Meningitis Basics: What you need to know.

Meningitis occurs when a virus or bacteria causes inflammation of our brain or spinal cord. We use several different vaccines to prevent a few types of meningitis, but it’s all very confusing. Recent commercials have raised questions about what these vaccines are and if they’re needed.

Today we’ll go over what meningitis is and what types of germs cause it. Next time I’ll discuss some of the new meningitis vaccines in more detail.

What is meningitis?

Symptoms of MeningitisBoth viruses and bacteria can cause meningitis, but not everyone with these germs gets meningitis. Most people have less severe symptoms when they get these infections.

Not everyone gets all the symptoms listed below when they have meningitis. Some of these symptoms are common to many less serious infections, but if your child has these symptoms and appears more sick than normal, he or she should be evaluated immediately.

Symptoms of meningitis include:
  • fever
  • stiff neck
  • body aches and pains
  • sensitivity to light
  • mental status changes
  • irritability
  • confusion
  • nausea
  • vomiting
  • seizures
  • rash
  • poor feeding

Viral meningitis

Viruses are the most common cause of meningitis. Thankfully viral meningitis tends to be less severe than bacterial meningitis.

Most people recover on their own from viral meningitis. As with many infections, young infants and people who have immune deficiencies are most at risk.

There are many types of viruses that can cause meningitis. It’s likely that you’ve had many of these or have been vaccinated against them.

Non-polio enterovirus

The most common virus to cause meningitis is one from the non-polio enterovirus family.

Fever, runny nose, cough, rash, and blisters in the mouth are all symptoms that kids can get from this type of virus.

Most kids are infected with this type of virus at some point. Adults are less susceptible, and can even have the virus without symptoms.

There is no routine vaccine given for non-polio virus strains.

MM(R)V

Measles, mumps and chicken pox viruses can cause meningitis.

We vaccinate against these typically at 12-15 months of age, so it is uncommon to see these diseases. The MMR and varicella vaccines can be given separately or as MMRV. (Rubella is the “R” and can lead to brain damage in a fetus, but does not cause meningitis.)

Influenza

Influenza can cause meningitis, which is one of the reasons we recommend vaccinating yearly against flu starting at 6 months of age.

Herpesviruses

Herpesviruses can cause meningitis. Despite the name, most of these are not sexually transmitted.

This family of viruses includes Epstein-Barr virus,which leads to mono most commonly. Cold sores from herpes simplex viruses are also in this group. Chicken pox (or varicella-zoster virus) is another of these blistering viruses.

Bacterial meningitis

Bacteria that lead to meningitis can quickly kill, so prompt treatment is important. If you’ve been exposed to bacterial meningitis, you may be treated as well, but remember that most people who get these bacteria do not get meningitis.

Most people who get bacterial meningitis recover, but some have lasting damage. Hearing loss, brain damage, learning disabilities, and loss of limbs can result from various types of meningitis.

Causes of bacterial meningitis vary by age group:

Newborns

Newborns can be infected during pregnancy and delivery as well as after birth. They tend to get really sick very quickly, so this is one age group we take any increased risk of infection very seriously.

Bacteria that tend to infect newborns include Group B Streptococcus, Streptococcus pneumoniae, Listeria monocytogenes, and Escherichia coli.

Mothers are routinely screened for Group B Strep during the last trimester of pregnancy. They are not treated until delivery because this bacteria does not cause the mother any problems and is so common that it could recur before delivery if it’s treated earlier. This could expose the baby at the time of delivery. If a mother does not get adequately treated with antibiotics before the baby is born, the baby may have tests run to look for signs of infection or might be monitored in the hospital a bit more closely.

Once the mother’s water breaks, we time how long it has been because this opens the womb up for germs to infect the baby. If the baby isn’t born during the safe timeframe, your delivering physician or midwife might suggest antibiotics. After delivery your baby might have tests done to look for signs of infection or might be monitored more closely in the nursery.

It is very important that sick people stay away from newborns as much as possible. Everyone should wash their hands well before handling a newborn.

Babies and children

As children leave the newborn period, their risks change. Streptococcus pneumoniae, Neisseria meningitidis and Haemophilus influenzae type b (Hib) are the bacteria that cause disease in this age group.

