Features

The meningitis safety net

07 September 2018

Rob Dawson of the Meningitis Research Foundation reveals the life-saving messages parents and CPs need to know if faced with bacterial meningitis or septicaemia.

Brain iStock
Rob Dawson

Around 50% of children with meningococcal disease – one of the leading causes of bacterial meningitis – are turned away by their GP at their first visit because the early signs are difficult to recognise (Thompson et al, 2006). As Meningitis Awareness Week (17-23 September), approaches, community practitioners can help parents to increase awareness and provide information on the right medical help to seek if a child is seriously ill. 

 

What are meningitis and septicaemia?

For decades, parents have named meningitis as the disease they fear most. No wonder: bacterial meningitis and septicaemia are both serious illnesses that can kill in a matter of hours. One in 10 people affected will die, and a third of survivors will be left with after-effects, some as serious as brain damage, amputations, blindness or hearing loss (Meningitis Research Foundation (MRF), 2018).

Meningitis is the swelling of the meninges, the lining around the brain and spinal cord. Bacterial meningitis occurs when certain kinds of bacteria invade this lining. Septicaemia, which triggers sepsis, is blood poisoning caused by the same bacteria.

Meningococcal bacteria are a leading cause of meningitis and septicaemia in the UK. The MRF estimates that each year there are nearly 2500 cases of bacterial meningitis and meningococcal disease. Over the last few decades, the main causes of bacterial meningitis among all age groups have been meningococcal, pneumococcal and  Haemophilus infuenzae b (Hib) bacteria. In new babies, the leading causes of disease are Group B streptococcus, E coli and listeria.

 

Preventing risk

Babies, children younger than five and teenagers are the most at risk, but anyone can be affected at any time.

Fortunately, several vaccines are available as part of the UK immunisation schedule to help prevent some of the causes of bacterial meningitis, including the MenACWY and Hib vaccines as well as those that cover some of the most common strains of pneumococcal bacteria.

To ensure people get all of the vaccinations available to them, it remains vital for health visitors to provide accurate information to parents of babies and toddlers about immunisation. Equally, school nurses play an important role in promoting and carrying out immunisations for students to ensure that there is high uptake of vaccines.

However, vaccines are not yet available to prevent all types of meningitis and septicaemia, which is why it’s so important for parents and health professionals to be aware of the symptoms.

 

Knowing the symptoms and taking action

Early recognition and treatment are vital for the best chance of a good recovery, but early symptoms can be easily confused with milder illness. The first symptoms parents notice are usually fever, vomiting, headache and feeling unwell, which are also common to many self-limiting viral illnesses.

The MRF encourages people to look for symptoms that are more specific to bacterial meningitis and septicaemia and less common in milder illnesses, such as 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 stiffness, dislike of bright lights and confusion tend to appear later – on average 13 to 22 hours (Thompson et al, 2006). However, these symptoms don’t always appear, which makes recognition very difficult (see Symptom checker in children, below).

Symptoms in babies are often non-specific too, including poor feeding, grunting, becoming less responsive and lethargic, having a stiff body or a floppy, lifeless one, and vacant staring. Parents may notice that the baby is particularly irritable when handled and has an abnormal cry: high-pitched or moaning. A bulging fontanelle is a late sign of the disease.

While clinicians are often on the lookout for fever, new research funded by the MRF showed that only around half of babies under three months of age with bacterial meningitis display fever (Okike et al, 2018). We have updated our symptom information for parents so that they know not to look out for fever alone in babies.

Another important thing to watch out for is progression of illness, as children with meningitis or septicaemia can get worse quickly.


A meningitis lifeline

As early signs of meningitis are difficult to distinguish from milder illness, it’s vital for sick children to be monitored closely to see if their condition is getting worse.

Guidance suggests that doctors provide ‘safety-net’ advice to parents if they are sending an unwell child home. This includes information about symptoms to look out for, the importance of parents trusting their instincts, frequently checking on the child and how to return or access further medical help if a child deteriorates rapidly.  


 

To coincide with Meningitis Awareness Week, the MRF is highlighting the need for a greater focus on safety-net advice and helping parents by providing a resources hub on our website.

This will make it easier for parents and health professionals to quickly access all of the current safety- netting advice on meningitis. This could be a lifeline in a time of crisis.  

Rob Dawson is director of communications and support at the MRF.


 

Resources

For more information, visit meningitis.org or call the free helpline available to health professionals and the public 
on 080 8800 3344.

The Meningitis Research Foundation has a range of useful resources at meningitis.org/resources

  • Meningitis Baby Watch
  • Meningitis Tot Watch
  • Symptom posters
  • Tools for health professionals.

Picture Credit | iStock


 

References

Meningitis Research Foundation. (2018) Scientists closer to reducing loss of life and risk of amputation caused by meningococcal disease. See: meningitis.org/news/scientists-closer-to-reducing-loss-of-life-and-ris (accessed 6 August 2018).

Okike IO, Ladhani SN, Johnson AP, Henderson KL, Blackburn RM, Muller-Pebody B, Cafferkey M, Anthony M, Ninis N, Heath PT. (2018)  Clinical characteristics and risk factors for poor outcome in infants less than 90 days of age with bacterial meningitis in the United Kingdom and Ireland. Pediatric Infectious Disease Journal. See: ncbi.nlm.nih.gov/pubmed/29384979 (accessed 6 August 2018). 

Thompson MJ, Ninis N, Perera R, Mayon-White R, Phillips C, Bailey L, Harnden A, Mant D, Levin M. (2006) Clinical recognition of meningococcal disease in children and adolescents. The Lancet 367(9508): 397-403.

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