Meningitis

General Overview

Presented by:
Robert W. White II, RS, MPH
Regional Epidemiologist

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Clinical description

Meningitis is a disease caused by the

inflammation of the protective membranes
covering the brain and spinal cord known
as the meninges. The inflammation is
usually caused by an infection of the fluid
surrounding the brain and spinal cord.
Meningitis is also referred to as spinal
meningitis.

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Causes of Meningitis
- bacteria
- viruses
- physical injury
- cancer
- or certain drugs

Severity/treatment of illnesses differ depending on

the cause. Thus, it is important to know the
specific cause of meningitis.

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 For Public Health Response
Meningitis can be:
Viral
OR
Bacterial

Both can create Public Health

Problems but not all Meningitis is
created equal
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Causes of Meningitis
• Bacterial • Viral
- Haemophilus influenzae - Arboviral (mosquito-
- Listeria borne) diseases
- Meningococcus - Influenza
- Mumps - LaCrosse Encephalitis
- Pneumococcus virus
- Group A Streptococcus - West Nile Virus
- Group B Streptococcus - Also enteroviral

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Symptoms can be the same for
Viral and Bacterial
• Fever and chills
• Mental status changes
• Nausea and vomiting
• Sensitivity to light (photophobia)
• Severe headache
• Stiff neck

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Viral Meningitis
Clinical description: A syndrome
characterized by acute onset of meningeal
symptoms- fever, and cerebrospinal fluid
pleocytosis (white cells in the spinal fluid)
with bacteriologically sterile cultures.
Confirmed: a clinically compatible illness
diagnosed as aseptic meningitis,
with no laboratory evidence of
bacterial or fungal meningitis
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Bacterial Meningitis

What types are important in Public Health

Response?

1. Neisseria meningitidis (also called

meningococcal meningitis)
2. Haemophilus influenzae Serotype b (Hib)
Why are they important?

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Neisseria meningitidis Prophylaxis

People who qualify as close contacts of a

person with meningitis caused by N.
meningitidis are
- Family and household contacts
- Child or nursery school contacts
- Anyone exposed to patient’s oral
secretions

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Hib Prophylaxis
The entire household, regardless of age, should
receive prophylaxis in these cases if-
- There is 1 household contact younger than 48
months who has not been fully immunized
against Hib, or
- An immunocompromised child (a child with a
weakened immune system) of any age is in the
household.

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So…you get a call from a Hospital
ER at 4:00 on Thursday

A patient has been intubated and the doctor

believes that the symptoms are consistent
with Meningitis
Spinal fluid cultures are incomplete
What should you do first?

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It’s now 4:05

Call your Regional Epidemiologist and the Division

of Infectious Disease Epidemiology (DIDE)
Get a copy of any lab results and fax them to DIDE
Obtain patient demographics from the hospital

But…what are you dealing with?

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It’s 4:15- Rest easy for a while

You have clinical symptoms of meningitis with no

laboratory confirmation
You have notified the right individuals
Just in case the news gets worse, the hospital has
prophylaxed the entire family

You don’t even have a reportable disease yet

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Friday 8:00 AM

The hospital lab calls you to say the culture

is growing Gram Negative diplococci
The patient has progressively gotten worse

Gram Negative Diplococci? So what?

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ASSUME

Neisseria Meningitis

If the lab would have been Gram

positive cocci in pairs and chains,
then Strep Pneumoniae would have
presented a problem

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Investigate
Assume 1 case is the start of an outbreak
but remember- most cases are single
cases
Talk to the ICP and get as much information
as possible
Talk to family members to get history
Determine if more individuals need
prophylaxis treatment

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Neisseria Meningitis

- Serogroups B, C, and Y account for 30%

each of reported cases
- Serogroups C, Y, and W-135 are vaccine
preventable
- In infants, 50% of cases are caused by
serogroup B and are not preventable by
vaccine

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Outbreak Steps /Case Management

1. Prepare for field work – go to internet

sites, Red Book, and CCD in Man
2. Establish the existence of an outbreak- is
one case enough?
3. Verify the diagnosis- try to get a lab
report
4. Define and identify cases- is anyone else
exhibiting symptoms?

