What Is Meningitis, Anyway?

27 01 2015

At PKIDs, we help families affected by infectious diseases, and we work to educate ourselves and others about these diseases. Our goal is to prevent infections.

In 2015, we’re turning the spotlight on meningitis, or more accurately, meningococcal disease.

Meningitis is scary—and confusing. For instance, if I say that I have meningitis, it sounds like I’m saying I’m infected with a No More Meningitisgerm called meningitis. But, there is no germ called “meningitis.”

Adding to the confusion is the fact that we tend to use that term loosely for what should be called “meningococcal disease.”

Meningococcal disease causes meningitis, and it may also cause blood poisoning (septicemia).

WHAT IS MENINGITIS?

Our brains and spinal cords are protected by three layers of tissues, one on top of the other, along with a thin river of fluid that runs between the middle and bottom layers. That river, the cerebrospinal fluid, helps the tissues cushion the brain and spinal cord. It also brings in food and takes out trash from the brain.

These tissues that protect our brains and spinal cords are called membranes, or meninges. The whole setup reminds me of a hand in a baseball glove; the hand and wrist are the brain and spinal cord, and the layers of the glove are the meninges.

When I say that I have meningitis, I’m saying my meninges, those tissues layered over my brain and spinal cord, are swollen or inflamed.

This swelling usually causes symptoms that are typical and a tip-off that a person is suffering from meningitis. Those symptoms include fever, a stiff neck, and a severe headache.

There are other symptoms that may be happening, but those three are the most common.

Lots of things can cause meningitis, and they’re not all germs. But the cause of most concern is bacteria.

When certain bacteria, such as Neisseria meningitidis, cause meningitis, it’s called bacterial meningitis.

The bacteria can get into the bloodstream, cross the blood-brain barrier, and cause meningitis, as described above. They get into the river, the cerebrospinal fluid, and multiply like crazy, spitting out poison. The tissues react to the poison by becoming swollen and inflamed. If it gets bad enough, the swelling may cause seizures, or even brain damage.

WHAT IS BLOOD POISONING?

When bacteria such as Neisseria meningitidis get into the bloodstream, they can cause septicemia, or blood poisoning.

The poison released by the bacteria into the bloodstream makes the immune system wake up and start fighting. This war between the bacteria and the immune system can cause inflammation, or sepsis, which in turn can cause blood clots, and it may stop oxygen from getting to the organs. If this happens, the infected person may lose limbs, organs, and sometimes, his or her life. This can happen within hours of initial infection.

HOW TO PREVENT MENINGOCOCCAL DISEASE

The bacteria that cause meningitis, and possibly septicemia, can spread in many ways, including through a kiss or a cough, a sneeze or a sip on a shared straw.

To avoid infection, we do the same things we do when we’re trying to avoid influenza.

  • Wash our hands.
  • Keep our hands off of our nose, mouth, and eyes.
  • Don’t share items like food, forks, lipstick—anything that can transfer germs from another person’s mouth to our own.
  • Get immunized. There are several germs that cause meningococcal disease, and luckily, there are several vaccines to protect us. Ask your provider which vaccines are appropriate for your age and immunization history.
  • Keep our immune system strong by doing all those things we hear about: exercise, eat healthy, and get plenty of sleep.
  • Be responsible and cover our coughs and sneezes. We don’t want to spread infections that we may have.

There are certain groups that are at greater risk of becoming infected with meningococcal disease: those living in close quarters with large groups of people, such as youth campers, dorm residents, or military barrack inhabitants; individuals whose immune systems are compromised; travelers to regions where meningococcal disease is common; or people exposed to others who are currently infected and infectious.

The harm that can come from this infection is so great, it’s simply not worth the risk. We all need to get ourselves and our loved ones in to see our provider for vaccination against this truly horrible disease.

by Trish Parnell





Meningitis B Vaccine – Who Gets It?

19 01 2015

My whole life is on the Outlook calendar. Birthdays, meetings, to-do lists, reminders—when anything pops up, it goes on the calendar. Doesn’t matter if it’s four days or four years from now, it gets noted.

