Meningitis is a serious disease that causes inflammation and swelling of the meninges – the membranes that surround the brain and spinal cord. In New Zealand meningitis is most commonly caused by meningococcal bacteria, and can be life-threatening. Around 100 cases of meningococcal disease are reported in New Zealand each year, typically during winter or spring.
Meningitis can be caused by bacteria (bacterial meningitis) and viruses (viral meningitis); and less commonly by fungi (fungal meningitis) and organisms like amoeba (parasitic meningitis).
There are five main groups of the meningococcal bacteria – A, B, C, W135 and Y. In New Zealand, a particular strain of group B meningococcal bacteria accounts for approximately 62% of all cases of meningococcal disease. Group C meningococcal bacteria account for approximately 38% of all cases, with the other groups only rarely causing disease.
Up to 15% of the population carry meningococcal bacteria in their nose and throat without becoming sick. However, for reasons unknown, these bacteria sometimes cause disease in some people, spreading to the bloodstream (causing blood poisoning) or the brain and spinal cord (causing meningitis).
Meningococcal disease is fatal in approximately four per cent of cases. In a further 20 per cent of cases the person is left with some degree of serious disability. This can include:
- Loss of skin, fingers, toes or limbs
- Brain damage
- Developmental delay in babies and children.
Who gets meningococcal meningitis?
Meningococcal disease is most likely to affect very young children, teenagers and young adults, with more than 80 per cent of all cases occurring in those aged 0 – 19 years. Of this group, approximately 50 per cent of cases will occur in children less than five years of age.
People who have a weakened immune system, such as the elderly, and those taking long-term immune suppressing medications, such as corticosteroids, may also be susceptible to the illness. The disease occurs more frequently in Maori and Pacific Islanders and in people living in lower socioeconomic areas, where overcrowded living conditions are a contributing factor to the spread of the disease.
Regional differences also occur with rates of meningococcal disease highest in Northland, Eastern Bay of Plenty and the Counties Manukau area of Auckland.
Between 1991 and 2004 New Zealand experienced epidemic levels of meningococcal disease. During this time there were over 5300 cases of meningococcal disease reported, with 215 deaths.
Meningococcal bacteria are very common and live naturally in the nose and throat (upper respiratory tract). People can carry the bacteria for days or even months without ever becoming unwell. It is estimated that at any one time up to 15 per cent of the population in New Zealand are carriers of the meningococcal bacteria.
The bacteria are present in saliva and can be spread through close contact with the saliva of a carrier. Situations where this can occur include:
- Intimate kissing
- Sharing drink bottles or cups
- Sharing plates, utensils or food
In a small number of people the meningococcal bacteria overcomes the body’s defences and causes meningitis. It may also go on to multiply in the blood to cause septicaemia. The incubation period (time from when the bacteria enter the bloodstream to when symptoms occur) is between two and ten days.
The bacteria do not live for long outside of the body; therefore they cannot be picked up from water supplies or public areas such as swimming pools.
Signs and symptoms
Meningococcal disease can be difficult to diagnose because initial symptoms are usually similar to a bad cold or ‘flu. The illness may develop slowly over a couple of days or may worsen rapidly over a few hours. Symptoms do not appear in any particular order and some may not occur at all.
Symptoms that may occur in adults and children include:
- High temperature (fever) – possibly with cold hands and feet
- Headache – which may be severe
- Neck stiffness – unable to touch chin to chest
- Muscle and joint pain
- Sensitivity to bright lights (photophobia)
- Vomiting and sometimes diarrhoea
- Seizures (convulsions)
Symptoms that may occur in babies include:
- High temperature (fever) – though the hands and feet may feel cold
- Refusing feeds
- High pitched moaning cry or whimpering
- Bending neck backwards or arching of the back
- Irritability and dislike of being handled
- Turning face away from light
- Pale and blotchy skin
- Lethargic and/or difficult to wake
- Blank staring expression
- Bulging fontanelle (the soft spot on the baby’s head)
- Seizures (convulsions)
Where meningococcal septicaemia occurs, a characteristic meningitis rash may develop. The rash can occur anywhere on the body and can spread very quickly. It can occur in babies, children and adults. Initially the rash looks like a collection of tiny blood spots. If left untreated, the spots can join to look like dark bruises.
The meningitis rash is characteristic in that it does not fade when pressed. The “glass test” is helpful to check whether the rash may be due to septicaemia. This involves pressing the side of a clear drinking glass firmly against the spots. If the spots do not fade, the rash may be due to septicaemia.
If meningococcal disease is suspected, it is vital to seek medical attention immediately. Urgent hospitalisation and treatment with antibiotics can be lifesaving and can reduce the effects of the disease.
The doctor will examine the person for signs of illness and take note of any of the symptoms experienced. If meningococcal disease is suspected it is likely that an injection of antibiotics will be given immediately.
A number of tests are used to help diagnose the illness:
- Blood tests: These will be taken to identify the causative bacteria, to check the function of body systems and to see if there is septicaemia or any indication of infection elsewhere.
