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Meningitis: act without delay

As we mark World Meningitis Day on 24 April, Meningitis Research Foundation (MRF) is raising awareness of the disease. The charity sets out the types and symptoms practitioners should be aware of and highlights the importance of immunisation.

Healthcare professionals working with babies and children in community settings are ideally placed to inform parents about the symptoms of meningitis, as well as the vaccines that are available as part of the immunisation schedule.

Meningitis – the inflammation of the lining around the brain and spinal cord – can be either bacterial or viral. The former is life threatening: bacterial meningitis and septicaemia (the blood poisoning form of the disease) can kill in hours and early diagnosis and treatment give the best chance of survival. While viral meningitis can be very unpleasant, it is almost never life threatening and most people make a full recovery.

Bacterial and viral meningitis can often present with similar symptoms including: headache, dislike of bright lights, neck stiff ness, fever and nausea or vomiting. Patients may also develop a rash or have muscle pain.

Since it’s not possible to reliably distinguish bacterial from viral meningitis on the basis of signs and symptoms, any child with suspected meningitis should be taken to hospital for further investigation and possible treatment.

Young infants are a particularly vulnerable group: any baby under one month of age with a fever should be taken to hospital for investigation, as should babies under three months with fever who appear unwell.

Community practitioners play an important role in educating parents about the signs and symptoms of serious illnesses, including meningitis and septicaemia, and discussing with them the best course of action when they are worried about an unwell child.

The first symptoms parents notice are usually fever, vomiting, headache and feeling unwell, which are common to many self-limiting viral illnesses. The earliest symptoms in children that are more specific to bacterial meningitis and septicaemia and less common in milder illnesses are often pale skin, cold hands and feet, and limb pain, often appearing by around eight hours from the onset of illness. The more serious, classic symptoms such as rash, neck stiff ness, dislike of bright lights and confusion tend to appear later.

Particular symptoms in babies are more non-specific: including poor feeding, grunting, slow to respond and lethargic, vacant staring, abnormal tone – either floppy or stiff , and irritable. Parents may notice that the baby is particularly irritable when handled and has an abnormal cry: highpitched or moaning. A bulging fontanelle is a late sign.

Advising parents

If a child becomes ill and their parents are worried it could be meningitis, healthcare professionals could offer them the following advice:

  • You know your child best – check on them often, trust your instincts
  • If you think your child has meningitis or septicaemia, get medical help immediately
  • Say that you are worried it could be meningitis or septicaemia
  • If you have been sent home by a doctor but your child’s symptoms progress, go back and get urgent medical help
  • Any baby under one month of age with a fever should be treated as an emergency
  • Don’t wait for a rash to appear because this is often a late-stage symptom and in some cases, it never appears. But if your child is already ill and they get a new rash or spots, use the tumbler test: press a clear glass tumbler firmly against the rash. If you can see the marks clearly through the glass, seek urgent medical help.

For unwell children taken to health services, the NICE guideline specifies that temperature, heart rate, respiratory rate and capillary refill time should be routinely recorded in all feverish children aged under five. Raised heart and respiratory rates are classified as amber warning signs in the NICE traffic light system. These children should be assessed face-to-face and the need for paediatric care should be considered.

Bacterial forms

Most cases of bacterial meningitis in the UK are caused by meningococcal bacteria. There are several strains or ‘serogroups’ of meningococcal bacteria, including A, B, C, W, X and Y. Serogroups A and X are extremely rare in the UK.

Pneumococcal and haemophilus influenzae b (Hib) are also major forms of bacterial meningitis. Bacterial forms that mostly, though not exclusively, affect newborn babies are: group B streptococcal (GBS); E. coli; and listeria.

Bacterial meningitis and septicaemia kill around one in 10, and leave a third of survivors with life-altering after-effects as severe as deafness and brain damage or the loss of limbs. After-effects may be temporary or permanent, physical or emotional.

Families affected by meningitis and septicaemia may have specific needs from their community health team. MRF has published Your guide, a useful document to help families who have children affected by the disease. The guide provides information about what to expect when a child is recovering from bacterial meningitis or septicaemia and links to more detailed information for those who have been left with specific problems following their illness.

Viral forms

Most people affected by viral meningitis recover without medical treatment. In fact, there are no effective treatments for most viruses that cause meningitis.

Acyclovir is sometimes used to treat viral meningitis if it is caused by the herpes simplex viruses (HSV) infection, but otherwise treatment is normally limited to easing the symptoms, for example with painkillers for headache or anti-emetics to stop vomiting.

Viral meningitis normally resolves within five days to a fortnight, but for some the recovery period is more prolonged, and HSV meningitis in particular can recur, which can have a considerable impact on quality of life.

Vaccines

There are vaccines available to prevent some of the major causes of bacterial meningitis and septicaemia. These have had a major impact in the UK and around the world.

The advice that health visitors and other public health nurses give to parents of babies and toddlers about immunisation is vital. The best way to prevent death and disability from bacterial meningitis and septicaemia is vaccination, so all parents should be encouraged to take up the offer of the vaccines included in the childhood immunisation schedule.

And the efforts that school nurses put into promoting and carrying out immunisations for students is crucial for ensuring a high uptake of vaccines.

Measles and mumps can be causes of viral meningitis, and measles can lead to even more severe encephalitis. It’s vital to ensure that parents understand the importance of the measles, mumps and rubella (MMR) vaccine, and it may help if they know MMR will give their children some protection against viral meningitis.

You may sometimes be faced with misplaced anxiety and suspicion about vaccines, and may need to reassure parents about safety and effectiveness. MRF provides a range of resources on its website to give you the facts you need.


Key statistics

3200 - the annual number of cases of bacterial meningitis and septicaemia in the UK over the past 20 years, estimated by MRF

7% of UK cases occur in Scotland

7% of UK cases occur in Northern Ireland

80% of UK cases occur in England and Wales 

Babies, toddlers and young adults are most at risk; however, these diseases can strike anyone, of any age 


  • For more information about meningitis and septicaemia and resources for community practitioners, go to meningitis.org or call the free helpline on 0808 800 3344; to view and download Your guide, visit bit.ly/MRF_your_guide
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