In a few months, my younger daughter will be 16. If you sat at my computer and clicked to that day, you’d find two things: 1) Bug’s birthday and, 2) Call to get mening booster for Bug. (Don’t tell her I called her Bug in this blog, but that is what you’d read in my calendar. It stands for Love Bug.)

Meningitis, or more accurately, meningococcal disease, is the real version of the monster under the bed. That’s how scared I am of this disease.

Love Bug - the early years.

Love Bug – the early years.

It’s not as common as flu, but when it strikes, it can kill or do horrendous damage to the body within hours of the first symptom appearing.

In the US, we have vaccines we use against several strains of the disease.

In the fall of 2014, the FDA approved a vaccine against serogroup B, a strain not found in our current vaccines. There’s at least one other vaccine against serogroup B that’s waiting for approval from the FDA, and I’m guessing that approval won’t be long in coming.

Because we haven’t had a vaccine against serogroup B, we’ve left our at-risk populations defenseless. When Princeton and Santa Barbara had their meningitis outbreaks in 2013, the culprit was serogroup B.

But, the good news is that the ACIP (Advisory Committee on Immunization Practices) will now take a look at the vaccine that protects against meningitis serogroup B and decide what recommendations it will make. The ACIP exists to make “recommendations on how to use vaccines to control diseases in the United States.”

It could be that the ACIP will decide to recommend that all young people ages 10 to 25 should be vaccinated. Or, they may recommend that the vaccine only be given in the event of an outbreak.

The CDC has a specific definition of outbreak when it comes to meningitis, and that is: An outbreak occurs when there are multiple cases in a community or institution over a short period of time. Specifically, an outbreak is defined as three or more cases of the same serogroup (“strain”) occurring within three months. Sometimes having just two cases in a school or college can meet the outbreak definition.

For a more precise definition, check out this Morbidity and Mortality Weekly Report (MMWR) on the Evaluation and Management of Suspected Outbreaks of Meningococcal Disease.

My personal feeling is that we’re a country that can afford to protect ourselves against vaccine-preventable diseases and we should take advantage of that fact. Why wait until an outbreak to start vaccinating? Let’s get the at-risk populations vaccinated and not worry about an outbreak.

I suspect that as discussions ensue, the cost of vaccinating pre-outbreak will be a major factor in determining what the official recommendations will be. After all, the federal government does have a budget. Maybe a few more zeroes in their budget compared to yours or mine, but still.

I know that other interests are clamoring for their share of the pot. Alzheimer’s research, foodborne illness, alcohol poisoning—everyone deserves some of the health and medical dollars available. As do those with other interests, such as agriculture, space exploration, or marine biology.

But still.

Preventing meningococcal disease has always made more sense to me than hoping treatment works and burying those for whom it does not.

I’d like to hear your thoughts on this. We will share them with ACIP members as they meet to discuss what recommendations to make for the new vaccines.

 

 

by Trish Parnell





Childhood Diseases Reaching Out to Adults

16 12 2014

Angelina Jolie has chickenpox, and a passel of NHL players suffers at home with mumps. What’s going on?

Adults are getting knocked sideways by childhood illnesses because (1) when they were children, they missed one or more recommended vaccines, (2) there were no vaccines for certain diseases when they were young, or (3) the protection they received as children from vaccines is waning.

It’s also possible that a vaccine simply didn’t work for this or that person. It happens.

I was already an adult when the chickenpox vaccine first became available. A couple of years prior to the release of that vaccine, my little nephew became infected. He was miserable, and as his parents were out of town, I was the go-to person.

I bathed him in cool water to help bring down his temperature (does that really work?). I cuddled with him, and generally took care of him until his parents came home.

A couple of weeks later, my face erupted in what I thought were spectacularly huge pimples. They flattered my shiny new adult braces and first-ever pair of glasses.

I could not understand why I was breaking out, and then I remembered. My nephew.

I called my mom to see if I’d had chickenpox as a kid, and you already know the answer.

Well, that was a long time ago, and I can happily report my nephew and I had complete recoveries.

All this is to say that diseases lurk. It doesn’t matter how old or young we are, if we’re not protected, we’re open to infection. And, diseases from our childhood pose just as much risk to us as adults.

It takes one phone call or email to the healthcare provider’s office. Ask about all vaccine-preventable diseases, and where you are in your level of protection.

