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