A child was hospitalized who attended the University School Shaker Campus (K-8), according to a letter sent by the school to parents.

The letter states he is doing better, and of course we all hope he recovers speedily and fully.   The letter also states that it is not yet known if he has bacterial or viral meningitis, a distinction that will be important to make in the next few days.

Many people have called our office, so I thought it would be helpful to clarify what is meningitis and what is the risk of exposure, both in turn defining what needs to be done.

What is meningitis?

The somewhat odd word meningitis comes from the Latin name for the sac that contains the fluid the brain and spinal cord float in- the meninges.  Inflammation of that sac is therefore, meningitis.

Some may be surprised to read that their brain floats in a watery sac, but it does, and a good thing too, since this system creates a very effective hydraulic suspension that protects the brain and spinal cord from the bumps that walking would otherwise cause.

The problem with the meninges, or the sac, getting infected, is that once it is infected, the fluid the sac holds gets infected and then the brain and spinal cord.

There are two types of germs that cause almost all the meningitis in otherwise healthy children- viruses and bacteria.

Readers of our posts will know these two types of germs are very, very different.

In the case of meningitis, the difference is enormous.

Viral meningitis

Meningitis caused by a virus, viral meningitis, is typically harmless.  The inflammation is mild, it lasts a few days, and typically causes no harm at all. Fever, stiff neck, splitting headache, nausea, yes.  But once the illness passes back to normal in nearly all cases.  And this is good since there is literally no treatment to get rid of the virus.

Viral meningitis is most often caused by the enterovirus.  The enterovirus mainly causes the summer stomach flu, and also hand-foot-mouth disease.  It is contagious, but the form of disease is not steady.  So if I have viral meningitis and a friend catches my enterovirus, they are far more likely to get stomach flu once the virus lands on them than viral meningitis.  It is unusual to see more than one case of viral meningitis, even in a family, never mind a classroom.

Viral meningitis spreads as all viruses do, in ways we simply cannot stop. Handwashing helps, but cannot stop its spread.  Fortunately, when it spreads it tends not to cause viral meningitis, more likely simple fevers, or stomach flu.

Bacterial meningitis

Where viral meningitis is typically harmless, the infection bacterial meningitis is one of nature’s most deadly infections.  It’s the disease that makes headlines and makes us all stop and hope we never see it.  The only good thing about bacterial meningitis is that it is incredibly rare.

Only about 1 in 100,000 (!) people ever get bacterial meningitis, that is very, very rare.

There are only a small number of bacteria that cause bacterial meningitis.  The three most common culprits are familiar to anyone who knows which immunizations their high school child has had:  Hib, pneumococcal, and meningococcal bacteria.  Hib and pneumococcal bacteria cause meningitis primarily in infancy, perhaps up to age 4 or so.  This is why immunization for these two types of bacterial meningitis are recommended as soon as possible after birth, really starting at 6-8 weeks of age, and being completed by 12-18 months of age.

The key bacteria that causes bacterial meningitis across all ages is the meningococcal bacteria, but this bacteria causes most of its infections in infancy (5 per 100,000, still rare), then again in freshman dorms (4 in 100,000) and in army barracks (even more) .  The immunization for this bacteria does not work in young children, so we can’t offer it for infants.

There are many types of the meningococcal bacteria, each go by a letter, but about 5 cover most cases of bacterial meningitis in the US- A. B, C, Y, and W-135.  The meningococcal vaccone, Menactra, protects against the A, C, Y, and W-135 types, but not B.  Newer vaccines for the B type are now available, but the CDC has not been convinced of them working well enough or being safe enough to recommend everyone get them.

The Issue of Contagion- What’s My Risk if I am in the Same Room?

As noted above with viral meningitis, the risk is very minimal, since the virus is usually an enterovirus, so if you are in the same room, you will likely get a stomach flu or fever, not meningitis.   But even more important, if enterovirus is around enough to cause one child to develop viral meningitis, then this virus is circulating in that community, and so the reality is, as it nearly always  is when it comes to virus, we are all exposed all the time.  Knowing of one case may let us all know a virus is present, but that child with the viral meningitis cannot be the only person passing the virus around, usually thousands are contagious with it in any community.