Thankfully we have vaccines against many of these bacteria. Infants should be vaccinated against S. pneumoniae and H. influenzae starting at 2 months of age. (Note: H. influenzae is not related at all to the influenza virus.)

Vaccines against N. meningitidis are available, but are not routinely given to infants at this time. High risk children should receive the vaccine starting at 2 months of age, but it is generally given at 11 years of age in the US.

Teens and young adults

Neisseria meningitidis and Streptococcus pneumoniae are the risks in this age group.

Thankfully most teens in the US have gotten the S. pneumoniae vaccine as infants so that risk is lower than in years past.

Tweens and are routinely given a vaccine against A, C, W, and Y strains of N. meningitis. A vaccine against meningitis B is recommended for high risk people and can be given to lower risk teens. This will be discussed further in my next blog.

Older adults

Streptococcus pneumoniae, Neisseria meningitidis, Haemophilus influenzae type b (Hib), group B Streptococcus and Listeria monocytogenes affect the elderly

Talk to your parents to be sure they’re vaccinated and follow the vaccine recommendations for yourself too. Vaccines are not just for kids!

‘NI, Leptomeningitis purulenta cerebralis. Alfred Kast’ . Credit: Wellcome Collection. CC BY

 

It’s not the flu!

I was at the gym today and an otherwise great instructor who seems to know a lot about health was sharing incorrect information about the flu with the class of about 40 people. She said that she had received several texts from other instructors asking her to cover their classes because they were vomiting. Then she went on to say that many at first thought it was food poisoning, but it’s spreading like illness, so it’s the flu, not food poisoning. She made a big deal that the flu is here. Is vomiting from the flu?

She’s only partially right.

Yes…

There’s a stomach bug going around.

It’s not food poisoning.

Influenza is in town.

But this extreme vomiting is not “the flu”

vomiting from the flu
Vomiting can be associated with influenza, but is not the main symptom.

The flu causes predominantly fever, cough, sore throat, and body aches for many days. It can cause vomiting and diarrhea, but those aren’t usually the predominant symptoms. And the flu doesn’t cause just a few hours of extreme vomiting like we’re seeing these days.

Why do I care if people call this stomach bug “flu”?

Runny nose is one of the symptoms of influenza.

The biggest reason I care is that it leads people to make other incorrect assumptions and to get the wrong treatments.

I hear all the time that people had the flu the year they got a flu shot, so they don’t want to get it anymore.

When probed about their illness, it’s usually not consistent with the flu. It was either a cold and cough or a stomach virus.

If they think a common cold or vomiting is from the flu, they’re mistaken.

They need to know that this isn’t the flu.
Cough is one of the most common symptoms of influenza, along with fever, sore throat, and body aches.

Common colds and vomiting are not prevented with the flu shot.

The flu shot has nothing to do with protecting against most cases of vomiting and diarrhea or most upper respiratory tract infections.

Of course there are people who got the flu shot (or FluMist when it was available) who did come down with the flu. They had a positive flu test and symptoms were consistent with the flu. But if they get influenza after the vaccine they tend to have milder symptoms. They tend to not end up in the hospital or dead if they’ve had the vaccine. Yes, even healthy young people can end up very sick from influenza. They can even die. (The FluMist didn’t protect well and was removed from the market due to this.)

We forget about all the times people did get the vaccine and they didn’t catch the flu even with likely exposure. Lack of disease is easy to fail to acknowledge.

We know the flu vaccine is imperfect. But if the majority of people get vaccinated, we can slow the rate of spread and protect us all against influenza most effectively.

We don’t have great treatments for influenza, so vaccinating and using other precautions is important!

Motion Sickness: Treatments for kids

School vacation often leads to travel, which brings up a lot of questions about motion sickness, also known as car sickness, sea sickness, and air sickness. If your child suffers from motion sickness, there are many options – though some take a while to show benefit, so plan ahead!

Whether it’s the threat of a long car trip, concern about flying, or anticipated problems on a cruise, there are many kids who suffer from motion sickness. Kids 2 – 12 years are the most likely to suffer from motion sickness. It’s less common in teens and adults and very rare in infants and toddlers. It is more common in women and people with migraines.

