Bacterial meningitis

What is bacterial meningitis? 

Bacterial meningitis is an infection which causes inflammation of the tissues surrounding the brain and spinal cord. Bacterial meningitis can be caused by any of several types of bacteria and is a medical emergency. Some of the most important causes are Haemophilus influenzae (H. flu), Streptococcus pneumoniae, and Neisseria meningitidis. (An infection caused by N. meningitidis is referred to as “meningococcal disease”, even if the infection does not affect the brain or spinal cord). All of these bacteria can also cause bloodstream infections. Some people may carry one or more of these bacteria in their nose and/or throat and have no symptoms of disease.

Signs and symptoms

• High fever
• Severe headache
• Stiff neck
• Sleepiness
• Nausea/vomiting
• Loss of appetite
• Being disoriented, irritable, or confused
• Eyes sensitive to light

Infants and very young children may have different symptoms. 

Incubation period

• Haemophilus influenzae (H. flu): Unknown (probably a few days)
• Neisseria meningitidis: 1-10 days (usually less than 4 days)
• Streptococcus pneumoniae: 1-10 days (usually less than 4 days)

Contagious period and spread

• Cases can be contagious until completing 24 hours of appropriate antibiotic treatment.
• Bacteria that cause meningitis can be spread by direct contact with saliva or nose/throat discharges of a person with infection. Infected individuals who do not have symptoms can still pass the bacteria to others. 

Public health reporting requirements

• For Neisseria meningitidis (meningococcal) disease, report the infection to the state or local public health agency by phone immediately (within four hours) of a suspected or confirmed diagnosis. 
• Report Haemophilus influenzae (H. flu) to public health within one working day. 
• For Streptococcus pneumoniae (pneumococci), report the infection to the state or local public health agency within four days of diagnosis.
• Contact your state or local public health agency for assistance if the school or child care facility plans to notify parents/guardians about a case of meningitis in the facility.

Control of spread

• Teach children to cover coughs and sneezes with a tissue or with an upper sleeve or elbow if no tissue is available,  wash their hands after using facial tissues or having contact with mucus, and dispose of tissues that contain nasal secretions after each use. Use good hand hygiene techniques at all times.
• Preventive antibiotics 
  • For meningococcal infections, close contacts (such as household members, romantic partners, and child care classroom contacts) should receive a preventive antibiotic. School classmates, teachers, and personnel do not routinely require a preventative antibiotic unless they had prolonged exposure beyond the classroom. 
  • For H. flu serotype B (Hib) infections, preventive antibiotics may be recommended for household and child care contacts in certain situations. Typically, the state or local public health agency will notify household contacts if a preventive antibiotic is needed.

Vaccination

Routine child/adolescent recommendations:

• Haemophilus influenzae type B (Hib) is a three- or four-dose series depending on the product type. Four doses for most Hib products (or when mixing PedvaxHIB with other Hib products), scheduled at 2, 4, 6, and 12-15 months of age, or three doses with PedvaxHIB (scheduled at 2, 4, and 12-15 months).
• Pneumococcal vaccines (PCV) is a four-dose series scheduled at 2, 4, 6, and 12-15 months of age.
• Meningococcal serogroup A,C,W,Y vaccine is routinely given to 11 and 12-year-olds, with a booster dose at 16 through 18 years. Meningococcal serogroup B is recommended for teens, preferably at 16 through 18 years old. 

Colorado school-required vaccines:

• Child care/preschool: Infants and children are required to have Hib and PCV vaccines starting at 2 months of age. 
• A complete school-required vaccine exemption provided to the child’s school may be accepted in place of documentation of an age-appropriate Hib and/or PCV vaccination series. 
• School (K-12): Because the risk of severe disease decreases as a child grows, there is no Hib or PCV vaccine requirement for K-12 grade. 
• College/university: New college or university students residing in student housing, are required to receive MenACWY or complete the Certificate of Immunization and Meningococcal Disease Information and Vaccine Waiver for college/university entry. 

Routine adult/other recommendations:

• Pneumococcal vaccination is recommended for adults 65 and older.
• Haemophilus influenzae type B (Hib), pneumococcal, and meningococcal vaccines are recommended for people at high risk of exposure or with certain medial conditions. 

Treatment

Meningitis is a medical emergency. Cases of bacterial meningitis and bloodstream infections often require hospitalization and treatment with antibiotics.

Exclusion

• Exclude infected students/children and staff until at least 24 hours after treatment with appropriate antibiotics.
• Readmit the child once cleared to return by a health professional and when the child is able to participate and the staff members determine they can care for the child without compromising their ability to care for the other children in the group.

Role of teachers, caregivers, and family

• Encourage routine vaccination and vaccination of individuals who are at higher risk of developing bacterial meningitis.
• Report the infection to the staff member designated by the child care program or school for decision-making and action related to the care of ill children.