Thursday, January 27, 2005
Progress is made in fighting childhood meningitis

By Dr. Anthony Policastro
Nanticoke Memorial Hospital

One of the disorders that I saw very frequently as a young pediatrician was meningitis. As you might expect an infection that close to the brain or spinal cord can be very serious. Diagnosis of meningitis can only be confirmed by doing a spinal tap. This means putting a needle into the patientís lower back and getting fluid out to see if it is infected. The Symptoms of meningitis were not always that clear. That created problems when the only way to diagnose it was to put a needle in the childís back. Parents often were hesitant to agree to that. For all these reasons, meningitis was difficult to diagnose. When you add to that the fact that it was a serious illness, the best approach was to try and prevent it from occurring. Over the years that is exactly what happened. There were three main bacteria that caused meningitis in young children. The first of those was known as Hemophilus. This was the most common cause. it occurred primarily in children between the ages of four months and 24 months. The younger the child, the less were the physical findings. Therefore, it was even harder to diagnose in very young children. We developed a vaccine to prevent infections with Hemophilus. The vaccine is now given as early as four weeks of age to provide early protection. The result is that there are many fewer cases of meningitis caused by this bacteria. The second offending bacteria was known as pneumococcus. This bacteria more often caused pneumonia than meningitis. However, it did cause both. The pneumonia was more of a concern because of its frequency. For that reason a pneumonia vaccine was created.
Unfortunately, the early forms of the vaccine did not work in children under 15 months of age. For that reason, meningitis that occurred before that age would not be affected. Now we have a vaccine that works at a younger age. The first dose can be given as early as four weeks of age. We still call it the pneumonia vaccine. However, it protects against the second most common cause of meningitis. The third most common cause of meningitis was a bacteria known as meningococcus. As the name would suggest, it commonly was found in patients with meningitis. However, it was found more often in older patients than in young children. It tended to occur more in epidemics than Hemophilus and pneumococcus. Because of the tendency for this one to occur in epidemics, the term meningitis had everyone scared when they heard that someone they had come in contact with had developed meningitis. Since Hemophilus and pneumococcus were more common, most meningitis is not of an epidemic nature. Therefore, getting upset about casual contact with someone who had meningitis is overreacting. For Hemophilus and pneumococcus, the only contact at increased risk are family members and day care contacts. Therefore, the list is short. Meningococcus is more of a community bacteria. For that reason, we see it in community living. Those communities include military barracks and college dormitories. The result is that we now have a meningococcal vaccine that we use for those groups. You will find that many colleges now require that vaccine as part of their admission immunization requirements. Unfortunately there are different types of meningococcus in existence. About one third of them may not be covered by the current vaccine. The good news is that two thirds are covered. The result of using these three vaccines is that the total number of meningitis cases in this country has decreased significantly. It has changed the practice of pediatrics from one of diagnosing a serious illness to one of preventing that illness in the first place.

Dr. Anthony Policastro is medical director at Nanticoke Memorial Hospital.