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Quick reference medical handouts used by Pediatric offices


Exposure to Meningitis: Who Needs Treatment?


Meningitis is an infection of the fluid that surrounds a child's brain and spinal cord (hence the name "spinal meningitis"). Viruses and bacteria are the most common causes of meningitis. Viral meningitis is generally less severe and resolves without specific treatment, while bacterial meningitis can be quite serious and may result in death, brain damage, hearing loss, or learning disability. Before the 1990s, Haemophilus influenzae type b (Hib) was the leading cause of bacterial meningitis in children, but new vaccines being given to all children have reduced the incidence of this disease. Today, Streptococcus pneumoniae ("pneumococcus") and Neisseria meningitidis are the most frequent cause of bacterial meningitis.

High fever, headache and stiff neck are common symptoms of meningitis in anyone over the age of 2 years. These symptoms can develop over several hours, or they may take 1 to 2 days. Other symptoms may include nausea, vomiting, discomfort looking into bright lights, confusion and sleepiness. In newborns and small infants, the classic symptoms of fever, headache and neck stiffness may be absent or difficult to catch, and the infant may only appear slow or inactive, or be irritable, have vomiting or be feeding poorly. As the disease progresses, patients of any age may develop seizures.

The bacterium Neisseria meningitidis is responsible for meningococcal meningitis, a rapidly progressing severe bacterial infection of both the bloodstream and meninges. While outbreaks have occurred in "semiclosed" communities, such as child care centers, schools, colleges and military recruit camps, 95 percent of cases occur as an isolated event. It is more common in infants, children and young adults, but anyone can get meningococcal meningitis.

Many children and adults normally carry the Neisseria meningitidis bacterium in their nose and throat without any signs of illness. The bacteria is then spread by droplets of respiratory tract secretions (nose and throat) to the child who later becomes sick. It is not known why some children and adults harbor the bacteria without getting sick and others develop serious symptoms when exposed to the bacterium. The symptoms may appear one to 10 days after exposure, but commonly occur in less than four days. A sick child can spread the disease from the time they are first infected until the bacterium is no longer present in discharges from the nose and throat.

When a case of meningococcal meningitis is diagnosed, widespread panic often occurs among parents, fueled by media coverage of the illness. Parents become worried that their child is at risk for contracting the disease. Who should receive preventative antibiotic? Only children who have been in close contact (household members, intimate contacts, day care center playmates, etc.) need to be considered for preventive treatment. Such children are usually given a prescription for a special antibiotic (either rifampin or ciprofloxacin) from their physician. Casual contact as might occur in a regular classroom, office or factory setting is not usually significant enough to cause concern. The attack rate for high risk contacts exposed to patients with meningococcal disease is four cases per 1,000 persons exposed, which is 500-800 times greater than for the total population. Because the rate of secondary disease for close contacts is highest during the first few days after onset of disease in the sick child, antimicrobial chemoprophylaxis should be administered as soon as possible (ideally within 24 hours after identification of the sick patient).

Disease Risk for Children Exposed to Meningococcal Disease

High risk: Preventative Antibiotic Recommended (close contact)

  • Household contact, especially young children

  • Child care or nursery school contact during the previous seven days

  • Direct exposure to the sick child's secretions through kissing, sharing toothbrushes, eating utensils, markers or close social contact (such as a boy friend-girl friend)

  • Frequently eats or sleeps in the same dwelling as the sick child.

Low risk: Preventative Antibiotic not Recommended
  • Casual contact; no history of direct exposure to the sick child's oral secretions
  • A school classmate or co-worker
  • Indirect contact: Only contact is with a high-risk contact,
    but no direct contact with the sick child

Table courtesy of the American Academy of Pediatrics Redbook 2000

How do children exchange nose and throat secretions?

  • sharing the same drinking utensil (cup, bottle, glass, can or jug)
  • sharing the same water bottle, jug or "hose" with many spigots during sporting practices and events
  • sharing the same mouthpiece on an instrument (i.e.: trumpet, clarinet)
  • sharing the same eating utensil
  • sharing the same cigarette (of any kind)
  • sneezing or coughing in someone's face
  • sharing the same chapstick or lipstick

Any exposed child who becomes ill with mild, flu-like symptoms should be watched for sudden onset of more severe symptoms such as fever, headache, vomiting, rash or  change in mental status. If any of these symptoms develop, parents should not delay in seeking medical attention.

There are no vaccines against the three most common causes of bacterial meningitis. The vaccine that protects against the four strains of N. meningitidis, but it is not routinely used in the United States and is not effective in children under 18 months of age. The vaccine against N. meningitidis is sometimes used to control outbreaks of some types of meningococcal meningitis in the United States.

For more information, Read The Facts About Meningitis on our site.

 

As a reminder, this information should not be relied on as medical advice and is not intended to replace the advice of your child’s pediatrician. Please read our full disclaimer.

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