 

 

by Trish Parnell





Flu and the drifting virus

5 12 2014

HiResWe get immunized against flu every year. It’s annoying, but the strains or types of viruses that cause flu are constantly changing, so the vaccines have to change.

Scientists track the viruses and figure out what will be dominant each year, and they keep those in mind as they concoct the vaccines.

This year, as has happened in the past, one of the dominant strains “drifted.” Over time, it’s changed enough that now the vaccines won’t protect against it because they no longer recognize it.

No one realized this strain that had drifted was around until this year’s vaccines had already been produced.

The vaccines we have will protect against a chunk of flu viruses floating around, but not this one. Which means, if you’re unlucky enough to become infected with this particular strain of flu virus, you’ll need to get into your provider ASAP if you have flu symptoms, such as:

  • Fever
  • Cough
  • Body or muscle aches
  • Chills
  • Runny or stuffy nose
  • Sore throat
  • Diarrhea
  • Vomiting

Your provider will put you on antivirals, which will help your body fight the infection. You need to get started on antivirals within a couple of days of symptoms appearing.

Don’t mess around with flu. It sounds like an old-timey illness that doesn’t mean much these days, but based on reports covering a 30-year span from 1977 to 2007, CDC estimates that, in any given year, there are between 3,000 and 49,000 flu-related deaths.

In addition to immunizing, make sure family members are cleaning their hands many times each day. The areas in the home that are frequently touched, like doorknobs, desktops, remotes, and faucets should be disinfected daily.

Keep your hands off of your eyes, nose, and mouth. Our hands pick up germs which enter our bodies when we rub our eyes or touch our noses or mouths.

Protect others by covering your coughs and sneezes, and stay home if you feel ill. Well, stay home AFTER you visit your provider.

That’s about it for flu right now. If you have questions, call the office or drop a line in the comments section.

 

By Trish Parnell





EV-D68

7 10 2014

We were writing an update on EV-D68 when this email arrived from CDC. We think the points are important for parents to know, so we’re going to share this with you and will provide future updates as warranted.

As parents, we’re all concerned about this virus which isn’t really new, but has captured the nation’s attention. If you have questions, please ask them in the comments and we’ll get answers for you.

[This information is current as of 23 October, 2014 and has been slightly edited for length (believe it or not). The bold text includes the latest updates]:

The United States is currently experiencing a nationwide outbreak of enterovirus D68 (EV-D68) associated with severe respiratory illness.

From mid-August to October 23, 2014, CDC or state public health laboratories have confirmed a total of 973* people in 47 states and the District of Columbia with respiratory illness caused by EV-D68.** This indicates that at least one case has been detected in each of those states but does not indicate how widespread infections are in each state.

In the United States, people are more likely to get infected with enteroviruses in the summer and fall. We are currently in the middle of the enterovirus season. EV-D68 infections are likely to decline later in fall.

For the week of October 8-12, 34 states reported to CDC that EV-D68-like illness activity is low or declining; 8 still have elevated activity, and only 1 has increasing activity.

Many state health departments are currently investigating reported increases in cases of severe respiratory illness in children. This increase could be caused by many different viruses that are common during this time of year. EV-D68 appears to be the predominant type of enterovirus this year and is likely contributing to the increases in severe respiratory illnesses.

Due to increasing knowledge about the nationwide EV-D68 outbreak, there has been a very large increase in the number of specimens tested from patients with severe respiratory illness. Awareness of these initial results is also contributing to increased recognition of new cases.

CDC is prioritizing testing of specimens from children with severe respiratory illness. There are likely many children affected with milder forms of illness.

Of the more than 1,700 specimens tested by the CDC lab, about half have tested positive for EV-D68. About one third have tested positive for an enterovirus or rhinovirus other than EV-D68. Almost all of the CDC-confirmed cases this year of EV-D68 infection have been among children. Many of the children had asthma or a history of wheezing.

CDC has developed, and started using on October 14, a new, faster lab test for detecting EV-D68, allowing CDC to rapidly process in about seven to 10 days the more than 1,000 remaining specimens received since mid-September. As a result, the number of confirmed EV-D68 cases will likely increase substantially in the coming days. These increases will not reflect changes in real time or mean the situation is getting worse.

