Meningitis

1. A Review for Health Care Professionals Meningitis Hector E. Hernandez Ph.D.: Epidemiology Walden University PUBH 8165-2 Instructor: Dr. Raymond Thron Spring , 2012

2. Agenda For today’s agenda we will: • Review presentation objectives. • Define the two main types of meningitis. • Bacterial and viral • Review the signs and symptoms. • Discuss treatments. • Review global meningitis. • The Meningitis Belt • Discuss prevention and control measures. • Health care providers • List exposure recommendations. • Health care providers • Discuss the 6 B’s. • Summarize with concluding remarks. • Include references. • Provide additional sources.

3. Expected Learning Objectives At the end of this presentation you will be able to: • Define meningitis. • Provide a historical perspective on the disease. • Provide awareness of the incidence and prevalence of meningitis. • Review the two main types of meningitis. • List the signs and symptoms. • Discuss exposure prevention tips for health care providers and recommendations for treatment if exposure occurs. • List the 6 B’s of meningitis.

4. Stakeholders • Health Care Providers • American Hospital Association • Centers for Disease Control and Prevention • Environmental Health Department • Public Health Department • National Meningitis Association Permission obtained from: State of Connecticut Department of Public Health.

5. What is Meningitis? • Meningitis is defined as a disease caused by the inflammation of the meninges; these provide protective functions to the central nervous system (CDC, 2012). • Cerebral spinal fluid that surrounds the central nervous system becomes infected, which causes the meningeal inflammation. Lee Memorial Health System. (2012). Meningitis requires swift care for best outcomes. Retrieved from http://www.leememorial.org/mainlanding/meningitis.asp. CDC. (2012). Meningococcal Disease. Retrieved from http://www.cdc.gov/meningococcal/about/index.html.

6. Historical Perspective • In the first decade of the 20th century, untreated meningitis had about an 80% mortality rate. • Anton Weichselbaum discovers the bacterium that causes meningitis. • Simon Flexner successfully treating bacterial meningitis with equine antiserum in 1913. A. Picture Source: Meningitis.com. (2012). History of Meningococcal Meningitis. Retrieved from http://www.meningitis.com/US/about/history-meningitis/#tab_1913. Morton, S.N. (2004). Bacterial meningitis: A view of the past 90 years. New England Journal of Medicine. 00284793, Vol. 351, Issue 18.

7. Historical Perspective • In the 1930’s, Sulfonomides decreased mortality rate to about 15%. • Penicillin therapy began in the 1940’s. • Today, a combination antibiotic therapy is the best treatment for meningitis • CT scan technology has revolutionized diagnosis. B. Picture Source: Meningitis.com. (2012). History of Meningococcal Meningitis. Retrieved from http://www.meningitis.com/US/about/history-meningitis/#tab_1913. Morton, S.N. (2004). Bacterial meningitis: A view of the past 90 years. New England Journal of Medicine. 00284793, Vol. 351, Issue 18.

8. Source: Morton, S.N. (2004). Bacterial meningitis: A view of the past 90 years. New England Journal of Medicine. 00284793, Vol. 351, Issue 18.

9. Incidence and Prevalence • From 1998 to 2007, about 1,500 Americans were infected each year. • Between 900 to 3,000 cases, (11% ),died annually. • 15% of all cases were adolescents and young adults which have an increased incidence of meningococcal meningitis. • One out of seven adults will die of meningitis. • Survivors of meningococcal meningitis, have a 20% chance of suffering brain damage, kidney disease, deafness or limb amputations (NMA, 2012). National Meningitis Association. (2012). Overview. Retrieved from http://www.nmaus.org/meningitis/.

10. Centers for Disease Control and Prevention. (2012). Active bacterial core surveillance. Retrieved from http://www.cdc.gov/abcs/index.html.

11. Types of Meningitis • There are 2 main types of Meningitis: 1. Viral etiology 2. Bacterial etiology Graphic Source: Vaccine News daily. (2012). CDC holding meetings on meningitis vaccine. Retrieved from http://vaccinenewsdaily.com/news/253692-cdc-holding-meetings-on-meningitis-vaccine/.

