Parental concerns

New cases of measles began being reported in some

countries—including Great Britain—in 2001 because of

parents’ fears about vaccine safety. The combined vac-

cine for measles, mumps, and rubella (MMR) wasclaimed to cause autism or bowel disorders in some chil-dren. However, the World Health Organization (WHO)

position is there is no scientific merit to these claims.

The United Nations expressed concern that unwarranted

fear of the vaccine would begin spreading the disease indeveloping countries and ultimately in developed coun-

tries as well. Parents in Britain began demanding the

measles vaccine as a separate dose, and scientists were

exploring that option as an alternative to the combined

MMR vaccine. Unfortunately, several children died dur-ing an outbreak of measles in Dublin because they had

not received the vaccine. Child mortality due to measles

is considered largely preventable, and making the MMR

vaccine widely available in developing countries is part

of WHO strategy to reduce child mortality by two-thirds

by the year 2015.

Resources

BOOKS

Katz, Samuel L. ‘‘Measles (Rubeola).’’ In Principles andPractice of Pediatric Infectious Diseases, 2nd ed. Editedby Sarah S. Long et al. St. Louis, MO: Elsevier, 2003.

Maldonado, Yvonne. ‘‘Measles.’’ In Nelson Textbook ofPediatrics. Edited by Richard E. Behrman et al.Philadelphia: Saunders, 2004.

PERIODICALS

Kerr, C. ‘‘Good response rate for MMRV vaccine.’’ LancetInfectious Disease 3 (December 2003): 748.

Stalkup, J. R. ‘‘A review of measles virus.’’ DermatologyClinics 20 (April 2002): 209–215.

ORGANIZATIONS

American Academy of Pediatrics (AAP). 141 Northwest PointBlvd., Elk Grove Village, IL 60007. Web site:

.

Centers for Disease Control and Prevention. 1600 Clifton Rd.,NE, Atlanta, GA 30333. Web site: .

Rosalyn Carson-DeWitt, MD

Rebecca J. Frey, PhD

Measles, mumps, rubella vaccineseeMMR vaccine

Meditation see Yoga

Mediterranean fever see FamilialMediterranean fever

Meningitis

Definition

Meningitis is a serious inflammation of the

meninges, the membranes (lining) that surround the

brain and spinal cord. It can be of bacterial, viral, or fun-

gal origin.

Description

Meningitis is usually the result of a viral or bacterial

infection. Viral meningitis, also called aseptic meningi-

tis, is generally less severe and often disappears without

specific treatment, while bacterial meningitis can be

quite serious and may result in brain damage, hearing

loss, or learning disabilities in children. The infection

may even cause death.

Bacterial meningitis is either monococcal or pneu-

mococcal, depending on the type of bacteria responsible

for the infection. Meningitis caused by Haemophilusinfluenzae and related strains (A, B C, Y, and W135) isalso called meningococcal meningitis. Similarly, menin-

gitis due to Streptococcus pneumoniae is also calledpneumococcal meningitis.

Transmission

Most types of meningitis are contagious. A person

may be exposed to meningitis bacteria when someone

with meningitis coughs or sneezes. The bacteria can also

spread through kissing or sharing eating utensils or a

toothbrush.

Demographics

According to the National Institute of Neurological

Disorders and Stroke (NINDS), some 6,000 cases of

pneumococcal meningitis are reported in the United

States each year. Meningococcal meningitis is common

in minors ages two to 18. Each year about 2,600 people

get this highly contagious disease. High-risk groups

include infants under the age of one year, people with

suppressed immune systems, travelers to foreign coun-

tries where the disease is endemic, and college students

and Army recruits who reside in dormitories and other

close quarters. Between 10 and 15 percent of cases are

fatal, with another 10 to 15 percent involving brain

damage and other serious side effects.

1159GALE ENCYCLOPEDIA OF CHILDREN’S HEALTH

Men

ingitis

Causes and symptoms

The bacteria which cause bacterial meningitis live

in the back of the nose and throat region and are carried

by 10 to 25 percent of the population. They cause menin-

gitis when they get into the bloodstream and travel to the

meninges.

At least 50 kinds of bacteria can cause bacterial

meningitis. According to the Centers for Disease Control

(CDC), before the 1990s, Haemophilus influenzae type b(Hib) was the leading cause of bacterial meningitis, but

subsequent vaccines given to all children as part of their

routine immunizations have reduced the occurrence of

the disease due to H. influenzae. As of 2004, Streptococ-cus pneumoniae and Neisseria meningitidis were theleading causes of bacterial meningitis.