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Outbreak Steps (continued)
5. Describe and orient the data in terms of time,
place, and person- organize your data, report
on WVEDSS
6. Implement control and prevention measures-
who else needs prophylaxis?
7. Communicate findings- The family will want
some answers and the media will want all the
details. Is a Health Alert to local physicians
warranted?
(Generally with Meningitis we are not going
to do a great deal on Hypothesis testing)

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What does the public know about
meningitis?
It’s bad and people die from it
The word “meningitis” conjures up chilling
memories of past deaths
If a school is involved, be prepared to have
protesters and news media on scene

The next 2 slides are real life situations

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Neisseria Meningitis

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Streptococcus Pneumoniae

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So let’s review- Viral Meningitis
Incubation period is about 3 to 6 days
Duration of the illness is approximately 7 to 10
days
Infectious period can last several weeks after
symptoms have resolved
Diagnosed by laboratory tests of a patient’s spinal
fluid
Many times tests are done to rule out Bacterial
Meningitis

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Viral Meningitis- Review
There is no specific treatment for viral meningitis.
-Enteroviruses are most often spread through
direct contact with an infected person’s stool.
Enteroviruses and other viruses (such as mumps
and varicella-zoster virus) can also be spread
through
-direct, or
-indirect contact with respiratory secretions (saliva,
sputum, or nasal mucus) of an infected person.

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Viral Meningitis- Review

Following good hygiene practices can

reduce the spread of viruses and bacteria
Wash your hands thoroughly and often
Clean contaminated surfaces
Cover your cough
Avoid kissing or sharing a drinking glass,
eating utensil, lipstick, or other such items

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Viral Meningitis- Review

Receiving vaccinations in the childhood

vaccination schedule can protect children
against diseases that can lead to viral
meningitis (measles, mumps, and
chickenpox)
Avoid bites from mosquitoes and other
insects that carry diseases that can infect
humans
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Viral Meningitis- Review

Outbreaks are rare but if you are around

someone with viral meningitis, you may be
at risk of becoming infected with the virus
that made them sick. But you have only a
small chance of developing meningitis as a
complication of the illness.

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Bacterial Meningitis- Review

Public Health Implications

- Listeria
- HiB
- Group B Strep (Pregnant women and
neonates)
- Streptococcus pneumoniae
- Meningococcal Meningitis (Neisseria
meningitidis ) – individual cases

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Bacterial Meningitis- Review
-Bacterial meningitis is contagious. The bacteria
are spread through the exchange of respiratory
and throat secretions (i.e., coughing, kissing).
-None of the bacteria that cause meningitis are as
contagious as things like the common cold or
the flu.
-The bacteria are not spread by casual contact or
by simply breathing the air where a person with
meningitis has been.

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Bacterial Meningitis- Review

Assure all isolates are referred to OLS for

serotyping
Assure all high risk contacts are offered
prophylaxis
Assure all providers are educated to report
suspect and confirmed cases of invasive
meningococcal disease properly

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Bacterial Meningitis- Review
Keeping up to date with recommended
immunizations is the best defense.
Good hygiene is also an important way to prevent
most infections.
Rifampin, ceftriaxone, and ciprofloxacin are
appropriate drugs for chemoprophylaxis in
adults. The drug of choice for most children is
rifampin.
Chemoprophylaxis may be administered in
conjunction with vaccinations.

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Bacterial Meningitis- Review
People who should be prophylaxed
- household contacts
- daycare center contacts
- anyone with direct contact with a patient's oral
secretions
Media releases may be appropriate to assist in
finding close contacts of the initial case.
Working with news services may prevent public
anxiety especially when investigations lead to
schools, colleges, and workplaces.

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Bacterial Meningitis- Review

People who should not be prophylaxed

- Casual contacts, no history of exposure to
index case
- Indirect contacts (2nd degree contact)
- Health care professionals without direct
exposure

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Bacterial Meningitis- Outbreaks
Local Health Departments
1. Investigate cases immediately
2. Report cases to Regional Epidemiologist
and Infectious Disease Epidemiology
3. Determine who is at risk by interviewing
physician, family or possibly the case
4. Organize notes and respond as though
this will be an outbreak
5. Send isolates to OLS
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Meningitis- For More Information

http://www.cdc.gov/meningitis/index.html

http://www.wvidep.org/AZIndexofInfectious
Diseases/MeningococcalDiseaseInvasive/ta
bid/1529/Default.aspx

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Meningitis- Q and A

Questions????

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