Meningitis is a condition that causes inflammation (swelling) around your spinal cord and brain. Some types of meningitis are contagious and can cause serious, long-term complications. If you get meningitis, it's a medical emergency. The best way to prevent meningitis is getting vaccinated.
In a WebMD Reddit AMA about meningitis and the vaccines that help prevent it, pediatrician Mikki Bouquet, MD, discussed a variety of topics, from meningitis risk factors and spread to who may benefit from the vaccine.
Bouquet works as a pediatric specialist at Our Lady of the Lake Children's Health Pediatric Academic Clinic in Baton Rouge, Louisiana.
Here are Bouquet's answers to some of the questions asked during the Reddit AMA. The answers have been lightly edited for length and clarity.
How does meningitis even spread? And how common is it in the U.S.?
Bouquet: Meningitis is typically caused by bacteria and viruses. These can be spread by respiratory droplets from coughing, talking, sneezing, and kissing. It can also be spread by sharing food or drinks. Those who live in the same household are the most vulnerable. Not all who're exposed will get sick.
Since the introduction of the haemophilus (Hib) and pneumococcal vaccines — from the late 1980s to the early 2000s — bacterial meningitis has dropped dramatically, with Hib meningitis specifically down by more than 99%. There's a whole generation of pediatricians who have never seen a case of haemophilus type B meningitis due to the vaccine. The rates of bacterial meningitis are less than four cases per 100,000 per year. We now see more viral meningitis. This isn't a reportable illness, so the rates are harder to track. Enterovirus meningitis is quite common around the late summer and early fall, and in my local large-scale children's hospital, we typically see five to 10 cases per year.
Is there a one-time vaccine for meningitis?
Bouquet: There isn't one universal vaccine that prevents meningitis. There are several vaccines including the pneumococcal (PCV), the haemophilus (Hib), and two types of meningococcal vaccines (MenACWY and MenB) that are routinely given in childhood. All are important to prevent meningitis.
Meningitis commonly affects the very young, adolescents, and the very old. These vaccines are recommended at the ages when patients are the most at risk. For example, the pneumococcal and Hib vaccines are given to children several times when they are less than 2 years of age, since young children are the most at risk of contracting these infections. The vaccines have greatly reduced the rates of meningitis but also pneumonia, ear infections, sinus infection, etc., since their production more than 20 years ago.
The pneumococcal vaccine shot is recommended for adults 50 and older since they're at an increased risk of pneumonia and meningitis. The meningococcal vaccines that protect against serogroups (A,C,W, and Y) are given at ages 11 and 16. [A separate vaccine, MenB, protects against serogroup B and is given to older teens.]
Other vaccines, like MMR, varicella, and polio, also prevent meningitis by providing immunity to the infections that can cause it.
How does someone choose which vaccine to get?
Bouquet: Most of the vaccines are a part of the routine childhood vaccination schedule and are given at times when the child is most vulnerable. The American Academy of Pediatrics updates the vaccine recommendations yearly using the most up-to-date recommendations. The meningococcal vaccines are given to teenagers to help prime their immune systems during the time when they're often in close quarters with their peers and about to go off to college. We recommend children in high-risk groups — such as those with asplenia, complement deficiency, HIV, etc. — to receive the above-mentioned vaccines on or earlier than schedule, as well as receive the PPSV23, a vaccine that protects against additional strains of the pneumococcal bacteria.
Additionally, older adults benefit from the pneumococcal and shingles (zoster) vaccines. Your doctor can tell you which vaccines are right for you and when is best to receive them.
Who should get booster shots for meningitis? How frequently are boosters necessary?
Bouquet: Kids receive their first neisseria meningitis vaccine — meningococcal ACWY vaccine (MenQuadfi, Menveo), or MenACWY — at 11 years old, which protects against neisseria meningitis strains A,C, W, and Y.
They receive a booster at 16 years old. Meningococcal B vaccine (Bexsero, Trumenba), or MenB vaccine, protects against serotype B Neisseria meningitidis, which is the most common form of meningitis for teenagers. They'll receive their first dose at 16 years old and a booster six months later.
MenACWY is a conjugate vaccine, so it'll provide longer-term immunity after the two-dose series is complete. MenB immunity does wane, but when given between 16 and 17 years old, it's most effective during their late adolescence and early adulthood, when they're most vulnerable.
