After Student's Death, A Primer On Bacterial Meningitis

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Just the word meningitis is enough to make many parents anxious. Now, Monday's death of a 12-year-old Boston Latin Academy student from a suspected case of bacterial meningitis has raised some parents' anxiety levels. The state recommends a vaccine for different strains of bacterial meningitis at certain ages, but those vaccines do not protect against all of the most dangerous strains. It isn't publicly known if the Boston Latin student who died had been vaccinated.

WBUR's All Things Considered host Sacha Pfeiffer spoke with Dr. Paul Sax, clinical director of the Division of Infectious Diseases at Brigham and Women's Hospital, about what symptoms are signs of a possible case of bacterial meningitis.

Dr. Paul Sax: A person who has a very severe headache, very high fevers, a person who says it's the worst headache of my life. A person who says that they have a very stiff neck in association with that fever and headache. Also, if there's been any change in sort of the level of cognition of a child or an adult, someone who's sort of not thinking right while those things are going on, those would also be very much warning signs. And also in particular, fever and headache and a rash would be particularly alarming.

Sacha Pfeiffer: This student at Boston Latin Academy died of a suspected case of bacterial meningitis. There's also a viral meningitis. Could you tell us the difference between the two?

Bacterial meningitis in general is much more severe. Fortunately, it's also much rarer. Bacterial meningitis is also, the good news, treatable if diagnosed and treated early. The prognosis in bacterial meningitis is strongly related to the time from the onset of symptoms until the first dose of the antibiotic. Viral meningitis, by contrast, is something we see a lot in the summertime. Patients with viral meningitis don't feel well either, don't get me wrong. But the prognosis is generally excellent, even though we don't have effective treatments for it.

I read that in Massachusetts there were just eight confirmed cases of bacterial meningitis last year. But it seems that when people do die from it, it's quite headline-grabbing.

That's absolutely the case. It causes the equivalent of panic, and it's quite understandable. These often strike young, otherwise healthy individuals. And they can go from being healthy to being critically ill, and sometimes even dead, within 24 hours.

So in terms of how bacterial meningitis spreads, how close to a person and how long do you have to be near a person for you to be at risk of getting it if they have it?

We talk about coughing distance in meningococcal meningitis; that is close enough so that if someone coughed, you'd be able to feel that cough. And we also don't think exposures that are very, very short are risky. So it has to be several hours of that. So someone who's a household contact, someone who shares a classroom, someone who shares a dormitory room, those would be the kind of contacts that really, really count. And then also, if health care workers actually are exposed directly to the secretions of someone with meningococcal meningitis, they also are at higher risk.

Can it spread through blood or saliva, such as by kissing or sharing a water bottle?

It is actually spread in oral and respiratory secretions. So by sharing a water bottle, sharing a toothbrush, something like that, yes it could. Sharing a hairbrush, I wouldn't expect it to be transmitted that way.

Could you remind us what meningitis does to the body, why this can kill people?

Bacterial meningitis, what they do is that they invade into the body through the bloodstream, spread from the bloodstream, and then infect the lining of the brain — the so-called meninges. And any infection in the meninges leads to an immediate change in a person's health. They get a headache, they get a stiff neck. And in worst case scenario, they can become comatose and die. In addition, this form of presumed bacterial meningitis that this unfortunate girl had also causes the blood to coagulate, to clot abnormally.

Any parting advice for people, particularly parents?

If somebody, say, has a child who's in a school where a case of meningococcal meningitis occurs, or if a child is in a dormitory where such a case occurs, or someone is sharing the room or a household, then there is a preventive treatment for close contacts and that's to take a single dose of an antibiotic and that reduces the risk of that person who got the contact of developing the disease. But also, I think this is another example of where we've made huge strides through widespread immunization. Another form of bacterial meningitis which used to be the most common in children, so-called H-flu meningitis, has virtually disappeared because of widespread immunization against that very, very dangerous pathogen.

This program aired on November 22, 2011.


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