What is meningitis?
Meningitis is inflammation of the protective layers that surround the brain and spinal cord. These layers are called the meninges.
What is septicaemia?
Septicaemia is blood poisoning and can be caused by some types of bacteria that also cause meningitis. The bacteria enter the bloodstream and multiply uncontrollably. As the bacteria die and breakdown, they release toxins (poisons) into the blood. These toxins damage the blood vessels throughout the body, causing organ damage. The rash associated with meningitis is actually caused by septicaemia.
What causes meningitis?
- Meningitis can be divided into two main types; viral and bacterial meningitis
- Viral meningitis is reasonably common, but rarely fatal
- Bacterial forms are comparatively rare, but extremely dangerous and can be fatal
- The most common bacterial cause in the UK is the meningococcus. This can cause both meningitis and septicaemia (meningococcal disease)
- Other forms of bacterial meningitis include pneumococcal, Hib, neonatal (caused by E. coli and group B streptococcus) and TB
What vaccines are available?
There are no vaccines to offer protection against all forms of meningitis and meningococcal disease. However, there are four vaccinations currently offered as part of the routine UK immunisation schedule:
- Men B is a new vaccine and was added to the UK Immunisation Schedule from 1 September 2015. The vaccine is offered to babies born on or after 1 May 2015 and doses are given at 2 months, 4 months and a booster at 12 months. Men B vaccine is offered at GP appointments alongside other routine vaccines.
- Hib – given to babies at two, three, and four months, with a booster at 12-13 months. It protects against Haemophilus influenzae type b
- MenC – given to babies at 12-13 months. This vaccine protects against meningococcal group C disease
- The Department of Health has announced that the Men B vaccine will be introduced into the NHS Childhood Immunisation Programme, with the aim to start vaccinating in September 2015. The vaccine will be offered to babies from 2 months of age. A total of three doses will be given at 2, 4 and 12 months of age. Babies who are already 3 and 4 months old when the vaccine is introduced, will also be offered it as part of a one-off catch-up programme
- Pneumococcal – given to babies at two, four and 12-13 months. It protects against pneumococcal meningitis
- From August 2015 the Men ACWY vaccination programme is being delivered to teenagers and first-time students in a carefully planned programme over the next three years. The priority is to vaccinate all teenagers in school years 9 to 13 before they complete school year 13. This is being done by replacing the routine teenage Men C booster given in school years 9 or 10 with the Men ACWY vaccine, and by a series of catch-up campaigns targeting older teenagers. For full details of the catch-up campaign go to NHS Choices
- MMR – given at around 12-13 months, with a booster dose before the age of five. It protects against mumps, measles and rubella. The virus that causes mumps is a common cause of viral meningitis
- Travel vaccines are also available for people visiting countries where there is a risk of meningococcal groups A, C, W135 and Y. A vaccine is also routinely offered to the over 65s in the UK to protect against pneumococcal disease (including meningitis)
Can you get meningitis more than once?
It is very unusual for anyone to have meningitis more than once, but it is possible. Most people develop immunity to the organism that has caused their disease. However, there are several different causes of meningitis and therefore it is possible, but rare, to have the disease more than once.
Although extremely rare, some viruses can cause recurring meningitis. This is known as Mollaret’s meningitis.
Can anyone get meningitis?
Everybody carries a very small risk, but certain age groups are more susceptible.
- The under fives are the most at risk group, particularly the under ones
- Teenagers and young adults are the second most at risk group
- The over 55s are also an at risk group
Scientists do not yet fully understand why a few people get meningitis or septicaemia from bacteria that appear to be harmless to most of us.
What is Men A, B, C, W and Y?
Meningococcal bacteria, the most common cause of bacterial meningitis in the UK, can be divided into several groups. The groups that most commonly cause the disease are A, B, C, W and Y.
What is the difference between meningitis and meningococcal septicaemia?