So, for viral meningitis, there is no action to take if you are exposed.  And, it is very, very likely, you have been exposed daily before and after this child gets sick.

Viral exposure is a constant, fortunately the enterovirus does not typically cause any harm if it should cause a case of meningitis.

For bacterial meningitis, the situation is also very reassuring.  Bacterial meningitis tends to happen in very few cases at a time.  Often just one.  It is very unusual even for siblings in a family to come down with the bacterial meningitis of their sibling.  Think about newspaper stories about tragic losses to bacterial meningitis, they tend to be about one single infected person.  Bacterial meningitis is a terrible infection, but in contrast to many infections, does not spread well.

Further, all three germs that cause bacterial meningitis, including the one we worry about in older kids mostly, the meningococcus, are found mainly on millions of us, in our nose and skin.  At any point in time about 10-20% of us carry this germ on us.  And for the millions and millions of us with this germ sitting in our nose and on our skin, nothing ever happens.

Further, the meningococcus dries out and dies quickly off the body, so if you don’t have it on you, it’s hard to catch being near someone.  You almost have to share saliva to catch it.  This can be done by kissing, or being literally within spitting distance for many hours.

What Can be Done?

#1- Don’t panic.  It does your child no good to panic.  News that a classmate or friend has meningitis is always very scary, but it’s very important to understand the actual risk of spread, which is very, very low.

#2-  If the exposure is to a bacterial meningitis, your child might be immunized already against it.  We give Menactra as a first dose in 6th grade so most children are immunized against meningococcal meningitis (Types A, C, Y, and W-135) from 7th grade on.  If your child is not immunized, and they are old enough to get it, remember getting a shot today offers little protection against an exposure yesterday, it takes a few weeks to take effect.

#3- Know which meningitis the exposure was to.  So far, as of Thursday night 9.28.17, we don’t know if this child was infected with a virus or bacteria.  It matters because viral meningitis is pretty harmless and the virus tends to be everywhere anyway, both facts mean there is nothing to do.  For bacterial, know that unless your child shared contact with saliva with the child with the meningitis, the risk of contagion is too low to matter.  This means that for nearly everyone, the risk of harm from contagion is too low to worry about.

#4-  If you are concerned reach out to your pediatrician, we have already answered many calls.  As we learn more, we will offer more specific guidance.

BOTTOM LINES

1. Meningitis is an infection of the sac that holds the fluid the brain and spinal cord float in, affecting the sac, the fluid, and the brain.
2. There are two main types: Viral which tends almost always to be harmless, and bacterial which is a very serious infection.
3. Contagion is less of a hazard than one would think.  For viral meningitis, the virus causing it tends to be quite widespread and so people are likely exposed to it all the time.  Knowing someone with it simply exposes the fact you have been exposed to this virus quite a bit in recent days.    And, catching the virus from a person with viral meningitis often results in a more common viral illness, such as simply fever or stomach flu.
4. Bacterial meningitis typically comes from bacteria on your own skin or nose, not from someone else.  As many as one in five of us have these bacteria on us on any given day, that’s a lot of bacteria on a lot of us.   We all face far more risk from our own bacteria than from someone with bacterial meningitis.  But, if the contact with someone with bacterial meningitis is very close, like kissing, or living together, then the risk can be raised.
5. FOR NEARLY EVERYONE, HEARING OF A CHILD IN A SCHOOL HAVING MENINGITIS PRESENTS NO DANGER AND REQUIRES NOT ACTION.
6. EXCEPTIONS, that is those who do need to take action:  people living with the infected child, people exposed who have compromised immune systems, and other special circumstances.

Let us all hope this child recovers fully and speedily.  And let us all reassure our own children the risk from spread is very minimal.

To your health,
Dr. Arthur Lavin