Recently, there have been frequent references in the press to outbreaks of meningitis that claim the lives of children and adults. Is there really a threat of an epidemic? And how to protect yourself and your children from this disease? Our expert is a pediatrician, infectious disease specialist at the Federal State Budgetary Educational Institution of Higher Education Russian National Research Medical University named after N. I. Pirogov of the Ministry of Health of the Russian Federation, Morozov Children's City Clinical Hospital, Chief Specialist in Infectious Diseases in Children in the Central Administrative District of Moscow, Candidate of Medical Sciences Alexey Rtishchev .
Meningitis (inflammation of the membranes of the brain) is an extremely dangerous disease. According to WHO estimates, up to 50% of patients die without treatment, and serious complications occur in more than 10% of cases. Alas, even timely medical care does not always guarantee a successful outcome. In 70% of cases, children suffer from this disease (the smaller the child, the more severe the meningitis and the worse the prognosis).
Virus, fungus or bacteria?
There are many pathogens for meningitis. For example, it can be caused by viruses. In summer, meningitis occurs more often, caused by an enterovirus, which enters the body from dirty hands or through water. Secondary meningitis caused by influenza or mumps viruses may also occur. Less commonly, the disease is caused by a fungal infection. It is impossible to distinguish the causative agent of the disease by eye - this requires laboratory analysis of the cerebrospinal fluid.
Viral meningitis is often not as dangerous as bacterial meningitis. The latter are caused by meningococci, as well as pneumococci and Haemophilus influenzae type B.
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Meningitis
Meningitis
Most of us first hear about meningitis in childhood, from parents or educators, and this word carries not just a negative, but downright frightening meaning: if you don’t put on a warm hat, you’ll get meningitis.
But even in adult life - no, no, but you have to hear this diagnosis, pronounced, as a rule, in a low voice and explaining a case of severe disability that turned a flourishing and successful person into a shadow hiding behind heavy curtains. This is a truly serious illness and a dangerous diagnosis. Like other diagnoses of this kind, this term is surrounded by an aura of myths, horror stories, prejudices and other irrational layers. The best way to clear this fog is through knowledge and understanding. Meningitis is a disease, not an evil fate or a heavenly punishment; like any other disease, it has its own causes and risk factors, its own pitfalls and ways to overcome it. This disease is now treated and in most cases cured. In addition, it can be prevented if you know and understand how.
The most important, in every sense, part of the nervous system, that is, the brain together with the spinal cord, we call the central nervous system (CNS). It is quite natural that nature has provided this functional block with the most powerful bone protection. However, the organs of the central nervous system are surrounded not only by the bones of the skull and spinal column. There are three additional meninges: two-lobed dura, arachnoid (arachnoid) and soft. Each of them has a different structure and performs its own functions, but under unfavorable conditions, an inflammatory process can begin in this three-layer brain protection, which is called meningitis. Isolated inflammation of any one membrane is considered impossible today, so the familiar diagnosis of “arachnoiditis” (inflammation of the arachnoid membrane of the brain) is outdated. In special sources, however, the terms “pachymeningitis” (inflammation of the hard membrane) and “leptomeningitis” (inflammation of the arachnoid and soft membranes) are used. If inflammation spreads to underlying brain structures, it is referred to as meningoencephalitis.
It is hardly legitimate to give the absolute frequency of occurrence of meningitis on the globe; however, such estimates are almost never published. There are several reasons for this. Firstly, meningitis is not one, but in fact a group of diseases, very heterogeneous in etiopathogenetic and clinical aspects (some authors even suggest that meningitis should be considered not a disease, but a syndrome or symptom complex). Secondly, as systematic medical statistics accumulate, rises and falls in morbidity are constantly recorded. Thirdly, there is a regional dependence (endemicity) of meningitis: for example, in the poorest African countries, the incidence, according to various estimates, is from 30 to 60 or more times higher than in developed countries with a temperate climate. People of both sexes, all races and nationalities, at all ages are at risk; At the same time, among those who become ill, there is a slight predominance of men, children, and people over 55 years of age (meningitis is most dangerous in the first months of life). In general, the estimate of incidence among prepubescent children living in a temperate climate zone can be considered acceptable and accurate: one case in approximately ten thousand in the general population. Again, using the best possible approximation and averaging, various sources report a trend towards a steady increase in incidence.
Before the advent of etiotropic treatments, the mortality rate for meningitis was close to one hundred percent. In the twentieth century, the situation changed dramatically, but even today the average mortality rate remains very high (primarily due to untreated and fulminant forms); estimates vary between 10-20%.
