Meningitis _1.2

Many readers will remember how prominent a subject meningitis was in the UK news cycle 20 years ago.

The condition had been known to doctors for many years, but the mid-90s saw a steep increase in cases (almost doubling in England and Wales between 1993/4 and 1997/8).

At the time, this prompted a number of media outlets to produce features which educated parents on how to spot the early signs of infection; so that they could take their children to a doctor right away for advice and treatment.

Since then, several advancements have been made in the prevention and treatment of meningitis (including, as we’ll discuss, the rollout of the meningitis C vaccine).

Perhaps this is partly the reason why meningitis doesn’t get as much media attention today as it did two decades ago; to mainstream news outlets at least, now there are more vaccination and treatment options to us, the issue might not seem as urgent as it once was.

However, meningitis hasn’t gone away, and is without doubt still an issue deserving of our attention. There continue to be a significant number of cases every year in the UK, and an infection can have very serious consequences; bacterial strains of meningitis can spread throughout the body quickly and pose a dangerous threat to health.

This week, we speak to Claire Donovan, Meningitis Helpline Manager at Meningitis Now, not only to see what developments have taken place in recent years, but also to get a reminder of what the condition can look like, and when to seek treatment.

What are the symptoms and who do they affect?

Meningitis isn’t as rare today as many might suspect.

There are around 3,200 cases of bacterial meningitis each year in the UK and around 6,000 cases of viral meningitis.’ Claire tells us.

Viral meningitis in most cases will clear up on its own in a few days, and is rarely life-threatening.

Bacterial meningitis however is quite different. This will require swift treatment at hospital in order to prevent the development of blood poisoning (septicaemia).

The symptoms of viral meningitis can be very similar to those of bacterial meningitis, and it is essential to seek urgent medical help if you are concerned that someone may have meningitis.’ Claire explains.

The early signs and symptoms of meningitis and septicaemia can be similar to flu and include:

  • fever
  • headache
  • nausea
  • vomiting
  • and muscle pain.
  • More specific signs and symptoms include:
  • fever with cold hands and feet
  • drowsiness
  • confusion
  • pale blotchy skin
  • stiff neck
  • dislike of bright lights
  • and a rash which doesn’t fade under pressure.’

In babies, symptoms can also include being floppy and unresponsive, dislike of being handled, rapid breathing, an unusual, moaning cry and a bulging fontanelle (soft spot on the top of the head).

But Claire also emphasises that people shouldn’t wait for the more specific signs of meningitis to develop before seeking medical attention.

It’s important to stress that symptoms can appear in any order and some may not appear at all. Also, don’t wait for a rash; not everyone will get a rash or it may appear as a late sign. If someone is ill and getting worse, get medical help immediately.’

The condition can be incredibly serious and possesses the capacity to cause long-term health effects, which is why getting treatment right away is so crucial:

Following bacterial meningitis or septicaemia,’ Claire explains, ‘one in ten people will die and at least a third of survivors will be left with lifelong after-effects such as hearing loss, epilepsy, limb loss or learning difficulties. Others are left with more “hidden” after effects such as memory or concentration problems, recurring headaches, anxiety or depression.’

What does treatment involve?

In short, it depends on the type of infection someone has.

As bacterial meningitis is much more aggressive, Claire explains that this type necessitates hospital admission:

Bacterial meningitis is life threatening and requires early recognition, diagnosis and then treatment with antibiotics. Someone with bacterial meningitis will require hospital treatment and some patients will be very ill and require intensive care.’

However, viral cases tend not be anywhere near as serious.

Viral meningitis is usually a self-limiting disease and there is no specific treatment.’

As with other viruses, rest is the most effective form of treatment for viral meningitis, along with drinking plenty of water.

Supportive treatment is given for all types of meningitis,’ Claire goes on to say, ‘and includes pain killers, anti-sickness drugs, fluids and rest.’

What vaccinations are available?

Fortunately, there are preventative measures people can take to limit their risk of meningitis; namely, getting vaccinated.