12. Is it Viral or Bacterial? • Meningitis is difficult to diagnose since it has symptoms that are similar to flu-like symptoms. • The bacterial form is the most dangerous and fatal. • Amputations, deafness and kidney damage are common long term effects. • Although viral meningitis has similar symptoms to its bacterial counterpart, it is neither as deadly nor as debilitating. • There is no treatment for viral meningitis. • Microscopic analysis and spinal fluid analysis will determine if the meningitis is of bacterial or viral etiology. National Meningitis Association. (2012). Overview. Retrieved from http://www.nmaus.org/meningitis/.

13. Types of Bacterial Meningitis A. • There are 3 main kinds of bacterial meningitis in the U.S.: 1. Meningococcal disease (Neisseriameningitidis) 2. Pneumococcal meningitis (Streptococcus pneumoniae) 3. Hib (Haemophilusinfluenzae type b) disease B. National Meningitis Association. (2012). Overview. Retrieved from http://www.nmaus.org/meningitis/. CDC. (2012). Meningococcal Disease. Retrieved from http://www.cdc.gov/meningococcal/about/photos.html.

14. Signs and Symptoms • Symptoms of meningococcal disease include: • Fever • Headache and neck stiffening • Nausea and vomiting • Sensitivity to light • Altered mental status • Seizures • Skin rash National Meningitis Association. (2012). Overview. Retrieved from http://www.nmaus.org/meningitis/.

15. Treatment • Health care consists of immediate and aggressive doses of antibiotics to prevent serious side effects and/or death. • Early treatment of heavy doses of antibiotics reduces the risk of death; because the disease can progress rapidly, early treatment does not guarantee a full recovery or prevent death. • Antibiotics therapy should also be administered to those having direct contact with a person who is diagnosed with meningitis (NMA, 2012). National Meningitis Association. (2012). Overview. Retrieved from http://www.nmaus.org/meningitis/.

16. Viral Meningitis • Enteroviruses are the most common cause of viral meningitis. • Transmission can occur through improper handwashing techniques , diaper changing, and using the restroom. • It can also be transmitted by saliva, sputum, and mucus from one person to the next. • Proper PPE is essential to reduce transmission. CDC. (2012). Viral Meningitis. Retrieved from http://www.cdc.gov/meningitis/viral.html#transmission.

17. Preventive Measures • Vaccination offers the best protection against the disease. • Meningococcal vaccines are available in the U.S. for people nine months of age and older. • Vaccination protects against four of the five strains of the bacteria (Neisseriameningitidis) that cause meningococcal disease in the U.S. National Meningitis Association. (2012). Overview. Retrieved from http://www.nmaus.org/meningitis/.

18. Global Meningitis • Meningitis occurs in small clusters around the world. • Most of the burden is Sub-Saharan Africa, where it is known as the meningitis belt, • WHO has taken global health response initiatives that promotes epidemic preparedness, prevention, and response. WHO. (n. d.). A new meningitis vaccine for Africa. Retrieved from http://www.who.int/features/2010/meningitis_vaccine/photo_story/en/index3.html. WHO. (2012). Meningococcal meningitis. Retrieved from http://www.who.int/mediacentre/factsheets/fs141/en/index.html.

19. Meningitis Belt Travel Medicine Inc. (2008). Travel-related diseases. Retrieved from http://www.travmed.com/health_guide/ch10.htm.

20. Hospital and Clinical Setting Prevention Tips • Wash hands frequently. • Change gloves frequently. • Clean and disinfect contaminated surfaces. • Use a dilute solution of bleach. • Use masks or shields when handling meningitis patients. • Ensure that you are properly vaccinated against meningitis. • Ensure that pests are properly controlled in the facility. • Click here for further information. Source: Clip Art CDC. (2012). Viral Meningitis. Retrieved from http://www.cdc.gov/meningitis/viral.html#transmission.

21. Exposure Recommendations for Health Care Providers • Chemoprophylaxis is recommend if workers were within 3ft from an infected patient. • There must be a clear history of exposure for chemoprophylaxis to be warranted. • Eye exposure does not constitute a clear exposure. • Masks are strongly encouraged. • ICU workers must wear masks using closed suction. • Workers must have routine vaccinations, except with meningococcal C conjugate. Stuart, J. M., Gilmore, A. B., Ross, A., Patterson, W., Kroll, J. S., Kaczmarski, E. B., et. al. (2001). Preventing secondary meningococcal disease in health care workers: Recommendations of a working group of the PHLS meningococcus forum. Communicable Disease and Public Health. Vol. 4, No. 2.