- Lumbar puncture: This test involves the insertion of a needle into an area in the lower spine. A small amount of liquid called cerebrospinal fluid (CSF) is drained out through the needle and sent for testing. CSF is normally a clear fluid that bathes the brain and spinal cord. If the CSF specimen is cloudy it usually means that bacteria are present. Laboratory tests will be performed to find out which bacteria are causing the infection.
- Computerised Tomography (CT scan): The doctor may order a special scan of the brain to see if there is any damage. The CT scanner uses a computer to combine several cross-sectional x-ray views of an area in the body. Sometimes a special dye injection may be needed for the x-ray to show up different information. The person is asked to lie still on a special bed while the scan is being done. Children may be given light sedation to ensure they lie still during the test.
Fluids, nutrition, pain relief and other medications, such as steroids, may also need to be given intravenously while in hospital.
In severe cases the person may be unable to breathe by themselves. In these cases the person is placed on a ventilator, which will breathe for them. If this occurs, they will be given sedative medications.
Surgical treatment may be required if complications occur. This may involve removing dead skin, amputating affected fingers, toes or limbs, and applying skin grafts. If significant complications occur, hospitalisation for treatment and rehabilitation may be required for weeks or even months.
Treatment and recovery
Once the bacteria that are causing the illness are identified, the person can be treated with the correct antibiotics. The antibiotic will most likely be given directly into the blood stream throught a drip (intravenously). Very high antibiotic doses may be required to fight the disease. Additional antibiotics may be required to prevent and/or combat secondary infections.
While many people recover well and return to full health quickly after being affected by meningococcal disease, for others recovery can be long and arduous.
Deafness is one of the most common consequences of meningococcal disease, affecting approximately one in 10 people. It can be temporary or permanent. A hearing test is likely to be undertaken, especially in young children in whom deafness is difficult to detect.
Brain damage, epilepsy and changes in eyesight are other serious complications that can result from meningococcal disease. Behavioural problems and learning difficulties are potential long-term complications.
Those who experienced significant complications will require ongoing care, support and in some cases further treatment. This may include:
- Physiotherapy – to regain strength and mobility
- Occupational therapy – to assist with activities of daily living
- Speech therapy
- The fitting of devices such as hearing aids
- Further surgery in cases of skin loss or limb amputation
- The fitting of artificial limbs.
The emotional after-effects of a major disease like meningococcal disease can also be significant. In children it can be particularly noticeable. Behaviours in children may include:
- Temper tantrums
- Being very clingy
- Babyish behaviour
- Difficulty sleeping, night waking and nightmares
- Demanding attention.
Adults may be affected by mood swings, depression and episodes of aggression.
Physical after-effects that may be experienced by both children and adults include:
- Sore, stiff joints
- Eyesight problems
- Short-term memory loss
- Balance problems.
These resolve with time, and rest. Avoiding stress during the recovery period is also important in speeding recovery. Some people have found complementary therapies such as counselling, acupuncture and homeopathy to be helpful in aiding recovery.
Doctors are required to report any cases of meningococcal disease to the Medical Officer of Health (MOH) in that area. In this way the Public Health Protection Service can help reduce the spread of this very serious disease.
Precautions should be taken to avoid transfer of the meningococcal bacteria from the infected person to others, which is primarily by coughing and sneezing. These include covering the mouth and nose when sneezing or coughing, effective hand-washing and drying after toileting and before eating or preparing food, and not sharing drink bottles, cups and utensils.
The person is infectious for as long as the bacteria are present in the body or until 48 hours after starting antibiotics. Both household members and day-care centre contacts of an infected person may be given antibiotic medications to prevent them from becoming sick. This may be given in the form of tablets or syrup. The infected person may also be given the same antibiotic after hospitalisation to clear the bacteria from their throat.
Vaccines for meningococcal disease are available but they are not free for most people. However, they may be funded by local district health boards during a disease outbreak. Currently available vaccines do not provide protection against all types of meningococcal disease, only strains A, C, Y, and W-135. Meningococcal vaccines are not long lasting – generally providing protection for three to five years. Therefore, someone who has been previously vaccinated may no longer still be protected against the disease. The MeNZB™ vaccine, which was developed in response to an outbreak of a specific strain of group B meningococcal disease from 2004 to 2008, is no longer available.
Immunisation Advisory Centre
Freephone: 0800 IMMUNE (0800 466 863)
The Meningitis Foundation (Aotearoa New Zealand)
Everybody (2009) Meningitis – Recovery. Auckland: MIMS (NZ) Ltd. www.everybody.co.nz/page-7b430f97-3bc8-4dfe-b480-c444e3da7e9a.aspx
Ministry of Health (2013) Meningoccocal. Wellington: Ministry of Health. www.health.govt.nz/our-work/diseases-and-conditions/meningococcal
Ministry of Health (2013) Meningococcal disease. Wellington: Ministry of Health.
O’Toole, M.T. (Ed.) (2013) Meningitis. Mosby’s Dictionary of Medicine, Nursing & Health Professions (9th ed.). St Louis: Elsevier Mosby.
Last reviewed – 25 June 2013