The pneumococcal (PCV) vaccine should be given to adults at 50 years or older. For most, a single shot is all that's needed. The shingles vaccine should also be given at 50 years of age. It's a two-dose series, and the second dose should be given two to six months after the first dose. The shingles vaccine should be given regardless of if the patient had chickenpox or shingles before. Shingles can cause meningitis/encephalitis, and new research has linked it to higher rates of dementia. So not only does the vaccine prevent the dreaded shingles rash, but it can also protect the brain.
How can the meningitis vaccination keep my college-age kids healthy?
Bouquet: The MenACWY and MenB are very effective at keeping children, especially college-aged patients, from contracting meningitis. Although neisseria meningitis is rare, it's deadly. The vaccines have reduced the rate of serious meningococcal disease by more than 90%.
Meningitis is the inflammation of the meninges and the spinal fluid. Spinal fluid (CSF) has very low amounts of immune defense cells; therefore, when an invader enters, it can replicate quickly. Once the immune system is aware, it mounts a destructive inflammatory response, which is the cause of most of the damage of meningitis. Vaccines allow the immune system to recognize the pathogen before it makes its way into the CSF and prevents the subsequent large immune response from happening at all. A vaccine is the safest and most effective way to protect your child from meningitis.
What are some of the risk factors for adolescent meningitis outside of non-vaccination and residing in a dorm?
Bouquet: Sharing foods or drinks puts teenagers at risk. Crowded spaces put adolescents at risk — not just sharing a dorm room. The recent Kent, U.K., outbreak — during which more than 30 students became infected and two died — stemmed from students being in close quarters at a nightclub.
Travel to areas where meningitis is more common, as well as being on a plane, puts people at risk. Meningitis is very virulent; it takes just one person to get infected for it to spread quickly to others. If a neisseria meningitis outbreak occurs, those who were exposed will receive antibiotic prophylaxis, and the health department will become involved to control the spread. If a pneumococcal outbreak occurs, the best way to prevent spread is for those in the community who aren't vaccinated to get vaccinated.
Are meningococcal vaccines recommended for people who've never been vaccinated before and are entering retirement communities, assisted living, rehab facilities, or nursing homes?
Bouquet: They're not routinely recommended in older individuals unless they have particular risk factors like asplenia, complement deficiency, or recent travel to an area where meningitis is endemic. But if there was an outbreak of meningitis, the vaccine would be given. Rates of neisseria meningitis are lower in the older population, which likely plays a role in why it's not routinely recommended. We do, however, recommend the pneumococcal vaccine in patients over 50, which can prevent meningitis as well as pneumonia and bacteremia. Pneumococcal disease is a cause of meningitis in older individuals, so vaccination can help prevent it.
What surprises you about your work?
Bouquet: One of the things that's surprised me most throughout my career is that some people are hesitant to embrace something that has the potential to protect their babies, their children, and themselves from such a serious disease. Vaccines are one of the great privileges of modern medicine, and I feel incredibly fortunate that we have these safe and effective tools to prevent illness rather than simply treat it after it happens.
Are you paid by any pharmaceutical companies or other organizations? And if so, which ones and how do you justify that as a physician?
Bouquet: I do not receive payment, honoraria, consulting fees, or other financial support from pharmaceutical companies for administering or recommending vaccines. Like most pediatricians, I am not paid by vaccine manufacturers to give vaccines. Vaccines are administered as part of routine medical care, and practices may receive reimbursement from insurers or other payers for the vaccine and the associated administration service. This reimbursement is fundamentally different from receiving payment from a pharmaceutical company to promote or administer a vaccine.
I understand the importance of transparency and agree that physicians should disclose relevant financial relationships with industry. However, the suggestion that pediatricians are routinely paid by pharmaceutical companies to give vaccines is misinformation and does not accurately represent how routine childhood immunization is delivered in pediatric practice. My recommendations are based on the evidence regarding vaccine safety, efficacy, and the recommendations of organizations such as the American Academy of Pediatrics — not on financial incentives from vaccine manufacturers.
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SOURCES:
Mikki Bouquet, MD, FAAP, pediatrician, Franciscan Missionaries of Our Lady Health System, Baton Rouge, Louisiana.
World Health Organization: "Meningitis."