A period of imaginary prosperity
The last rise in meningococcal infection was observed in 2003–2004. There were at least twice as many cases of the disease then as there are today. The surge in infection led to the formation of an “immune layer”, thanks to which people began to get sick less often. But last year there was an increase in the incidence of meningitis by more than 13%.
It is quite easy to get this infection. This can happen through the usual airborne route, but only with close contact with the source of infection. Even children who do not attend kindergartens are not insured. The fact is that some people (usually adults) are only carriers of dangerous bacteria, while they themselves either feel normal or experience only symptoms of a mild acute respiratory infection. Therefore, children often become infected at home from their own parents, brothers or sisters. People at particular risk of contracting meningitis include people living in crowded conditions - first-year students living in dormitories, migrant workers, military recruits, as well as people with a removed spleen and various immunodeficiencies.
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What is meningococcal infection?
Meningococcal infection is one of the most dangerous infectious diseases that affects both children and adults, especially adolescents.
Meningococcal infection is caused by the bacterium Neisseria meningitis. This name alone indicates that with meningococcal infection, the membranes of the brain are primarily affected and meningitis develops. Another dangerous manifestation of meningococcal infection is meningococcemia - i.e. acute generalized response of the body to the introduction of meningococcus. In this case, the deterioration occurs acutely, the temperature rises sharply to extremely high numbers and a hemorrhagic rash in the form of “stars” appears throughout the body. When a doctor sees such a picture, his heart shrinks - after all, there is practically no salvation from meningococcemia. This catastrophic picture of infection is mainly developed by people belonging to a high-risk group - young children, adolescents, weakened by long-term and frequent illnesses, people with chronic diseases that weaken the immune system. But, to be honest, no one in the world knows or can predict what form of the disease this or that person will experience: why someone suffers the disease easily, while others have an extremely difficult time. All subgroups (scientifically called serotypes) of meningococci can cause meningitis or meningococcemia, and these serotypes are distributed throughout the world. For example, group A meningococci are more common in Asia and Africa; meningococci group C - in Europe and America. But today there are such migration processes that not only people, but also all serotypes are mixed and the spread of pathogenic bacteria becomes wider and the diseases they cause become more severe.
Caution, heat!
Meningitis does not have any one significant symptom. And the signs of this disease can easily be confused, for example, with the flu. Therefore, with any rise in temperature above 38–39 degrees and a sharp deterioration in the child’s general condition, it is better to immediately consult a doctor. Doctors have several tests that can help suspect meningitis. For example, a dangerous sign is when a child cannot bring his chin to his chest. In this case, the patient must be urgently hospitalized. Many believe that a purple rash on the skin is the main symptom of meningitis. In fact, bright spots on the body, buttocks and other places are a sign of meningococcemia, which can be combined with meningitis, or can occur separately. This rash itself is a sign that the infectious agent has spread through the bloodstream, that is, sepsis has begun. This is a life-threatening situation. Moreover, sometimes not even a day passes from the appearance of the first symptoms to the death of the patient.
How is meningitis treated?
At the Yusupov Hospital, patients can receive a full range of medical services for the detection and treatment of meningitis, rehabilitation after illness and prevention. Patients with meningitis can contact the neurologist clinic of the Yusupov Hospital every day for 24 hours to receive emergency care.
The staff of the Yusupov Hospital follows the tradition of attentive and respectful treatment of each patient, therefore they approach the treatment of each case individually. Neurologists inform patients at risk about how to distinguish meningitis from other diseases and prevent its development.
When patients are admitted to the Yusupov Hospital, a comprehensive diagnosis is carried out, including a number of examinations to identify the causes of meningitis, collection of complaints and symptoms. Patients with meningitis need inpatient treatment, so the Yusupov Hospital has created comfortable living conditions and ensures interaction with qualified personnel.
A terrible threat
Since meningitis can lead to death in a matter of hours, a small patient requires hospitalization as soon as possible. But, alas, even the necessary treatment started on time does not always save, especially if a child under 1 year of age is ill. Meningococcal infection is dangerous and has complications. It thromboses blood vessels, which can cause areas of tissue necrosis (death) in the limbs. Therefore, among the possible consequences is amputation of limbs. Meningitis can also negatively affect many mental functions (memory, for example), and also lead to paralysis and paresis. The infection is fraught with decreased or loss of hearing and vision, the development of epilepsy, decreased intelligence and delayed mental and motor development in children.