As a result, confirmed cases increased today and will likely continue to increase in coming days. This does not mean the situation is getting worse.

Faster testing will help to better show the trends of this outbreak since August and to monitor changes occurring in real time.

EV-D68 has been detected in specimens from eight*** patients who died and had samples submitted for testing.

CDC is reporting the test results to state health departments as we obtain them. State and local officials have the authority to determine the cause of death, the appropriate information to release, and the time to release it. CDC will defer to states to provide this information.

So far, state and local officials have reported that two of these deaths were caused by EV-D68.

CDC will post updated data to the website every Thursday.

CDC understands that Americans may be concerned about these severe respiratory illnesses and the new reports of neurological illness. Severe illness is always a concern to us, especially when infants and children are affected. We will share information as soon as we have it, and post updates on our website (http://www.cdc.gov/non-polio-enterovirus/outbreaks/EV-D68-outbreaks.html).

Clinicians should consider EV-D68 as a possible cause of severe respiratory illness, particularly in children, and report unusual increases in the number of patients with severe respiratory illness to their health department.

The general public can help protect themselves from respiratory illnesses by washing hands with soap and water, avoiding close contact with sick people, and disinfecting frequently touched surfaces. Anyone with respiratory illness should contact their doctor if they are having difficulty breathing, or if their symptoms are getting worse.

*Total confirmed case count includes results from State Public Health Laboratories that can do testing to determine type of enterovirus.
**The primary reason for current increases in cases is that a backlog of specimens is being processed from several states that are investigating clusters of people with severe respiratory illness. It can take a while to test specimens and obtain lab results because the testing is complex and slow, and can only be done by CDC and a small number of state public health laboratories. These increases will not necessarily reflect changes in real time, or mean that the situation is getting worse.
***Investigations are ongoing; CDC will review and update available data every Wednesday.

 

BACKGROUND

Enteroviruses are very common viruses; there are more than 100 types.

It is estimated that 10 to 15 million enterovirus infections occur in the United States each year. Tens of thousands of people are hospitalized each year for illnesses caused by enteroviruses.

Different enteroviruses can cause different illnesses, such as respiratory, febrile rash, and neurologic [e.g., aseptic meningitis (swelling of the tissue covering the brain and spinal cord) and encephalitis (swelling of the brain)].

In general, the spread of enteroviruses is often quite unpredictable. A mix of enteroviruses circulates every year, and different types of enteroviruses can be common in different years.

In the United States, people are more likely to get infected with enteroviruses in the summer and fall.

 

Enterovirus D68

EV-D68 was first recognized in California in 1962. Small numbers of EV-D68 have been reported regularly to CDC since 1987. However, this year the number of people with confirmed EV-D68 infections is much greater than that reported in previous years.

The strains of EV-D68 circulating this year are not new.

CDC, working with state health departments, has identified at least three separate strains of EV-D68 that are causing infections in the United States this year; the most prominent strain is related to the strains of EV-D68 that were detected in the United States in 2012 and 2013.

There is no evidence that unaccompanied children brought EV-D68 to the United States; we are not aware of any of these children testing positive for the virus.

It is common for multiple strains of the same enterovirus type to be co-circulating in the same year.

Respiratory illnesses can be caused by many different viruses and have similar symptoms. Not all respiratory illnesses occurring now are due to EV-D68.

EV-D68 has been previously referred to as human enterovirus 68 (or HEV-68) and human rhinovirus 87 (or HRV-87). They are all the same virus. The D stands for enterovirus species D.

 

SYMPTOMS

EV-D68 infections can cause mild to severe respiratory illness, or no symptoms at all.

Mild symptoms may include fever, runny nose, sneezing, cough, and body and muscle aches.

Severe symptoms may include wheezing and difficulty breathing.
Anyone with respiratory illness should contact their doctor if they are having difficulty breathing, or if their symptoms are getting worse.

Enteroviruses are known to be one of the causes of acute neurologic disease in children. They most commonly cause aseptic meningitis, less commonly encephalitis, and rarely, acute myelitis and paralysis.

