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Meningitis in Children

Dr Joseph Mizzi MD MRCP MRCPCH

Meningitis is a rare but serious disease. There are about ten reported cases every year in Maltese children. Every effort should be made to procect our children from meningitis because it can result in permanent neurological problems, such as hearing loss and seizures, and even death in about 5% of cases.

There are two lines of defence; firstly, children can be protected by immunisation; secondly, parents should learn how to recognize the signs of meningitis so that the ill child is brought immediately to medical attention. Early treatment results in a better outcome, usually with full recovery.

Vaccines

Meningits can be caused by viruses and bacteria. Viral meningitis is more common, but it is usually not serious. Many cases of viral meningitis manifest flu-like symptoms and often remain undiagnosed. Previously polio and mumps were significant causes of meningitis. These diseases have been practically eradicated by routine immunisation.

Bacterial meningitis is less common, but it is a more serious infection. There are three bacteria that commonly cause meningitis in infants and children after the first month of life. As late as the 1990’s, Haemophilus influenzae B (Hib) was a common cause of meningitis. However since the introduction of the Hib vaccine, given at 2, 3 and 4 months of age, this form of meningitis has become exceedingly rare.

Streptococcus pneumoniae, or pneumococcus, is a common cause of middle ear infection and pneumonia. It can also cause meningitis (approximately one child every two years in Malta). The rate of pneumococcal disease in children was reduced dramatically with the introduction of the conjugate pneumococcal vaccine in the USA in the year 2000. The World Health Organization recommends that the pneumococcal vaccine should be included in the national immunization programme of all countries as a matter of priority. Indeed, it is currently under consideration for inclusion into the Maltese schedule. The pneumococcal vaccine is administered at 2 and 4 months of age, with a booster dose given in the second year of life. Children under five years of age who were not previously immunized can also recieve the vaccine.

Neisseria meningitides, or meningococcus, is the leading cause of bacterial meningitis. It can also cause septicaemia (blood infection) which has a worse outcome than meningitis. There are several strains of meningococcus, including group A, B, C, W135 and Y. Group B is the most common form of meningococcus disease in our country. A vaccine for meningooccus B is undergoing clinical trials, and hopefully it will become available in the coming years.

A polysaccharide vaccine is available that covers the other serotypes (ACWY). It provides short-term protection when travelling to countries where these forms of meningitis are present (e.g. Sub-Saharan Africa).

Meningococcus type C, although rare, is sometimes seen in young Maltese children and can result in death. It was far more common in other countries such as the UK before a vaccine against meningococcus C was included in their national schedule. This conjugated vaccine offers long-lasting protection against meningococcus C. It is given in two shots in infancy, with a booster dose at one year. Children over one year of age who were not previously immunized only need to receive one dose.

Early Recognition

The symptoms of bacterial meningitis and septicaemia can develop rapidly, often within a few hours. The signs of meningitis are fever, severe headache, neck stiffness, vomiting, dislike of bright light and drowsiness. Infants and young children may not manifest the typical signs of meningitis. An infant may simply feed poorly, dislike being handled or become very lethargic. A shrill cry or unusual moaning should alert parents to the possibility of meningitis. Seizures (abnormal jerking movements and loss of consciousness) are rarely associated with meningitis and, in fact, most seizures in young children are simply the result of a high fever (‘febrile fit’).

A rash is an important sign to look for when a child is unwell with fever. It may start as tiny spots that looks like small pin pricks; may spread quickly and develop into large dark red blotches. These spots do not blanch – in other words, they don’t fade if a transparent glass is pressed against the skin.

Parents should seek immediate medical advice in the following circumstances.

1. Infant less than 3 months with fever irrespective of the general condition.
2. Infant less than 1 year of age with fever if the child looks unwell.
3. Older child with fever and signs of meningitis (as above).
4. Child of any age with fever and a non-blanching rash.
5. If the general condition deteriorates even if the child had already been examined before.

June 2009

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