In newborns, the most common agents of meningitis

are those that are contracted from the newborn’s mother,

including Group B streptococci (becoming an increas-

ingly common infecting organism in the newborn per-

iod), Escherichia coli, and Listeria monocytogenes. Thehighest incidence of meningitis occurs in babies less

than a month old, with an increased risk of meningitis

continuing through about two years of age.

Older children are more frequently infected by the

bacteria Haemophilus influenzae, Neisseria meningitidis,and Streptococci pneumoniae.

Most cases of viral meningitis are caused by entero-

viruses (viruses that typically cause stomach flu). How-

ever, many other types of viruses, such as the herpessimplex virus, the mumps and measles viruses (againstwhich most children are protected due to mass immuni-

zation programs), the virus that causes chickenpox, therabies virus, and a number of viruses that are acquiredthrough the bites of infected mosquitoes.

Meningitis symptoms include high fever, head-ache, and stiff neck in children over the age of twoyears. These symptoms can develop over several hours,

or they may take one to two days. Other symptoms may

include nausea, vomiting, discomfort looking intobright lights, confusion, and sleepiness. In some cases, a

rash may be present. In newborns and small infants,

these symptoms may be absent or difficult to detect, and

the infant may only appear slow or inactive, or be irrita-

ble, have vomiting, or be feeding poorly. As the disease

progresses, patients of any age may also have seizures.

Brain tissue infectedwith acute meningitis. (�CustomMedical Stock Photo, Inc.)

1160 GALE ENCYCLOPEDIA OF CHILDREN’S HEALTH

Men

ingitis

When to call the doctor

Parents should call a doctor if a child has a tempera-

ture above 101�F (38.5�C). If any meningitis symptomsoccur, the child should see a doctor immediately, as

early diagnosis and treatment are very important for a

successful outcome.

Diagnosis

Viral meningitis often remains undiagnosed because

its symptoms are similar to those of the common flu. As

for bacterial meningitis, the diagnosis is established by

growing bacteria from a sample of spinal fluid. The

spinal fluid is obtained by performing a lumbar puncture

(also called a spinal tap), in which a needle is inserted

into an area in the lower back where fluid in the spinal

canal is readily accessible.

Treatment

Bacterial meningitis treatment usually involves

intravenous administered antibiotics, for a minimum offour days. The type of meningitis contracted will deter-

mine the specific antibiotic used. It is imperative that

treatment start as early as possible, in order to avoid

brain damage and death.

Viral meningitis cases usually resolve without com-

plications, but typically, antibiotics are ineffective in

treating it, so none are prescribed. The child will be told

to get as much rest as he or she can. If the child has painrelated to the disease such as headaches or other body

pains, medication can be used to treat it.

Prognosis

The long-term outlook for children who develop

bacterial meningitis varies significantly. The outcome

depends on the child’s age, the bacteria causing the

infection, complications, and the treatment the child

receives. The complications of bacterial meningitis can

be severe and include neurological problems such as

hearing loss, visual impairment, seizures, and learning

disabilities. The heart, kidneys, and adrenal glands may

also be affected. Although some children develop long-

lasting problems, most children who receive prompt

diagnosis and treatment recover fully.

The majority of cases of viral meningitis resolve

with no complications.

Prevention

Many children as of 2004 routinely receive vaccines

against meningitis, starting at about two months of age.

Immunizations are recommended by the American

Academy of Pediatrics and many other organizations. If

a child has not been vaccinated, parents should talk to

their doctor about the Hib and pneumococcal (Prevnar 7)

vaccines.

Vaccines are available for both meningococcal and

pneumococcal meningitis. Specifically, there are vac-

cines against Hib and against some strains of N. meningi-tidis and many types of Streptococcus pneumoniae. Thevaccines against Hib are very safe and highly effective.

There is a vaccine that protects against four strains of N.meningitidis, but it is not routinely used in the UnitedStates. There are also vaccines to prevent meningitis due

KEY TERMS

Analgesics—A class of pain-relieving medicines,including aspirin and Tylenol.

Antibody—A special protein made by the body’simmune system as a defense against foreign mate-rial (bacteria, viruses, etc.) that enters the body. Itis uniquely designed to attack and neutralize thespecific antigen that triggered the immuneresponse.

Antigen—A substance (usually a protein) identifiedas foreign by the body’s immune system, triggeringthe release of antibodies as part of the body’simmune response.

