Meningitis: A traveller's illness?
WORLDWIDE | Thursday, 26 March 2009 | Views [1357]
WorldNomads.com's roving medical expert Dr. Erik McLaughlin MD explains why meningitis is an illness that all travellers need to be aware of.
Why? Disease spread is typically associated with groups of people in close quarters, such as prisons, military barracks and ... hostels.
Meningitis takes its name from the delicate tissue layer surrounding the brain and spinal cord (meninges) and the inflammation that results from the infection(-itis). Meningitis is a contagious disease, meaning it can be spread from person to person, and is divided into two basic forms based on cause: Viral and Bacterial.
Symptoms of meningitis are similar in both forms of the illness and include headaches, stiff neck, fever and sensitivity to bright light (photophobia).
Viral Meningitis
Viral Meningitis can be caused by a large number of viruses with exotic sounding names like Echovirus and Coxsackievirus. Fortunately, this a serious health concern but rarely fatal in people with a competent immune system.
Typical symptoms last for 1-2 weeks and resolve without further problems. This infection is commonly spread through the inhalation or contact with respiratory droplets or secretions like saliva or mucous. The best way for travelers to avoid viral meningitis is a regular routine of proper hand washing.
Perhaps the biggest concern with viral meningitis is not being able to differentiate it from bacterial meningitis, which is a much more serious and life threatening disease. For this reason, all cases of suspected meningitis need prompt medical evaluation.
Bacterial Meningitis
Bacterial Meningitis is a serious and life-threatening emergency and needs immediate medical treatment.
The two most common forms of bacteria involved are Neisseria Meningitidis and Streptococcus Pneumoniae. Symptoms of bacterial and viral meningitis are similar and those with fevers, headaches and neck stiffness should consider meningitis as a cause.
Neisseria is famous for causing a rash with a special feature: the rash does not Blanche when pressed with a glass. Typical rashes lose their redness when pressed and return to a rash appearance when the pressure is removed. A drinking glass works well for this as you can apply pressure and still see through at how the rash is behaving. A rash that does not turn back to normal skin color when pressure is applied can be a warning sign of a Neisseria bacterial infection, especially when found with headaches, fevers and neck stiffness. This infection requires immediate antibiotics as death can occur rapidly, within 24-48 hours. Long term complications can include deafness and other neurological disability.
Diagnosis & treatment
Doctors differentiate bacterial and viral meningitis by testing a sample of spinal fluid, obtained during a lumbar puncture (yes, the long needle in the spine) or “spinal tap”. This is a safe procedure, carries few risks and is vital in proper diagnosis.
Treatment of bacterial meningitis requires intravenous antibiotics immediately, while the more benign viral type is largely supportive care consisting of fluids with pain and fever control. Special concerns exist for those who have come in close contact with a confirmed case of bacterial meningitis and those people may require oral antibiotics as prophylaxis (disease prevention).
Can you get vaccinated against it?
Both Neisseria and "Strep. Pneumo" are bacteria for which there are vaccines to prevent illness. Vaccines for S. Pneumo are typically given during childhood, in developed nations. The vaccine for Neisseria Meningitidis covers 4 of the 5 strains of the bacteria including types A, C, Y, and W-135. Each serotype has certain geographical preferences with Group A being most common in the "African Meningitis Belt" and Asia.
There is a group B type of Neisseria Meningitidis that is not covered by the vaccine. Unfortunately, this is one of the most common forms, especially in the Americas and Europe and full protection is not guaranteed by the vaccines at present.
Tips for staying healthy as a traveller
Clearly, those traveling to areas know for meningitis risk should do a review of the immunizations and discuss the need for a meningitis vaccine with their health care provider. Even with vaccines for bacterial meningitis already taken, precautions such as hand washing and not sharing food or drinks are sound advice as the bacterial forms typically spread via saliva and mucous.
Further Reading:
Meningococcal disease in Nigeria (WHO, March 2009)
Meningitis Overview (Centre for Disease Control)
Prevention of Specific Infectious Diseases: Meningitis (Centre for Disease Control)
Meningitis belt in Africa. Photo courtesy of the Centre For Disease Control (wwwn.cdc.gov)
Tags: travel health, travel safety, disease, travel vaccination, travel immunization, virus, africa, meningitis
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