Meningitis: how to recognize and how to avoid getting sick. Infographics Read more
Saving injection
There are effective vaccines against meningococcal disease. In Europe, babies are vaccinated against meningitis from the first months of life, in the USA teenagers are vaccinated. Alas, the vaccine against this disease is not yet included in the Russian vaccination calendar, and therefore parents can use it in most cases at their own expense. The vaccine registered in Russia includes the 4 most common pathogens of meningococcal infection - A, C, W and Y. Children are vaccinated with it starting from 9 months. A vaccine against another common meningococcus, group B, is not yet available in Russia. But, since the causative agents of meningitis can be not only meningococci, but also other bacteria, parents should also think about the possibility of vaccinating their children with the vaccine against Haemophilus influenzae (HIB) and the vaccine against pneumococcal infection (the latter was introduced into the National Calendar in 2014). vaccinations).
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How to protect your child from meningitis?
You can protect your baby from illness by following simple principles:
Prudence and awareness of parents. In most situations, meningitis pathogens are transmitted by airborne droplets. For this reason, there is no need to take children (especially small ones!) to places where the “human sea” usually splashes - for example, to large shopping centers on weekends, to museums, theaters and circuses during school holidays, etc.- Developed hygiene skills. Many bacteria that initiate meningitis are quite weak - the simplest washing can be harmful to them.
Advice! Teach your child (of course, and don’t forget!) to wash his hands with soap for at least 20 seconds, wash his face and gargle with plain water after returning from the street, kindergarten, store, etc. - Vaccination. BCG vaccination (against tuberculous meningitis) is given to absolutely all children right in the maternity hospital. If, according to some circumstances, this did not happen, the injection will be given at the clinic in the first 2 months of the children’s life without any tests, and then only if there is a negative Mantoux reaction.
Our information
Meningococcal group A vaccine, dry polysaccharide (Russia), from 700 rub. Allows protection against meningococci serotypes A and C. Allowed for use from 1 year, after 3 years revaccination is required.
Meningo A + C (France), from 1500 rub. Prevents the development of cerebrospinal meningitis. For adults and children over 2 years old.
Mencevax ACWY (Belgium), from RUB 4,000. Protects against serogroups A, C, W, Y. For children from 2 years of age and adults.
Menactra (USA), from RUB 4,000. Protects against the causative agent of meningococcal infection from serogroups A, C, Y and W‑135. Used in children over 9 months. and adults under 55 years of age. At the age of 9 months to 2 years, the vaccine is given twice with an interval of 3 months, and after 2 years - once.
According to the order of the Ministry of Health, free vaccination against meningococcal infection is carried out only for epidemic indications.
Types of prevention of meningitis in children
There are no completely reliable ways to protect your baby from infection. Moreover, an effective vaccine that would significantly reduce the threat has not yet been invented. For this reason, it is advised to adhere to standard methods of prevention, and at the first symptoms of the disease, immediately consult a doctor.
Natural
- Limit children's contact with possible carriers of infection. Thus, if cases of the disease are noticed in a kindergarten or school, you need to keep the baby at home for several days.
- During the epidemic season (autumn-winter), use cotton-gauze bandages if you are in a public place.
- Remind the children that after going outside they need to immediately wash their hands with soap. If this is not possible, treat them with a disinfectant.
- Avoid traveling to regions with difficult epidemiological conditions. As a last resort, take care of purchasing special medications that protect against insects (certain types of meningitis can only be tolerated by them).
- Do not swim in open water. As the Center for Medical Prevention states, “protecting a child from meningitis will be possible by following general rules of hygiene and a cautious approach to recreational areas on the water.”
Specific
Meningococcal vaccines (vaccine of serogroups A and C, there is a quadrivalent vaccine for serogroups of meningococci A, C, Y, W-135) are not sufficiently reactogenic, safe, immunologically active, stimulate the increase in antibodies from the 5th day after a single administration and after 2 weeks the antibodies reach the maximum level.
The meningococcal vaccine is used for preventive purposes and for the purpose of urgent prevention in areas of meningococcal infection. For preventive purposes, immunization is carried out:
- According to the conclusion of the district health authorities in the zones, there is a danger of epidemic growth. Children from 1 to 8 years old are subject to vaccinations.
- If there is a sudden increase in incidence and the rate is more than 20.0 per 100,000 inhabitants, mass immunization of the entire population is carried out with coverage of at least 85%. For the purpose of urgent prevention, the vaccine is administered at the site of infection in the first 5 days after the first incident of the disease with a generalized form of meningococcal infection is detected. Persons who have been in close contact with the patient are subject to vaccination.
Chemoprophylaxis
Chemoprophylaxis is carried out for those people who have been in close contact with a patient with meningitis. For this purpose, the following is carried out:
- Rifampicin orally for two days in a row.
- Ceftriaxone intramuscularly and once.
Recommendation! When a disease appears, you need to think not about the consequences, but about the possibility of preventing them. To do this, you should go to the doctor in time and follow his instructions.