Bacterial meningitis—Meningitis caused by bac-teria. Depending on the type of bacteria responsi-ble for the infection, bacterial meningitis is eitherclassified as monococcal or pneumococcal.

Immunization—A process or procedure that pro-tects the body against an infectious disease by sti-mulating the production of antibodies. A vaccina-tion is a type of immunization.

Meninges—The three-layer membranous coveringof the brain and spinal cord, composed of the duramater, arachnoid, and pia mater. It provides pro-tection for the brain and spinal cord, as well ashousing many blood vessels and participating inthe appropriate flow of cerebrospinal fluid.

Viral meningitis—Meningitis caused by a virus.Also called aseptic meningitis.

1161GALE ENCYCLOPEDIA OF CHILDREN’S HEALTH

Men

ingitis

to S. pneumoniae, which can also prevent other forms ofinfection due to S. pneumoniae.

Parents should teach children to wash their hands

often, especially before they eat and after using the bath-

room, or after petting animals. They should be taught

how to wash their hands vigorously, covering both the

front and back of each hand with soap and rinsing thor-

oughly under running water.

Parental concerns

Some forms of bacterial meningitis are contagious.

The bacteria are spread through coughing, kissing, and

sneezing. Fortunately, the bacteria that cause meningitis

are not as contagious as the common cold or the flu, andthey are not spread by casual contact or by simply

breathing the air where a person with meningitis has

been. However, people in the same household or daycare

center, or anyone with direct contact with a patient’s oral

secretions is considered at increased risk of acquiring the

infection.

Awareness of the symptoms and signs of meningitis,

especially the rash which may accompany meningococ-

cal meningitis is very important.

Resources

BOOKS

Leigh, Jenny. A Dr. Spot Casebook: George Has Meningitis.London: Haldane &Mason, 2003.

Routh, Kristina.Meningitis (Just the Facts). Chicago:Heineman Library, 2004.

Tunkel, Allan R. Bacterial Meningitis. Philadelphia: LippincottWilliams &Wilkins, 2001.

PERIODICALS

Anderson, V., et al. ‘‘Cognitive and executive function 12

years after childhood bacterial meningitis: effect of acute

neurologic complications and age of onset.’’ Journal ofPediatrics & Psychology 29, no. 2 (March 2004): 67–81.

Gupta, S., and A. B. Tuladhar. ‘‘Does early administration of

dexamethasone improve neurological outcome in children

with meningococcal meningitis?’’ Archives of Disease inChildhood 89, no. 1 (January 2004): 82–83.

Hvidd, A., and M. Melhye. ‘‘Impact of routine vaccination with

a conjugate Haemophilus influenzae type b vaccine.’’

Vaccine 22, no. 3–4 (January 2004): 378–82.

Posfay-Barbe, K. M., and E. R. Wald. ‘‘Pneumococcal

vaccines: do they prevent infection and how?’’ CurrentOpinions in Infectious Diseases 17, no. 3 (June 2004):177–84.

Spach, D. H. ‘‘New issues in bacterial meningitis in adults.

Antibiotic resistance has complicated treatment.’’

Postgraduate Medicine 114, no. 5 (November 2004):43–50.

ORGANIZATIONS

Meningitis Foundation of America. 6610 North ShadelandAvenue, Suite 200, Indianapolis, IN 46220–4393. Web

site: .

National Institute of Allergy and Infectious Diseases (NIAID).National Institutes of Health, 6610 Rockledge Drive,

MSC 6612, Bethesda, MD 20892–6612. Web site:

.

National Meningitis Foundation. 22910 Chestnut Road,Lexington Park, MD 20653. Web site:

.

Meningitis Research Foundation.Midland Way, Thornbury,Bristol BS35 2BS, UK. Web site: .

WEB SITES

‘‘Meningococcal Disease Homepage.’’ Centers for DiseaseControl and Prevention. Available online at (accessed October 25, 2004).

Monique Laberge, Ph.D.

Meningocele see Spina bifida

Meningococcal meningitisvaccine

Definition

The meningococcal meningitis vaccine is given byinjection (shots) to provide immunization against menin-

gococcal disease and meningitis caused by the bacterium

Neisseria meningitides.

Description

Meningococcal disease, or meningococcemia, is aleading cause of meningitis in children, and then disease

can also lead to infections of the blood. People who

acquire the disease can become very ill, especially the

young children. Meningococcal disease is treated with

antibiotics, and the vaccine is not routinely recom-mended for most people in the United States. Particu-

larly, it is not for children under age two, except under

special circumstances.