There are a number of vaccines to help protect against meningitis.’ Claire tells us. ‘The vaccines in the current NHS vaccine programme which help to protect against causes of bacterial meningitis are:

  • Childhood programme (under 5s): Hib, Men B, Men C and pneumococcal vaccines
  • Teenage programme: Men ACWY
  • Adults over 65 are offered a pneumococcal vaccine

The MMR (measles, mumps and rubella) vaccine will also help to protect against viral meningitis caused by the mumps virus (this used to be a major cause of viral meningitis but since the introduction of the vaccine it is now a rare cause).’

But it’s important to note that a vaccination doesn’t completely eradicate the chances of infection.

No vaccine is 100% effective. Recent data for the newest vaccine, Men B, suggests that this vaccine is around 83% effective against all Men B strains in vaccine-eligible infants. Vaccines do not exist to protect against all types of meningitis, so you can still get meningitis even if fully vaccinated.’

This is why being aware of the symptoms the infection can cause, even if your vaccines are all up-to-date, remains so important.

Who’s at risk?

No-one is immune from contracting meningitis, as Claire explains, but there are certain people more prone to infection:

Meningitis can affect anyone, of any age, at any time, however there are ‘at risk’ groups.

  • Children under five are the most at risk group, particularly those under one (as their immune systems are not fully developed).
  • Teenagers and young adults are the second most at risk group, being more likely to be carrying the bacteria that cause meningitis in the back of their throats.
  • First year university students do have a higher risk because they usually live in cramped student halls of residence and are mixing with lots of new people for the first time.
  • Adults over 55 are also an at risk group, as their immune system is not as effective.

Are the other measures besides vaccination someone can take to help prevent infection? Unfortunately not, as Claire explains:

The only way to prevent meningitis is through vaccination. The NHS vaccine programme targets those at most risk.’

Are cases rising or falling?

As touched upon earlier, it was the rising number of cases in the UK in the 1990s which prompted so many news publications to carry stories on the condition, and its early symptoms.

So what has happened since? Have meningitis cases fallen, risen or stayed the same?

Cases of bacterial meningitis have been declining in the UK in recent years.’ Claire tells us.

Viral meningitis cases have probably remained the same (viral meningitis is underreported so accurate stats for these cases are not available).’

Vaccines have had a major impact. For example, before the introduction of the Men C vaccine there were around 1,000 cases of Meningococcal group C meningitis (Men C) in the UK. Since the introduction of the Men C vaccine in 1999-2000, cases are now less than 30 per year.’

However, meningococcal meningitis (the most common cause of bacterial meningitis in the UK) goes through cycles. During the last ten years cases of Meningococcal group B (Men B) meningitis have varied from 400 to 1200 per year. It is not known what causes this fluctuation. At present we are seeing a relatively low rate of cases.’

But of course, the issue isn’t one just limited to the UK; the condition is much more prevalent in certain other international regions than it is here.

Globally, there are certain areas with a higher risk of meningitis,’ Claire tells us, ‘in particular sub-Saharan Africa where epidemics of Men A have been common (a cause rarely seen in the UK).’

Fortunately, programmes have been developed for the region in order to try and minimise the spread of the disease. The MenAfricaVac® vaccine was developed by the Meningitis Vaccine Project and the Serum Institute of India Private Ltd and, Claire tells us, ‘has made a huge impact on disease in Africa.’

Research and the future

Even though more measures are available now to prevent it than ever before, Meningitis still poses a problem. Undoubtedly, the more we learn about the condition, the more we can do to keep outbreaks to a minimum. This is why further studies into the condition are so vital; and, as Claire illustrates, Meningitis Now plays a crucial role in many of these:

Meningitis Now currently fund a number of research projects. Our research is primarily focused on the prevention of meningitis. However, we commissioned a research project a few years ago which looked at the outcomes of children and adolescents who had suffered from meningococcal disease.’

‘The aim of this study was to look at the impact of meningitis (physical, psychological, social and economic burden), estimate after care needs of those affected and to collect information that was used to support the need for, and introduction of, a meningococcal group B vaccine.’

Our current projects focus on prevention with the aim of reducing cases of meningitis. Projects include how the bacteria invades the body and what can be done to prevent this and improving and developing new vaccines.’

You can find more information on the research projects Meningitis Now is involved in on their research page. Also on their site, you can find more information on the condition itself, including signs and symptoms, as well as details of upcoming campaigns and how you can donate or volunteer.