CDC is aware of two published reports of children with neurologic illnesses confirmed as EV-D68 infection from cerebrospinal fluid (CSF) testing.

 

PEOPLE AT RISK

In general, infants, children, and teenagers are most likely to get infected with enteroviruses and become sick. That’s because they do not yet have immunity (protection) from previous exposures to these viruses. We believe this is also true for EV-D68. Adults can get infected with enteroviruses, but they are more likely to have no symptoms or mild symptoms.

Children with asthma may have a higher risk for severe respiratory illness caused by EV-D68 infection.

 

TRANSMISSION

Since EV-D68 causes respiratory illness, the virus can be found in an infected person’s respiratory secretions, such as saliva, nasal mucus, or sputum.

The virus likely spreads from person to person when an infected person coughs, sneezes, or touches a surface that is then touched by others.

Diagnosis

EV-D68 can only be diagnosed by doing specific lab tests on specimens from a person’s nose and throat.

Many hospitals and some doctor’s offices can test sick patients to see if they have enterovirus infection. However, most cannot do specific testing to determine the type of enterovirus, like EV-D68. CDC and some state health departments can do this sort of testing.

CDC recommends that clinicians only consider EV-D68 testing for patients with severe respiratory illness and when the cause is unclear.

 

TREATMENT

There is no specific treatment for people with respiratory illness caused by EV-D68 infection.

For mild respiratory illness, you can help relieve symptoms by taking over-the-counter medications for pain and fever. Aspirin should not be given to children.

Some people with severe respiratory illness caused by EV-D68 may need to be hospitalized and receive intensive supportive therapy.

There are no antiviral medications are currently available for people who become infected with EV-D68.

 

PREVENTION

You can help protect yourself from getting and spreading EV-D68 by following these steps:

  • Wash hands often with soap and water for 20 seconds
  • Avoid touching eyes, nose and mouth with unwashed hands
  • Avoid close contact such as kissing, hugging, and sharing cups or eating utensils with people who are sick, or when you are sick
  • Cover your coughs and sneezes with a tissue or shirt sleeve, not your hands
  • Clean and disinfect frequently touched surfaces, such as toys and doorknobs, especially if someone is sick
  • Stay home when you are sick
  • There are no vaccines for preventing EV-D68 infections.

Children with asthma are at risk for severe symptoms from EV-D68 and other respiratory illnesses. They should follow CDC’s guidance to maintain control of their illness during this time:

  • Discuss and update your asthma action plan with your primary care provider.
  • Take your prescribed asthma medications as directed, especially long term control medication(s).
  • Be sure to keep your reliever medication with you.
  • Get a flu vaccine when available.
  • If you develop new or worsening asthma symptoms, follow the steps of your asthma action plan. If your symptoms do not go away, call your doctor right away.
  • Parents should make sure the child’s caregiver and/or teacher is aware of his/her condition, and that they know how to help if the child experiences any symptoms related to asthma.

 

WHAT IS CDC DOING

CDC continues to collect information from states and assess the situation to better understand  EV-D68 and the illness caused by this virus and how widespread EV-D68 infections may be within states and the populations affected.

CDC is helping states with diagnostic and molecular typing for EV-D68.

We are working with state and local health departments and clinical and state laboratories to enhance their capacity to identify and investigate outbreaks, and perform diagnostic and molecular typing tests to improve detection of enteroviruses and enhance surveillance.

CDC has developed, and started using on October 14, a new, faster lab test for detecting EV-D68 in specimens from people in the United States with respiratory illness. CDC will provide protocols to state public health labs and explore options for providing test kits.

CDC’s new lab test is a “real-time” reverse transcription polymerase chain reaction, or rRT-PCR, and it identifies all strains of EV-D68 that we have been seeing this summer and fall. The new test has fewer and shorter steps than the test that CDC and some states were using previously during this EV-D68 outbreak. This will allow CDC to test and report results for new specimens within a few days of receiving them.

The previous test, which CDC used for about nine years,  is very sensitive and can be used to detect and identify almost all enteroviruses; however, it requires multiple, labor-intensive processing steps and cannot be easily scaled up to support testing of large numbers of specimens in real time that is needed for the current EV-D68 outbreak.