1162 GALE ENCYCLOPEDIA OF CHILDREN’S HEALTH

Men

ingo

coccal

men

ingitisvaccine

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Diseases and Conditions Meningitis Print  

Sections 1. Basics 

1. Definition 2. Symptoms 3. Causes 4. Risk factors 5. Complications 6. Preparing for your appointment 7. Tests and diagnosis 8. Treatments and drugs 9. Prevention 

2.  3. InDepth 4. Expert Answers 5. Multimedia 6. Resources 7. News From Mayo Clinic  1. Definition 2. Symptoms 3. Causes 4. Risk factors 5. Complications 6. Preparing for your appointment 7. Tests and diagnosis 

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 Definition 

By Mayo Clinic Staff Meningitis is an inflammation of the membranes (meninges) surrounding your brain and spinal cord. The swelling associated with meningitis often triggers the "hallmark" signs and symptoms of this condition, including headache, fever and a stiff neck. Most cases of meningitis in the U.S. are caused by a viral infection, but bacterial and fungal infections also can lead to meningitis. Depending on the cause of the infection, meningitis can get better on its own in a couple of weeks — or it can be a lifethreatening emergency requiring urgent antibiotic treatment. If you suspect that you or someone in your family has meningitis, seek medical care right away. Early treatment of bacterial meningitis can prevent serious complications. 

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March 19, 2013  

References 

1. Meningitis and encephalitis fact sheet. National Institute of Neurological Disorders and Stroke. http://www.ninds.nih.gov/disorders/encephalitis_meningitis/detail_encephalitis_meningitis.htm. Accessed Dec. 29, 2012. 2. Bacterial meningitis. Centers for Disease Control and Prevention. http://www.cdc.gov/meningitis/bacterial.html. Accessed Jan. 2, 2013. 3. Bartt R. Acute bacterial and viral meningitis. Continuum Lifelong Learning in Neurology. 2012;18:1255. 4. Viral meningitis. Centers for Disease Control and Prevention. http://www.cdc.gov/meningitis/viral.html. Accessed Jan. 2, 2013. 

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5. Fungal meningitis. Centers for Disease Control and Prevention. http://www.cdc.gov/meningitis/fungal.html. Accessed Jan. 2, 2013. 6. Derber CJ, et al. Head and neck emergencies. Medical Clinics of North America. 2012;96:1107. 7. Longo DL, et al. Harrison's Online. 18th ed. New York, N.Y.: The McGrawHill Companies; 2012. http://www.accessmedicine.com/resourceTOC.aspx?resourceID=4. Accessed Dec. 28, 2012. 8. Acute bacterial meningitis. The Merck Manuals: The Merck Manual for Healthcare Professionals. http://www.merckmanuals.com/professional/neurologic_disorders/meningitis/acute_bacterial_meningitis.html. Accessed Dec. 31, 2012. 9. Prevention — Listeriosis. Centers for Disease Control and Prevention. http://www.cdc.gov/listeria/prevention.html. Accessed Jan. 2, 2013. 10. Subacute and chronic meningitis. The Merck Manuals: The Merck Manual for Healthcare Professionals. http://www.merckmanuals.com/professional/neurologic_disorders/meningitis/subacute_and_chronic_meningitis.html. Accessed Jan. 2, 2013. 11. Van de Beek D, et al. Advances in treatment of bacterial meningitis. The Lancet. 2012;380:1693. 12. Recommended immunization schedule for persons aged 0 through 18 years — United States, 2013. Centers for Disease Control and Prevention http://www.cdc.gov/vaccines/schedules/hcp/childadolescent.html. Accessed Feb. 19, 2013. 13. Recommended adult immunization schedule — United States, 2012. Centers for Disease Control and Prevention. http://www.cdc.gov/vaccines/schedules/downloads/adult/adultschedule.pdf. Accessed Dec. 28, 2012. 14. Meningococcal vaccine: Who and when to vaccinate. Centers for Disease Control and Prevention. http://www.cdc.gov/vaccines/vpdvac/mening/whovaccinatehcp.htm. Accessed Dec. 28, 2012. 

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See also 

1. Anthrax 2. CT scan 3. CT scans: Are they safe? 4. Headache 5. Lumbar puncture (spinal tap) 6. Lyme disease 7. Managing Meningitis 8. Nausea and vomiting 9. Neurontin side effects: How do I manage them? 10. Polio 11. Common skin rashes 12. Valley fever 13. CT scan 14. West Nile virus 15. Xray 

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