspect of the disease. The only certainty is that there are - and will remain - many committed people, working internationally, who are devoted to its ultimate eradication and support for those who have suffered from it.