Meningitis in toddlers and preschoolers

What is meningitis?

Meningitis is an inflammation of the meninges, the membrane covering the brain and spinal cord. It can develop very rapidly and is very serious.

There are many different types of meningitis. The two main forms are viral and bacterial. Viral meningitis is the most common type and can be relatively mild. Some sufferers aren’t even aware they have an infection. The bacterial form is rare (about 750 cases a year), but is life threatening and requires prompt treatment.

Bacterial meningitis also comes in many forms (meningococcal and pneumococcal are the two main types). It is always a serious and severe illness, but rapidly developing complications can make it even more dangerous. Depending on the type, bacterial meningitis is fatal in 10 per cent of cases and can cause serious disability such as deafness, loss of limbs or brain damage in 20 per cent of cases (DH 2015, VDH 2014).

Immediate treatment is vital. Septicaemia (blood poisoning) is a complication of meningitis caused by bacteria entering the bloodstream and multiplying rapidly. The septicaemic form of meningitis is the most dangerous.

What are the symptoms?

There’s no textbook pattern to the disease. Symptoms can occur in any order or may not appear at all. In young children, you should look out for the following:

• unusual cry or moaning
• grunting or rapid breathing
• being fretful/irritable when touched
• vomiting
• severe headache
• refusing food
• pale or blotchy skin
• being floppy, listless or unresponsive
• being drowsy or difficult to wake
• being confused or delirious
• having a fever with cold hands or feet
• seizures or convulsions
• spots or a rash (see below)
  (MN nd, MRF 2013)

Many of the symptoms commonly associated with meningitis only appear when the disease is already advanced. Lots of the symptoms are also common for other childhood illnesses, such as flu. The important thing to remember is that if you're worried you should seek urgent medical advice. Don’t wait.

I've heard that children with meningitis have a rash. What should I look out for?

There may be a rash caused by septicaemia, which appears under the skin as a cluster of tiny spots. They look like pinpricks and can start anywhere on the body. If untreated, they develop a bruise-like appearance, followed by purple skin damage and discolouration. They can be harder to see on dark skin, so check paler areas of the body.

You can use the “glass test” to check suspicious rashes. Press the side of a clear drinking glass on to the spots. A meningitis rash doesn’t fade. The rash may fade at first so keep checking. If there’s any doubt, call for medical help immediately. The rash is one of the later signs of blood poisoning (sepsis), after which your child’s condition can rapidly become critical (MN nd).

Check on your child frequently if you have any suspicions of worsening illness. If no rash develops but your child’s condition is deteriorating rapidly, take her to hospital or call 000 immediately.

When do I need help?

If you suspect meningitis, you need to see a doctor for treatment immediately. The earlier antibiotics are given the greater the chance that your child will survive without complications. Always trust your instincts. Call 000 or take your child to a hospital.

How is meningitis diagnosed?

Diagnosis is by lumbar puncture. A doctor will insert a hollow needle into the lower spine, remove a sample of fluid from the spinal cord, and examine it. The procedure takes under 20 minutes and may give your child a headache afterwards. If a doctor suspects bacterial meningitis he should give your child antibiotics as soon as possible (NICE 2013).

What’s the treatment?

Viral meningitis doesn’t respond to antibiotics, so treatment is based on rest and nursing care. It often clears up quickly, though headaches, tiredness, and depression can last for some time. In very rare cases, viral meningitis can cause encephalitis (inflammation of the brain). In these cases, antiviral treatment may be needed.

Bacterial meningitis requires immediate treatment in intensive care so your child’s bodily functions can be supported while the antibiotics take effect.

Is meningitis infectious?

Most cases of bacterial meningitis are isolated, but clusters of meningococcal meningitis occasionally appear. People who’ve been in close contact (usually defined as sharing a house) with someone with bacterial meningitis or meningococcal septicaemia are offered antibiotics usually as a precaution because of the risk of infection. Infection is spread by sneezing or, in adults, intimate kissing. The bacteria that cause the problem are extremely common, living naturally in the back of the nose and throat, and many people carry them without becoming ill.

Viral meningitis is spread, just like other viruses, from person to person, some by coughing and sneezing and others by poor hygiene, such as not washing your hands after going to the toilet. Viral meningitis used to be a complication of childhood illnesses like measles and mumps, but the MMR vaccination has virtually eliminated this threat.

How can meningitis be prevented?

There are vaccines available that offer protection against some forms of meningitis.

Hib vaccine
Your child will be offered the Hib (Haemophilus influenzae type B) vaccine at two, four and six months, and a booster at six months (before 1 July 2018, this booster was at 12 months). The Hib vaccination also offers protection against some other bacterial infections.

Pneumococcus vaccine
The pneumococcus bacterium is the cause of one in 10 cases of meningitis. The pneumococcal vaccine (PCV) is offered at two, four and 12 months (before 1 July 2018, the last dose was at six months). Your child may be offered extra doses if she’s considered at higher risk, including if she was born prematurely, or she is Aboriginal or Torres Strait Islander and living in certain parts of the country (ATAGI 2018).

Meningococcal ACWY vaccine
The meningococcal ACWY vaccine is now offered to all children at 12 months (DH 2018). This vaccine protects against the A, C, W and Y strains of the meningococcal organism. If your child had her 12-month vaccinations before 1 July 2018, though, she would have received the meningococcal C vaccine instead, which only protects against the C strain of the bacteria.

The meningococcal ACWY vaccine is also recommended for older adolescents and young adults because of the increasing number of cases of serious meningococcal disease caused by the W strain in Australia. There have also been outbreaks of the W strain in younger children in some areas.

Some state and territory governments offer free meningococcal ACWY vaccines for young children who didn’t receive it through the Australian government’s schedule of childhood immunisations, as well as for older adolescents.

So check with your GP or child health nurse if your child is eligible for a free vaccine. Otherwise, you'll need to pay for the vaccine at your doctor’s if you want your child to be vaccinated. It costs between $38 and $120 per dose, depending on the brand and your health provider's consultation fee.

The meningococcal ACWY vaccine is recommended for people at risk of exposure to one of these strains through their work or travel to certain countries, or who have a particular medical condition (NCIRS 2017).

Meningococcal B vaccine
There's now a vaccine available in Australia against the B strain of meningococcal, called Bexsero. It's not part of the Australian immunisation scheme and costs between $110 and $150 per dose (depending on your health provider's booking costs). Talk to your doctor if you're thinking of having your child vaccinated.

Some states and territories are offering free MenB vaccines for young children, so check with your child health nurse or GP if your baby might be eligible.

The MenB vaccine can be administered in babies from two months of age. The number of doses your baby needs depends on her age when she has her first dose:

• If your baby is between two and five months of age, she'll need three doses (the first two at least two months apart, and and the last when she's 12 months old).
• If your baby is between six and 11 months of age, she'll need three doses (the first two at least two months apart, and the last when she’s 12 months old or two months after her second dose, whichever is later).
• If your child is between 12 and 24 months of age, she'll need two doses (at least two months apart).
• If your child is between 2 and 10 years of age, she'll need two doses (at least two months apart).
• People aged 10 years or older also need two doses. Depending on which brand of MenB vaccine is used, these doses will either be two months or six months apart.
  (ATAGI 2018)

See our immunisations chart for when your child will be offered vaccinations. You may also want to download the Red Cross First Aid app, to brush up on your first-aid skills or help you through an emergency.

There is some (limited) research that suggests that smoking within the household may increase the chances of a child contracting meningitis, so giving up may reduce the risk (Iles et al 2001). Contact Quit if you need help.