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Meningitis General Overview. Presented by: Robert W. White II, RS, MPH Regional Epidemiologist. Clinical description.

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meningitis general overview

MeningitisGeneral Overview

Presented by:

Robert W. White II, RS, MPH

Regional Epidemiologist

clinical description
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.

causes of meningitis
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.

for public health response meningitis can be
For Public Health Response Meningitis can be:

Viral

OR

Bacterial

Both can create Public Health Problems but not all Meningitis is created equal

causes of meningitis5
Bacterial

- Haemophilus influenzae

- Listeria

- Meningococcus  

- Mumps

- Pneumococcus

- Group A Streptococcus 

- Group B Streptococcus

Viral

- Arboviral (mosquito-borne) diseases

- Influenza

- LaCrosse Encephalitis virus

- West Nile Virus

- Also enteroviral

Causes of Meningitis
symptoms can be the same for viral and bacterial
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
viral meningitis
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

bacterial meningitis
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?

neisseria meningitidis prophylaxis
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
hib prophylaxis
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.
so you get a call from a hospital er at 4 00 on thursday
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?

it s now 4 05
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?

it s 4 15 rest easy for a while
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

friday 8 00 am
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?

assume
ASSUME

Neisseria Meningitis

If the lab would have been Gram positive cocci in pairs and chains, then Strep Pneumoniae would have presented a problem

investigate
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

neisseria meningitis
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
outbreak steps case management
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?

outbreak steps continued
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)

what does the public know about meningitis
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

so let s review viral meningitis
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

viral meningitis review
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.

viral meningitis review25
Viral Meningitis- Review

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

viral meningitis review26
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

viral meningitis review27
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.

bacterial meningitis review
Bacterial Meningitis- Review

Public Health Implications

  • Listeria
  • HiB
  • Group B Strep (Pregnant women and neonates)
  • Streptococcus pneumoniae
  • Meningococcal Meningitis (Neisseria meningitidis ) – individual cases
bacterial meningitis review29
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.

bacterial meningitis review30
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

bacterial meningitis review31
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.

bacterial meningitis review32
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.

bacterial meningitis review33
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
bacterial meningitis outbreaks local health departments
Bacterial Meningitis- OutbreaksLocal Health Departments
  • Investigate cases immediately
  • Report cases to Regional Epidemiologist and Infectious Disease Epidemiology
  • Determine who is at risk by interviewing physician, family or possibly the case
  • Organize notes and respond as though this will be an outbreak
  • Send isolates to OLS
meningitis for more information
Meningitis- For More Information

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

http://www.wvidep.org/AZIndexofInfectiousDiseases/MeningococcalDiseaseInvasive/tabid/1529/Default.aspx

meningitis q and a
Meningitis- Q and A

Questions????