We are providing information to healthcare professionals, policymakers, general public, and partners in numerous formats, including Morbidity and Mortality Weekly Reports (MMWRs), health alerts, websites, social media, podcasts, infographics, and presentations.

CDC has obtained one complete genomic sequence and six partial genomic sequences from viruses, representing the three known strains of EV-D68 that are causing infection at this time.

Comparison of these sequences to sequences from previous years shows they are genetically related to strains of EV-D68 that were detected in previous years in the United States, Europe, and Asia.

CDC has submitted the sequences to GenBank to make them available to the scientific community for further testing and analysis.

 

GUIDANCE FOR CLINICIANS

Clinicians should:

  • consider EV-D68 as a possible cause of acute, unexplained severe respiratory illness, even if the patient does not have fever.
  • report suspected clusters of severe respiratory illness to local and state health departments. EV-D68 is not nationally notifiable, but state and local health departments may have additional guidance on reporting.
  • consider laboratory testing of respiratory specimens for enteroviruses when the cause of respiratory illness in severely ill patients is unclear.
  • consider testing to confirm the presence of EV-D68. State health departments can be approached for diagnostic and molecular typing for enteroviruses.
  • contact your state or local health department before sending specimens for diagnostic and molecular typing.
  • follow standard, contact, and droplet infection control measures

The antiviral drugs pleconaril, pocapavir, and vapendavir, have significant activity against a wide range of enteroviruses and rhinoviruses. CDC has tested these drugs for activity against currently circulating strains of enterovirus D68 (EV-D68), and none of them has activity against EV-D68 at clinically relevant concentrations.

 

SURVEILLANCE

U.S. healthcare professionals are not required to report known or suspected cases of EV-D68 infection to health departments because it is not a nationally notifiable disease in the United States. Also, CDC does not have a surveillance system that specifically collects information on EV-D68 infections.

No data is currently available regarding the overall burden of morbidity or mortality from EV-D68 in the United States. Any data CDC receives about EV-D68 infections or outbreaks are voluntarily provided by labs to CDC’s National Enterovirus Surveillance System (NESS). NESS collects limited data, focusing on circulating types of enteroviruses and parechoviruses.

For a large image and details of EV-D68-like illness activity in states, see http://www.cdc.gov/non-polio-enterovirus/outbreaks/EV-D68-activity.html.

MORE INFORMATION

CDC Enterovirus D68 in the United States, 2014 website: http://www.cdc.gov/non-polio-enterovirus/outbreaks/EV-D68-outbreaks.html

CDC Enterovirus D68 general website: http://www.cdc.gov/non-polio-enterovirus/about/EV-D68.html

CDC Enterovirus D68 for Health Care Professionals website: http://www.cdc.gov/non-polio-enterovirus/hcp/EV-D68-hcp.html

CDC Activity of Enterovirus D68-like Illness in States website: http://www.cdc.gov/non-polio-enterovirus/outbreaks/EV-D68-activity.html  

CDC What Parents Need to Know about Enterovirus D68 webpage: http://www.cdc.gov/features/evd68/

Enterovirus D68 in the United States: Epidemiology, Diagnosis & Treatment, COCA Call, September 16, 2014 (http://www.bt.cdc.gov/coca/calls/2014/callinfo_091614.asp)

Severe Respiratory Illness Associated with Enterovirus D68 – Multiple States, 2014, Health Alert Network, September 12, 2014 (http://emergency.cdc.gov/han/han00369.asp)

Severe Respiratory Illness Associated with Enterovirus D68 – Missouri and Illinois, 2014, MMWR, September 8, 2014 (http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6336a4.htm?s_cid=mm6336a4_w)

Clusters of Acute Respiratory Illness Associated with Human Enterovirus 68 — Asia, Europe, and United States, 2008–2010, MMWR, September 30, 2011 (http://www.cdc.gov/mmwR/preview/mmwrhtml/mm6038a1.htm)





Ebola

2 10 2014

Ebola is in the US, but we have many reasons not to panic. A short infographic to share, if you think it helpful.

 

Ebola





EV-D68 Infographic

10 09 2014

We put this together with the hope that it will simplify communications about this virus. Use it, share it, as you like.

 

EV-D68








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