Communicable Disease Control
Meningitis is an infection of the meninges, the thin lining that surrounds
the brain and the spinal cord. Several different bacteria can cause
meningitis and Neisseria meningitidis is one of the most important because
of its potential to cause epidemics.
Several different bacteria can cause meningitis and Neisseria meningitidis
is one of the most important because of its potential to cause epidemics.
- Bacteria – Most serious, can cause severe disease that can result in brain
damage and even death- most commonly caused by one of three types of
- Neisseria meningitidis-MENINGOCOCCAL MENINGITIS
- streptococcus pneumoniae-PNEUMOCOCCAL MENINGITIS
- Haemophilus influenzae type b (Hib).
- Viruses - Commonest, rarely serious:common intestinal viruses, mumps or
herpes virus,Mosquito-borne viruses & unknown viruses.
- Fungi - Cryptococcal meningitis is a fungal form of the disease that
affects people with immune deficiencies, such as AIDS
- Other causes - drug allergies, some types of cancer and inflammatory
diseases such as lupus, protozoa.
- person to person through droplets of respiratory or throat secretions.
- Close and prolonged contact (e.g. kissing, sneezing and coughing on
someone, living in close quarters or dormitories (military recruits,
students), sharing eating or drinking utensils, etc.) facilitate the spread
of the disease.
- N. meningitidis only infects humans; there is no animal reservoir. The
bacteria can be carried in the pharynx and sometimes, for reasons not fully
known, overwhelm the body’s defences allowing infection to spread through
the bloodstream and to the brain.
Signs and Symptoms
- The average incubation period is 4 days, ranging between 2 and 10 days
- High fever
- Severe headache, Vomiting or Nausea with Headache
- Generalised malaise, Confusion
- Sleepiness or Difficulty waking up
- Stiff neck
- Sensitivity to light
- Lack of interest in drinking and eating
- Newborns and young infants may not have the classic signs and symptoms of
headache and stiff neck. Instead, they may cry constantly, seem unusually
sleepy or irritable, and eat poorly. Sometimes the soft spots on an infant's
head may bulge. A very late sign may be a spasm consisting of extreme
hyperextension of the body (opisthotonos).
The diagnosis of meningococcal meningitis is suspected by the clinical
presentation and a lumbar puncture showing a purulent spinal fluid.
Sometimes the bacteria can be seen in microscopic examinations of the spinal
The diagnosis is confirmed by growing the bacteria from specimens of spinal
fluid or blood.
Meningitis in South Africa has sporadic outbreaks, which are most prevalent
during droughts, dry and dusty or winter seasons
The number of cases increases in winter and spring.
During the dry season, between December and June, because of dust winds and
upper respiratory tract infections due to cold nights, the local immunity of
the pharynx is diminished increasing the risk of meningitis.
At the same time, the transmission of N. meningitidis is favoured by
overcrowded housing at family level and by large population displacements
due to pilgrimages and traditional markets at regional level.
- Meningitis is potentially fatal, always a medical emergency.
- Admission to a hospital is necessary.
- Isolate patient.
- Antimicrobial therapy must be commenced as soon as possible after the
lumbar puncture has been carried out
- A range of antibiotics may be used for treatment, sensitivity dependent .
This includes penicillin, ampicillin, chloramphenicol, and ceftriaxone.
Under epidemic conditions in Africa, oily chloramphenicol is the drug of
choice in areas with limited health facilities because a single dose of this
long-acting formulation has been shown to be effective.
- Other medications may be needed depending on the condition prevailing.
- Currently recommendations for chemoprophylaxis in South Africa are as follows:
- Contacts :
- Adults: Non-pregnant Ciprofloxacin 500mg po. (single dose)
or Ceftriaxone 250mg imi. (single dose)
- Pregnant women Ceftriaxone 250mg imi (single dose)
- Children > 12 years Ceftriaxone 250mg imi (single dose)
- Children < 12 years Ceftriaxone 125mg imi (single dose)
Mainstay of Control of Disease
- Several vaccines are available to prevent the disease.
- All these vaccines have been proven to be safe and effective with
infrequent and mild side effects.
- The vaccines may not provide adequate protection for 10 to 14 days
- The duration of protection through vaccination is limited (3 to 5 years).
- Travellers to areas affected by meningococcal outbreaks are advised to be vaccinated.
- Includes: educating the public on the need to reduce direct contact and
exposure to droplet infection (using disposable paper tissues to wipe your
nose and to cover both nose and mouth when coughing, not sharing cigarettes
and glasses and minimizing close body contact, e.g. kissing)
- reduce overcrowding in living quarters and workplaces, such as barracks,
schools and camps.
- Clinical vigilance
- early treatment
- prompt notification
- appropriate chemoprophylaxis of close contacts
For further information on Meningitis, please contact the Communicable
Disease Component on 033 395 2051
Compiled by: Premi Govender (STA-CDC)
Notes courtesy of World Health Organisation & Dr. Ayo Olowolagba
The material on this website may be copied for non-commercial use as long as our copyright notice and website address are included.
Copyright © KwaZulu-Natal Department of Health, 2001