22. The 6 B’s To prevent meningitis transmission: • 1. Be aware. • 2. Be alert. • 3. Be clean. • 4. Become vaccinated. • 5. Become informed. • 6. Become an advocate. Source: Clip art.

23. Conclusion Source: Clip Art

24. Thank You! Questions?

25. References • Anatomy and Physiology @Suite 101. (2011). Meninges: Brain meningeal layers dura mater, arachnoid, pia mater. Retrieved from http://lakshmiananth.suite101.com/meninges-brain-meningeal-layers-dura-mater-arachnoid-pia-mater-a338847. • Centers for Disease Control and Prevention (CDC). (2012). Bacterial Meningitis. Retrieved from http://www.cdc.gov/meningitis/bacterial.html#transmission. • Centers for Disease Control and Prevention (CDC). (2012). Meningococcal Disease. Retrieved from http://www.cdc.gov/meningococcal/about/index.html. • Centers for Disease Control and Prevention (CDC). (2012). Meningococcal Disease. Retrieved from http://www.cdc.gov/meningococcal/about/photos.htm. • Centers for Disease Control and Prevention (CDC). (2012). Viral Meningitis. Retrieved from http://www.cdc.gov/meningitis/viral.html#transmission. • Gardner, P. (2006). Prevention of Meningococcal Disease. New England Journal of Medicine. Vol. 355, Issue 14. • Lee Memorial Health System. (2012). Meningitis requires swift care for best outcomes. Retrieved from http://www.leememorial.org/mainlanding/meningitis.asp.

26. References con’t • Meningitis.com. (2012). History of Meningococcal Meningitis. Retrieved from http://www.meningitis.com/US/about/history-meningitis/#tab_1913. • Morton, S.N. (2004). Bacterial meningitis: A view of the past 90 years. New England Journal of Medicine. 00284793, Vol. 351, Issue 18. • National Meningitis Association (NMA). (2012). Overview. Retrieved from http://www.nmaus.org/meningitis/. • Stuart, J. M., Gilmore, A. B., Ross, A., Patterson, W., Kroll, J. S., Kaczmarski, E. B., et. al. (2001). Preventing secondary meningococcal disease in health care workers: Recommendations of a working group of the PHLS meningococcus forum. Communicable Disease and Public Health. Vol. 4, No. 2. • Travel Medicine Inc. (2008). Travel-related diseases. Retrieved from http://www.travmed.com/health_guide/ch10.htm. • World Health Organization (WHO). (n. d.) A new meningitis vaccine for Africa. Retrieved from http://www.who.int/features/2010/meningitis_vaccine/photo_story/en/index3.html. • World Health Organization (WHO). (2012). Meningococcal meningitis. Retrieved from http://www.who.int/mediacentre/factsheets/fs141/en/index.html.

27. Additional Sources • Centers for Disease Control and Prevention (CDC). (2011). Meningococcal: Who needs to be vaccinated? Retrieved from http://www.cdc.gov/vaccines/vpd-vac/mening/who-vaccinate.htm. • Meningitis Research Foundation. (2011). Meningococcal Disease. Retrieved from http://www.meningitis.org/disease-info/types-causes/meningoccal-disease. • Thigpen, M.C., Whitney, C.G., Messonnier, N. E., Zell, E.R., Lynfield, R., Hadler, J.L., et al. (2011). Bacterial meningitis in the United States, 1998-2007. New England Journal of Medicine. Vol. 364, Issue 21. • Tunkel, A. R., Hartman, B. J., Kaplan, S. L., Kaufman, B. A., Roos, K. L., Shield, W. M., et al. (2004). Practice guidelines for the management of bacterial meningitis. Clinical Infectious Diseases. Vol. 39. • World Health Organization (WHO). (2012). The meningitis vaccine project-frequently asked questions. Retrieved from http://www.who.int/immunization/newsroom/events/menafrivac_faqs/en/index.html.

28. Contact Information Hector E. Hernandez hector.hernandez@waldenu.edu