Q. What is pneumococcal meningitis?
A. Pneumococcal meningitis is caused by the bacterium streptococcus pneumoniae and usually occurs in older adults and young children. It causes about a tenth of bacterial meningitis cases, has a high fatality rate (about 20%) and is associated with a higher risk of permanent neurological damage.
The bacteria are commonly found in the respiratory tract and may be transferred via the bloodstream or as a result of an infection of the middle ear or sometimes through a tiny fracture or defect in the linings of the brain. Very rarely, this may result in recurring cases of pneumococcal meningitis and surgery may be needed to repair the defect.
Q. Is Hib meningitis ever seen in the UK?
A. About two fifths of bacterial meningitis cases were due to Hib before the introduction of the Hib vaccine into the routine immunisation programme in October 1992. This has dramatically reduced the number of Hib meningitis cases. Hib was the most common form of meningitis in infants, and very few cases occur after the age of four. This type of meningitis is now rare.
Q. Do most cases of meningitis occur in clusters?
A. No, most cases of meningitis are isolated incidents, but clusters (i.e.two or more cases) of meningococcal meningitis have been recorded in different parts of the country. Possible explanations may be that some bacterial strains are more prevalent and that some people are more prone to the disease than others.
Q. What other forms of bacterial meningitis exist?
A. Some forms of bacterial meningitis particularly affect new-born babies. The most common are E.coli (properly called Escherichia coli) and group B streptococcus (streptococcus agalactiae). Fatality rates can be as high as 20%, but these forms are very rare.
Other forms that exist are TB meningitis and fungal meningitis. TB meningitis is comparatively rare. People at particular risk include the elderly, those already ill and people form the Indian sub-continent, in whom TB infections are more frequent. It develops much more slowly than other bacterial forms and can be difficult to diagnose.
Some fungi, especially Cryptococcus, can occasionally cause meningitis, but the disease again, is very rare. It usually occurs in patients whose immune system has been severely depressed by disease (e.g. AIDS or leukaemia) or by drug therapy. Fungal meningitis may also be slow in onset and difficult to diagnose and treat.
Q. We understand that viral meningitis is more common than the bacterial form, but generally less serious, although it can be debilitating. How is viral meningitis caused and how many cases are there each year?
A. It can be caused by many different viruses. Some are spread between people by coughing or sneezing, or through poor hygiene. Others can be found in sewage-polluted water.
In mild cases of viral meningitis, people may not even go to their doctor. Therefore it is difficult to say exactly how many cases there are of viral meningitis. The symptoms can be similar to the bacterial form and someone with a severe case of viral meningitis will need to be admitted to hospital for tests to find out which form they are suffering from.
Q. The new vaccine only protects against the C strain of meningococcal meningitis. Is there are any other way to protect yourself against meningitis?
A. The Hib vaccine was introduced into the routine immunisation programme in 1992 and protects against the Hib bacteria. The new meningitis C vaccine was introduced at the end of 1999 and has resulted in many lives being saved.
These two vaccines mean that the most ‘at-risk’ groups receive long term and effective protection against the deadly Hib and C strain of meningococcal disease.
However, we need to ensure that everyone is aware that these vaccines do not protect against other strains of the disease. The new C vaccine is not effective against the B strain of the disease, which accounts for about 60% of all meningococcal cases.
Everyone still needs to be aware of the signs and symptoms of the disease.The best form of protection is to be able to recognise the signs and symptoms of the disease. Prompt action can save lives.
Q. If a child contracts meningitis, are his school friends at risk? Many parents get extremely frightened and worried about such cases. Who is at risk when this happens?
A. The bacteria is only spread by direct coughing, sneezing and intimate kissing. The bacteria is extremely fragile and does not live outside the body, therefore meningitis is not highly contagious.
The family and kissing contacts of a case are at a less than 1% higher risk of contracting meningitis. School friends are not usually at any increased risk unless they have stayed overnight with the case in the week before admission to hospital.
Antibiotics are only given to close contacts to eradicate meningococcal bacteria which may be carried at the back of the nose and throat to prevent transmission. These antibiotics are not a form of prevention; if someone is already incubating the disease the antibiotics will not stop them developing the disease.
Q. Are we close to finding a vaccine which will protect against all strains of meningitis?
A. We are delighted with the development that has been made with the new C vaccine. However, we are some years off finding a vaccine that will protect people against the most prevalent strain in the UK – meningococcal B. We are making significant progress into development of a vaccine for the B, and last year we committed a record £670,000 to research and are currently funding sixteen individual research projects.
We are indebted to the National Meningitis Trust for their help in compiling this section.