The meningococcal bacteria can affect the body in several ways:
- Meningitis is caused when bacteria enter the bloodstream and travel to the meninges, where they multiply and cause inflammation
- Septicaemia is caused when bacteria enter the bloodstream and multiply rapidly. They release toxins that poison the blood. If the bacteria do not reach the meninges, meningitis does not occur
- Commonly, the bacteria will multiply in both the meninges and the bloodstream, causing meningococcal meningitis and septicaemia to occur. This is referred to as meningococcal disease.
What are the main symptoms?
The common signs and symptoms associated with meningitis and septicaemia, can appear in any order, and some may not appear at all.
Fever with cold hands and feet – vomiting – drowsy, difficult to wake – confusion and irritability - severe muscle pain – pale blotchy skin, spots or a rash that does not fade under pressure – severe headache – stiff neck - dislike bright lights – convulsions/seizures.
Fever with cold hands and feet – refusing food or vomiting – fretful, dislike being handled – drowsy, floppy, unresponsive – rapid breathing or grunting – pale blotchy skin, spots or a rash that does not fade under pressure – unusual cry, moaning – tense, bulging fontanelle – neck stiffness, dislike bright lights – convulsions/seizures.
What is the rash?
When meningococcal bacteria multiply in the blood stream, they release toxins (poisons) that damage the blood vessels. The rash is caused by blood leaking from the damaged blood vessels into the tissues underneath the skin.
What does it look like?
The rash can start anywhere on the body. It begins as tiny red pin pricks, but may quickly develop to look like fresh bruising. The Glass Test can be used to see if the rash might be septicaemia. If you press the side of a clear drinking glass firmly onto the spots or bruises, they will not fade. A rash will not always appear with meningitis and can be one of the last symptoms to be displayed. Never wait for a rash if you suspect meningitis.
Are signs and symptoms different for septicaemia?
If the patient has septicaemia alone, the common signs for meningitis are not present. Early warning signs are sometimes not there, or are very difficult to spot. These can include:
- Fever with cold hands and feet
- Vomiting, muscle pain
- Pale blotchy complexion
- Stomach cramps and diarrhoea
What should you do if someone has signs and symptoms?
If you have identified signs and symptoms and the patient's general health is deteriorating, you need to act quickly.
- Seek medical help immediately
- Describe the symptoms as accurately as possible
- Say that you think it could be meningitis or septicaemia
- If you have had advice and are still worried, get medical help again
The National Institute for Health and Care Excellence (NICE) provides national guidance and advice to improve health and social care. The following links are relevant to the diagnosis and treatment of meningitis and septicaemia:
How is it meningitis treated?
- Bacterial meningitis and septicaemia need urgent hospital admission so appropriate care and treatment can be given as quickly as possible
- Bacterial meningitis can be treated with antibiotics, but depending on the condition of the patient many other procedures and interventions can be needed
- The progression of the disease varies, with some people needing only a few days in hospital and others needing a longer stay with treatment in an intensive care unit
- There is no specific treatment for viral meningitis, however some people will need hospital care, ensuring the patient has plenty of fluids, pain relief and rest
What are the after-effects?
- Brain damage - Deafness - Learning difficulties – Epilepsy - Mood swings - Disruptive behaviour - Sight problems –Headaches – Tiredness – Memory loss - Concentration problems.
The toxins that are released during septicaemia cause damage to blood vessels. This can prevent the vital flow of blood and oxygen to major organs and can result in after-effects such as:
- Skin and tissue damage
- Organ failure
Why are antibiotics given to some people after a case of bacterial meningitis?
When there is a case of meningococcal disease there is a slightly increased risk of the disease spreading to the household and kissing contacts of a primary case.
Antibiotics are given to kill any meningococcal bacteria which may be carried at the back of the throat of the contact and prevent any further transmission. These antibiotics are not a form of prevention. If someone is already incubating the disease, the antibiotics will not stop them developing meningitis and/or septicaemia.
It is still important to look out for signs and symptoms.
Is meningitis seasonal?
Although meningitis can occur at any time of the year, in the UK the number of bacterial meningitis cases rises during the winter months and the number of viral meningitis cases increases during the summer months.