Sunday afternoon, Feb. 28, 2001, marked the end of a busy weekend for the Verbakel family of London, Ont.
There had been hockey games, a birthday party, Sunday school and playing with pals, so Lisa Verbakel wasn't surprised when her son Kyle, then 7, wanted to lie down in the afternoon. His older brother, Derek, 11, had just recovered from the flu. Kyle, she figured, was next in line.
Lisa dispensed a little TLC and, after dinner, tucked herself in beside a sleeping Kyle, a comforting custom when her kids are sick. By morning Kyle would be better.
But Lisa never got to sleep that night. And Kyle was anything but better in the morning.
By midnight he was vomiting every half-hour. When his fever spiked past 40 C, Lisa rushed him to the nearest hospital. The diagnosis? A virus. Strange rashes on his elbow and wrist were dismissed as badges of courage from a hockey game or a brotherly tussle.
Back home by 2:30 a.m., Kyle slept fitfully. Lisa didn't sleep at all. By 4 a.m. bruises had developed on her son's right hand. Shortly after that, Kyle complained that his fingers had "frostbite." His wrists were burning hot, his fingertips freezing cold, and dark red, purplish, almost black splotches had spread to his right palm.
Although doctors had cleared her son only hours earlier, Lisa gave in to her "gut instinct" that something was very wrong and this time took him to the more-specialized Children's Hospital of Western Ontario in London. Within five minutes doctors had done blood work and hooked Kyle up to an IV. As Lisa watched them start blood transfusions, she knew that her gut feeling had been right: her son was indeed very, very ill. Deterioration was rapid; within hours he suffered two cardiac arrests.
The little boy playing with some friends Sunday afternoon was on life support before dawn Monday morning with meningococcemia, a disease broadly known as meningitis. While the most serious strains of meningitis can kill up to half of its victims, Kyle was lucky: he survived with no serious long-term side-effects.
An outbreak -- an unusually high number of cases that are not linked to one source â€“ of meningitis occurs about once every 10 to 15 years in Canada. The last peak occurred in 1992, when more than 400 cases were reported. For the next six years the number of cases in Canada fell to about 190 each year. But the cycle is on an upswing again.
As stories that detail outbreaks emerge, parents begin to ask questions such as What exactly is meningitis? Who gets it? Why? and How can I protect my kids? Here are the answers to these and other questions, gathered from medical experts, educators and a family whose child beat the deadly threat to his life.
Q. What is meningitis?
A. It's an inflammation caused by an infection of the lining of the meninges, the tissue that covers the brain and spinal cord. Meningitis comes in two distinct forms -- viral and bacterial -- both of which are spread by infected saliva, such as through kissing, sneezing or coughing.
Viral meningitis is by far the more common, but it is usually the least serious, says Dr. Donald Low, the chief microbiologist at Toronto Medical Laboratories and Mount Sinai Hospital in Toronto. In fact, those suffering from mild cases of viral meningitis may not need to see a doctor. If they do there's no treatment other than good care: antibiotics are powerless against a virus. Unlike bacterial meningitis, the viral infection can also be spread by inadvertently drinking polluted water, although you can't get it by swimming in polluted waters.
Bacterial meningitis is a different kettle of fish. The bacteria's structure is more complex than that of the virus, and the bacteria produce deadlier toxins that cause significantly more inflammation and tissue damage, says Low. Bacteria overpower the body's immune system, infecting -- and actually poisoning -- the blood. This poisoned blood then infects the lining of the brain or the spinal cord. The disease can cause widespread inflammation, which can cause the body's vital organs, such as the heart, liver and kidneys, to shut down, and eventually result in death unless treated in time.
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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.
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.
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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Q. What do I do if a student at my child's school is diagnosed with meningitis?
A. You can continue to send your child to school because he is not at risk with just casual contact with classmates. Sitting next to someone who contracted the disease does not put him at increased risk, nor does breathing the same air in a classroom or playing soccer in the gym. However, if he shared a water bottle after gym class with someone who has been diagnosed, then he will probably be identified as a "close contact." Close contacts include family members, roommates, child-care and nursery-school contacts, and anyone else possibly contaminated by the patient's oral or nasal secretions.
Q. What about day-care centres?
A. Day-care centres may be somewhat riskier. A study done in 1999 in the United States revealed that children aged 13 to 23 months in a day-care setting for four hours or more a week with two or more children developed pneumococcal disease or another invasive bacterial disease twice as often as those not in day care. For those aged 24 months to about five years, the risk increased threefold.
However, while those ratios seem high, the numbers are still low. Only an estimated 65 Canadian children under age five develop pneumococcal disease each year â€“- inside day-care centres or out, according to Tam.
On the rare occasion when a child is diagnosed, all children in the same day care or nursery school are given antibiotics.
Q. Does my child need treatment if she turns out to be a "close contact"?
A. When meningitis is identified by a doctor, the cases are reported to the local public-health unit. With the help of schools and day-care centres, the public-health unit will get in touch with anyone who was in close contact with the affected person and may have contracted meningitis from him. Your child is identified as a close contact if she was with the patient any time in the seven days before symptoms appeared and up to 24 hours afterward, and if she shared mucosal fluids with this patient. If this is the case, she needs antibiotics within 24 hours. Doctors stress that antibiotics do not take the place of vaccinations.
Q. Will I be alerted if someone has been diagnosed with meningitis at my child's school or day-care centre?
A. You and your neighbours will be alerted if experts identify two or more people with meningococcal disease in the same geographical area who likely got the disease from the same infected person. Health Canada calls this a cluster.
You'll also be told if an outbreak is declared in your area. An outbreak is defined as more than the usual number of cases for that specific community that are not linked to one source.
Because multiple sources mean the germ may spread rapidly, immunization programs paid for by the province or territory may be set up in your community to target at-risk groups. In this case, antibiotics are also given to identified people, and schools send information packages home with your children.
Q. Will I know if a single case is diagnosed in my community or at my child's school?
A. Maybe, but maybe not. Each province has procedures in place to quickly alert local medical officers of health when a case is identified. The case is then reported to provincial and, eventually, national authorities.
There is usually no general public announcement for a single "sporadic" case, even if the patient dies.
Few public-school boards have policies in place regarding the reporting of a case of meningitis to parents. Most school authorities say they would follow procedures outlined by their community's health unit.
Q. What else can I do to protect my child from meningitis?
A. Teach your children to avoid any saliva-sharing activities, such as kissing or sharing objects with fresh saliva on them such as straws, cups, glasses, bottles, team water bottles, forks, spoons, toothbrushes, sports mouth guards, musical-instrument mouthpieces, lip gloss, lipstick, cigarettes, food and drinks. Encourage them to practise the No. 1 hygiene rule: wash hands regularly.
Don't forget your older kids, especially college-bound freshmen who may easily dismiss something very serious as "just the flu." Recent studies in the U.S. show that college freshmen living in residence have a slightly higher risk of contracting meningitis than those of the same age group living in other settings (i.e., at home or in off-campus housing).
Another important tip is to familiarize yourself with the signs and symptoms of the disease, and to know how and when to get help.
The final piece of advice comes from Lisa: "Do more than trust your instinct: act on it."
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