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Guidelines for the Early Clinical and Public Health Management of Bacterial Meningitis (including Meningococcal Disease) Viral meningitis What is viral meningitis Viral meningitis is the commonest type and is most frequently seen in children. It is a milder disease than bacterial meningitis and is rarely fatal. People with viral meningitis may have severe symptoms but they usually recover completely. There is no specific drug treatment for viral meningitis. What are the symptoms of viral meningitis The symptoms of viral meningitis may include: • High temperature • Severe headache • Stiff neck • Bright lights hurt the eyes • Drowsiness • Confusion • Nausea and vomiting The symptoms in young babies may be more difficult to identify and include high temperature, irritability, difficulty in waking the baby from sleep and refusing to eat. The symptoms of bacterial meningitis may be identical, particularly in the early stages of the disease. For this reason it is important that if you think that your child may have meningitis you should contact your doctor as soon as possible. How is viral meningitis spread The viruses that cause viral meningitis are contagious and can be easily spread from person to person. However, most people who get infected with these viruses do not become ill, or else just develop a mild cold or rash with a slight fever. Less than 1 in 1000 people infected with these viruses develop viral meningitis. What are the most common bugs causing viral meningitis Viral meningitis can be caused by many different viruses. The most common cause is an enterovirus infection (either an echovirus or coxsackie virus). Less commonly reported (or very rare nowadays) viruses include the following; poliovirus, mumps virus, herpes simplex type 2 virus, herpes zoster, influenza types A or B, arbovirus, rubella, Epstein Barr virus. How is viral meningitis diagnosed Viral meningitis is usually diagnosed following laboratory tests on the fluid surrounding the brain (cerebrospinal fluid, also known as CSF), by detection of virus in the stool of the patient, from throat swabs or blood samples. How can I protect myself from infection The most important protection against the viruses that cause viral meningitis is hand washing to protect against the enteroviruses: • You should wash your hands with soap and water after any contact with someone who has viral meningitis or a similar illness. • You should also wash your hands after using the toilet and before preparing or eating food. • Because babies frequently carry the viruses that cause viral meningitis it is particularly important to wash your hands after changing or handling dirty nappies. • Viral meningitis is mainly seen in children so it is important to encourage your children to wash their hands after using the toilet, before eating or if they are in contact with someone who is ill. • Vaccination against mumps, rubella and polio will protect you against these diseases. For further information on viral meningitis please see http://www.hpsc.ie/hpsc/A-Z/Respiratory/ViralMeningitis/ -118-
Guidelines for the Early Clinical and Public Health Management of Bacterial Meningitis (including Meningococcal Disease) References 1. Guidance for the early clinical and public health management of meningococcal disease in Australia. Australian Government Department of Health and Ageing, October 2007. 2007. 2. European Centre for Disease Prevention and Control. Public health management of sporadic cases of invasive meningococcal disease and their contacts. Stockholm: ECDC; 2010. 2010 Oct. 3. HPA. Guidance for public health management of meningococcal disease in the UK. Health Protection Agency Meningococcus Forum. Updated 2011. 2011. 4. Health Protection Agency. Interim UK guidelines for the public health management of clusters of serious pneumococcal disease in closed settings. 2008. 5. Scottish Intercollegiate Guidelines Network. Management of invasive meningococcal disease in children and young people. A national clinical guideline. 2008. 6. NICE guidance. Bacterial meningitis and meningococcal septicaemia. Clinical guidelines CG102. 2010. 7. S.I. No. 707/2003 - Infectious Diseases (Amendment) (No. 3) Regulations 2003. 2010. 8. Peltola H. Meningococcal disease: still with us. Rev Infect Dis. 5[1], 71-91. 1983. 9. Hahne SJ, Charlett A, Purcell B, Samuelsson S, Camaroni I, Ehrhard I, et al. Effectiveness of antibiotics given before admission in reducing mortality from meningococcal disease: systematic review. BMJ 2006 Jun 3;332(7553):1299-303. 10. Thompson MJ, Ninis N, Perera R, Mayon-White R, Phillips C, Bailey L, et al. Clinical recognition of meningococcal disease in children and adolescents. The Lancet 367[9508], 397-403. 2006. 11. Granier S, Owen P, Pill R, Jacobson L. Recognising meningococcal disease in primary care: qualitative study of how general practitioners process clinical and contextual information. BMJ 1998 Jan 24;316(7127):276-9. 12. Thompson MJ, Ninis N, Perera R, Mayon-White R, Philips C, Bailey L, et al. Clinical Recognition of meningococcal disease in children and adolescents. Lancet 2006;367:397-403. 13. Haj-Hassan TA, Thompson MJ, Mayon-White RT, Ninis N, Harnden A, Smith LF, et al. Which early 'red flag' symptoms identify children with meningococcal disease in primary care 2011 Mar. 14. Nascimento-Carvalho CM., Moreno-Carvalho OA. Changing the diagnostic framework of meningococcal disease. Lancet 2006;367(371):372. 15. Bigham J, Hutcheon ME, Patrick DM, Pollard AJ. Death from invasive meningococcal disease following close contact with a case of primary meningococcal conjunctivitis. CCDR 2001;27(02):13-8. 16. Gossain S, Constantin CE, Webberley JM. Earley parenteral penicillin in meningococcal disease (letter). Br Medical J 2011;305:523-4. 17. Cartwright K, Strang J, Gossain S, Begg N. Early treatment of meningococcal disease (letter). Br Medical J 1992;305:774. 18. Surtees SJ, Stockton VIG, Gietzen TW. Allergy to penicillin: fable or fact Br Medical J 1991;302:1051-2. 19. Healy CM, Butler KM, Smith EO, Hensey OP, Bate T, Moloney AC, et al. Influence of serogroup on the presentation, course, and outcome of invasive meningococcal disease in children in the Republic of Ireland, 1995-2000. Clin Infect Dis 2002 May 15;34(10):1323-30. 20. Fitzgerald M, Cotter S, Cafferkey M, Murphy K. Epidemiology of meningococcal disease in Ireland. Epi-Insight, Disease \ surveillance report of the HPSC 2006;(7):2-3. 21. Wood A, O'Brien S. How long is too long Determining the early management of meningococcal disease in Birmingham. Public Health 1996;110:237-9. 22. Sorensen HT, Nielsen GL, Schonheyder HC, Steffensen FH, Hansen I, Sabroe S, et al. Outcome of pre-hospital antibiotic treatment of meningococcal disease. J Clin Epidemiol 1998 Sep;51(9):717-21. 23. Cartwright K, Reilly S, White D, Stuart J. Early treatment with parenteral penicillin in meningococcal disease. BMJ 1992 Jul 18;305(6846):143-7. 24. Harnden A, Ninis N, Thompson M, Perera R, Levin M, Mant D, et al. Parenteral penicillin for children with meningococcal disease before hospital admission: case-control study. BMJ 2006 Jun 3;332(7553):1295-8. 25. Thompson MJ, Ninis N, Perera R, Mayon-White R, Phillips C, Bailey L, et al. Clinical recognition of meningococcal disease in children and adolescents. Lancet 2006 Feb 4;367(9508):397-403. 26. McIntyre PB, Berkey CS, King SM, Schaad UB, Kilpi T, Kanra GY, et al. Dexamethasone as adjunctive therapy in bacterial meningitis. A meta-analysis of randomized clinical trials since 1988. JAMA 1997 Sep 17;278(11):925-31. -119-
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