What every parent needs to know about meningitis

Q. What causes bacterial meningitis?
A Three bacteria cause most cases of bacterial meningitis in Canada:

1. Haemophilus influenzae, type B (HiB)
Formerly the No. 1 cause of bacterial meningitis in children, this bug has been greatly reduced in Canada due to the routine immunization of babies. The HiB vaccine is administered as part of a "one-in-five" package shot at two, four and six months of age. Most provinces cover the costs of these vaccinations.

2. Pneumococcus
This bacteria is now the leading cause of meningitis; approximately one in 3,600 Canadian children will develop pneumococcal disease by the age of five years. But a vaccine (Prevnar) approved by Health Canada in 2001 should help fight the most common strains in children. Most provinces offer programs for children considered to be at high risk. Ask your doctor or public health nurse for more detailed information.

3. Meningococcus
The primary cause of meningitis in adolescents and young adults -- and the second most common cause in young children -- is the culprit that infected young Kyle. It comes mainly in five types -- A, B, C, Y and W-135 -- four of which can be prevented through vaccines. Menjugate, a vaccine against meningococcal disease, type C, is available for children of all ages in Canada. Three doses are necessary for youngsters under one year old (the vaccine can be administered to infants two months and up), but older children need only one dose. The vaccine offers long-term protection. No vaccine exists, however, to prevent type B, the most common strain in children.

Q. My child was vaccinated for meningitis with HiB; won't this protect her?
A. The HiB vaccine will only protect her from infection by the Haemophilus influenzae, type B bacterium. This bug once caused about two-thirds of all cases of meningitis in Canada, but the vaccine has all but wiped it out, says Dr. David Scheifele, a pediatric infectious-diseases specialist in Vancouver. "There has been a dramatic drop -- from about 500 cases a year to six," he says. "It has been thrilling to watch the near-eradication of the disease caused by this bacteria."

This vaccine won't, however, protect your child against infection by pneumococcal or meningococcal bacteria; she would have to get separate vaccines for these (see previous answer). At any given time, about 10 to 25 per cent of the population carry these bacteria in their noses, throats or mouths. However, Dr. Gillian Arsenault of Abbortsford, B.C., the medical health officer in the Fraser Valley Health Region, says that, for the most part, the bacteria "just hang out there" and cause no harm.

Q. Why do young children and adolescents get the disease more often than adults?
A. Anyone can get the disease -- anywhere, anytime -- although the number of cases of meningococcal disease peak during the winter months. In Canada, however, those at highest risk are babies and youngsters. The next highest-risk group is teens and young adults aged 15 to 24.

The young are particularly susceptible because they have immature immune systems and little practice fighting bacteria due to reduced exposure to germs, says Dr. Theresa Tam, a specialist in respiratory diseases at Health Canada. As well, youngsters exhibit riskier behaviours: babies and toddlers put everything in their mouths, then share such objects with others, while adolescents and young adults spread the disease through kissing and sharing food, drinks and cigarettes.

Q. What symptoms do I need to watch for?
A. In the early stages the symptoms of both viral and bacterial meningitis are wide-ranging, can appear in different combinations and often resemble the flu. Developing in just hours or over the course of one to two days, they can include fever, vomiting, joint pain and general malaise. More specific symptoms include severe headaches, neck stiffness, an aversion to bright light and drowsiness.

Very significant -- in the case of bacterial meningitis -- is a rash that develops anywhere on the body, caused by bleeding under the skin. The rash usually begins as patches of tiny, dark red pinpricks; it can develop into a blotchy, purple bruising that doesn't turn white when pressed. Lisa described Kyle's rash as "blood blisters," "rug burn" and "bruising." The rash is a key indicator of blood poisoning and should spur parents to get their child to a hospital right away.

Q. At what point should I take my child to the doctor?
A. Don't wait for every symptom to appear; some symptoms may never surface, and speed is of the essence if the illness is indeed meningitis.

Low suggests that you seek help if the child's fever is above 38.5 C and is accompanied by some of the other symptoms, and if he doesn't "look well." You are the best judge as to how sick your child is, he adds. "Only you know your child and how he usually reacts to illness," says Low. "If your parental instinct causes you to feel uncomfortable, then get medical advice."

Don't be shy about seeking help a second time -- if you've already taken your child to a doctor but he continues to deteriorate. "Nobody should feel inhibited about returning for a reassessment -- nobody," says Low.

(Click here for an up-to-date list of publicly funded children's immunization programs across Canada.)

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