Meningitis General Overview. Presented by: Robert W. White II, RS, MPH Regional Epidemiologist. Clinical description.
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Robert W. White II, RS, MPH
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.
Severity/treatment of illnesses differ depending on the cause. Thus, it is important to know the specific cause of meningitis.
Both can create Public Health Problems but not all Meningitis is created equal
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
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?
People who qualify as close contacts of a person with meningitis caused by N. meningitidis are
The entire household, regardless of age, should receive prophylaxis in these cases if-
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?
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?
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
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?
If the lab would have been Gram positive cocci in pairs and chains, then Strep Pneumoniae would have presented a problem
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
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?
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)
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
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
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
-indirect contact with respiratory secretions (saliva, sputum, or nasal mucus) of an infected person.
Following good hygiene practices can reduce the spread of viruses andbacteria
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
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
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.
Public Health Implications
-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.
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
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.
People who should be prophylaxed
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.
People who should not be prophylaxed