Doctors Talk: Meningitis

Doctors Talk: Meningitis

Anjuli Gans, MD: So, Dr. Offit, as a pediatrician, I've seen a lot of meningitis in young babies, but I'd love to know a little bit more about the history about the meningitis vaccine.

Paul Offit, MD: Sure. Well, I mean, I did my pediatric residency in the 1970, so that was before the development of three vaccines to prevent bacterial meningitis. One was Haemophilus influenzae type b. The other was pneumococcus. And then the third was meningococcal. So, I saw a lot of meningitis when I was training. I mean, there would be 20,000 cases a year, 25,000 cases a year. We would admit several children every week to the wards with bacterial meningitis, which could be devastating. Although there is, there are antibiotics to treat bacterial meningitis; nonetheless, children often suffered sequela, meaning post-infection problems, like hearing loss, vision loss, difficulties, you know, with movement, etc. So, bacterial meningitis was a nightmare and occasionally fatal. Now we have a vaccine to prevent all three of those diseases. So, most people your age actually don't see a lot of bacterial meningitis, which is interesting. So, we're not as good at doing these lumbar punctures, or spinal taps, as we used to be.

Anjuli Gans, MD: Yes, absolutely. You don't have as much occasion, I think. I remember being with attendings in the ICU and they would say, we used to do these all the time when we admitted kids with meningitis, and you all are really learning on the fly right now.

Paul Offit, MD: It’s, it’s, you know, we take it for granted. I think because we don't see meningitis at nearly the rate that we saw it before, I think some people think, you know, it's not a problem. Vaccines are often a victim of their own success, and I think that’s at some level the case here.

Actually, I used to have this trick that I used to do when there was a baby that had bacterial meningitis, like someone between 6 say and 24 months of age. I used to have this little measuring tape, just a little, blue plastic measuring tape, and I would pull out this thing, and then you would push this little white button, and it would snap back in. So, you would show that to the young child, now they're interested, right? They're interested in what you have. And then I would bring it up. And typically, what happens is children will normally maintain their eyes in the midline, so they'll look up to see it as best as possible. But children who had neck stiffness would lift them up because they didn’t want to move their neck.

Anjuli Gans, MD: Oh, what a good clinical trick, Dr. Offit. That's really neat.

And you know, I think that it's important with meningitis to really know, like you say, how sick they can be, how sick kids are. Because even though we don't see it that frequently, when you do and you see a child with meningitis, it's very frightening. It seems very emergent, and they look very, very sick.

Paul Offit, MD: And it's a word that scares parents. That word, “meningitis,” scares parents. And it's not just bacteria. I mean, there are viruses also that can cause meningitis, viruses like measles or mumps which can cause meningitis. Although typically when bacteria cause meningitis, they sort of infect the lining of the brain and spinal cord. But when viruses cause meningitis, it's really not just meningitis, it's often called meningoencephalitis, which means it's not just the lining of the brain and spinal cord but also the brain itself. Again, vaccine preventable with a measles and mumps vaccine.

Anjuli Gans, MD: Did you see a lot of GBS meningitis?

Paul Offit, MD: Yeah. So, group B strep is a bacteria that can sort of colonize or live on the lining of, sort of the, the birth canal. And so, children would acquire that bacteria then when they pass through that birth canal. Yeah, so we saw some group B strep, but mostly it was Haemophilus influenzae type b and pneumococcus and less commonly meningococcus. But those diseases dominated my residency.

Anjuli Gans, MD: So interesting, because now when I counsel parents during those early visits when they have babies like 2 months and 4 months, and we go through a roster of the different kinds of vaccines, everyone says, oh yeah, I've heard about pneumococcal or I've heard about DTaP, but meningitis Hib is the one that they really don't know that much about. So, you're right, it's sort of a victim of its own success. It's really interesting to talk to parents about it and explain how serious it can be.

So, you know, it's interesting in terms of the meningitis vaccine, I’ve seen a lot of it before the pandemic hit with travel. So, a lot of our families that we see are going to places like Africa or Asia or different parts of the world. And it's interesting to think about even now you don't see that much meningitis because we have preventable vaccines to help during travel.

Paul Offit, MD: I think that's right. And again, I think it's something we often take for granted. I think we don't think about all those diseases that are out there when we travel and are not always great about getting those vaccines, but we need to.

Anjuli Gans, MD: I had a patient when I was in training in DC, and they had had meningitis. It was a 17-year-old. They have been completely unvaccinated, and they'd gotten it. And they had headaches and a question of some seizures and a lot of lingering effects after that when you don't see meningitis that much, you might not think about because we think about it as sort of a disease that's of our past, but it does linger those effects afterward.

Paul Offit, MD: Absolutely. That's why it's so important to prevent it. I mean, talk about fears of long COVID now, but there are a lot of diseases which have long-term consequences, so prevent them.