Meningitis A and C

What is meningitis A and C?

Three major strains of meningococcal bacteria cause meningitis: A, B and C. Epidemic meningitis occurring in tropical countries is usually caused by group A strains; cases in Ireland are usually group B. Meningitis is an infection of the fluid of the spinal cord and the fluid that surrounds the brain. Viral or aseptic meningitis, which is the most common type, is caused by an infection with one of several types of viruses. Knowing whether meningitis is caused by a virus or bacterium is important because the severity of illness and the treatment differ.

How is meningitis transmitted?

The disease is spread by close contact, including droplets spread in coughs and sneezes. In countries where meningitis is prevalent, up to 10% of people may be asymptomatic carriers of the bacteria. Meningitis is caused by Neisseria meningitidis, a gram-negative bacterium. Serogroup A and C meningococci are the main causes of epidemic meningitis. Serogroup B, generally associated with sporadic disease, may cause some upsurges or outbreaks. A small proportion of those who come into contact with the bacteria develop clinical disease.

What are the symptoms of meningitis A and C?

The symptoms of meningitis may not be the same for every person. The symptoms usually start abruptly and include fever, an intense headache, confusion, sleepiness, nausea and vomiting; frequently a rash develops. The person may complain of a stiff neck and be unable to tolerate bright light. These symptoms can develop over several hours, or they may take one to two days.

In what areas of the world do meningitis A and C occur?

Meningitis persists in both the developed and developing world, but every December marks the start of the six-month meningitis season in a strip of sub-Saharan Africa known as the "meningitis belt", which extends across Africa just south of the Sahara desert. The most affected countries have been Nigeria, Burkina Faso, Mali, Niger, Chad and Cameroon.

How can meningitis A and C infection be prevented?

Most travellers are unlikely to contract meningitis. However, those who are staying for longer periods or come into close contact with local populations should consider vaccination. The vaccine protects against the A and C strains only.

A single dose provides protection for three years, though small children might need more frequent boosters. Before the 1990s, Haemophilus influenzae type b was the leading cause of bacterial meningitis, but new vaccines being given to all children as part of their routine immunisations have reduced the occurrence of invasive disease due to H. influenzae.

A vaccine to combat the meningococcal C virus has been introduced to Ireland as of the 3rd October 2000. All children and young adults are expected to receive this vaccine, so future generations of Irish farflung travellers will be immunised against the Meningitis C and septicaemia diseases.

There is also a vaccine that protects against four strains of N. meningitidis, but it is not effective in children under 18 months of age.

Overseas travellers should check to see if meningococcal vaccine is recommended for their destination. Travellers should receive the vaccine at least one week before departure, if possible.

How are meningitis A & C diagnosed?

Viral meningitis is generally less severe and resolves without specific treatment, while bacterial meningitis can be quite severe and may result in brain damage, hearing loss, or learning disability. For bacterial meningitis, it is also important to know which type of bacteria is causing the meningitis because antibiotics can prevent some types from spreading and infecting other people.

How long is the incubation period?

Two to 10 days, often three to four days.

How is meningitis A & C treated?

Bacterial meningitis can be treated with a number of effective antibiotics depending on antibiotic susceptibility: penicillin G, ampicillin; chloramphenicol, ceftriaxone. Oily chloramphenicol may be the drug of choice in areas with limited health facilities because a single dose of the long-acting form has been shown to be effective. Travellers to areas affected by meningococcal outbreaks are advised to be vaccinated. It is important, however, that treatment be started early in the course of the disease. Untreated, more than 50% of patients may die.

How contagious is meningitis?

The bacteria are spread through the exchange of respiratory and throat secretions (ie. coughing, kissing). Many infected people become symptomless carriers. Climatic conditions such as dry season or prolonged drought and dust storms contribute to the spread of meningitis A and C. Fortunately, none of the bacteria that cause meningitis are as contagious as things like the common cold or the flu, and they are not spread by casual contact or by simply breathing the air where a person with meningitis has been.

What can I do?

Travellers to areas affected by meningococcal outbreaks are advised to be vaccinated. As this vaccination is now part of the national immunisation programme, you are not required to attend a tropical diseases clinic. Your GP can administer the vaccination.

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