What causes motion sickness?

motion sickness treatments for kidsMotion sickness is thought to be triggered when the inner ear senses motion but the eyes don’t. These mixed signals coming into the brain can cause nausea, dizziness, vomiting, paleness and cold sweats.

Motion sickness often happens on ships and boats, but it also can affect kids when they travel in planes, buses and cars. Motion sickness is often worst if there is a bumpy or curvy ride.

It can also be triggered by strong smells, which is why avoiding gas stations (if possible) can help prevent it.

Sometimes trying to read a book or watching a movie during travel can trigger motion sickness.

In both children and adults, playing computer games can sometimes lead to motion sickness.

Some general tips to avoid motion sickness:

  • Look out the window during travel. Don’t watch other moving objects (such as cars) — watch the horizon. Teens and adults can benefit from sitting in the front seat. Younger children (12 and under) are safer in the back seat.
  • Avoid strong smells, such as those at the gas station, if possible.
  • Eat small amounts of high protein, non-greasy foods during travel. Spicy and fatty foods can exacerbate symptoms. Crackers can help.
  • Sleep. Or at least close eyes.
  • Take deep, controlled breaths.
  • Use a headrest to prevent head movement.
  • In a plane: sit over the wing and recline when possible.
  • On a ship: stay on deck where you can see the horizon as much as possible. Avoid the bow and stern.
  • Take breaks for fresh air and a short walk if possible.
  • Some people believe that opening the car window for fresh air helps, but close windows if the air quality is poor or irritates the rider.
  • No smoking or e-cigarette use in the car. Ever. Even when no one is in the car with the driver. The compounds left behind can be dangerous to children.
  • Avoid reading books or playing video games when traveling. Movies are tolerated more often than reading, but if they are not tolerated, stop them.
  • Be aware that some medicines increase the risk of motion sickness. Avoid these if possible. A full list is included in the link, but those more commonly used in children and teens are ibuprofen, some antibiotics, some antidepressants, and hormones (birth control pills).

Medicines for motion sickness:

All medicines have side effects, but many of the ones that seem to help motion sickness can have significant side effects, so risks and benefits must be considered.

Note that none of these medicines is approved under 2 years of age, but motion sickness is uncommon in infants and toddlers. If you decide upon a medicine, be sure to keep it out of reach of children to avoid overdose. Remember that during travel childproofing is more difficult!

Warning: know this number!

In case of suspected overdose, call your local poison control center at 1-800-222-1222. Put this number in all of your phones for easy access in times of emergency.

If a person is not breathing or unconscious, first call 911 and initiate CPR.
Benadryl

Benadryl (diphenhydramine) is an over the counter antihistamine that can help some kids over 2 years of age with motion sickness.

Follow the over the counter package directions for weight – based dose and give it 30 minutes before travel and before meals and at bedtime if needed.

It can lead to excessive sleepiness – or hyperactivity in some kids, so be careful!

If your child has never had Benadryl, I recommend doing a test dose at home before travel to be sure they don’t get wired or irritable on it.

Dramamine

Dramamine (dimenhydrinate) can also help kids over age 2 and is available over the counter.

It also should be started 30-60 minutes before traveling and every 4-6 hours (for 12 years and up) and every 6-8 hours (for children under 12 years) as needed.

Side effects include drowsiness, dry mouth, blurry vision, thickened mucus in their airways, feeling excited or restless, and increased heart rate.

Dramamine Less Drowsy

Dramamine Less Drowsy (meclizine) is also available over the counter and can help prevent motion sickness in children over 2 years of age.

Meclizine comes as a regular and chewable tablet and a capsule.

It should be taken 1 hour before you travel. Doses may be taken every 24 hours if needed.

Side effects include drowsiness, dry mouth, and blurred vision.

Phenergan

Phenergan (promethazine) is sometimes prescribed for motion sickness.

Some significant warnings exist for children, so see the attached link and talk to your doctor about the risks and benefits of this medication.

The drug comes in suppository and tablet form.

When promethazine is used to treat motion sickness, it is taken 30 to 60 minutes before travel and again after 8 to 12 hours if needed.

On longer trips, promethazine is usually taken in the morning and before the evening meal on each day of travel.

Side effects include dizziness, anxiety and drowsiness. It can slow or stop breathing in children.

Zofran

Zofran (ondansetron) is a prescription medicine that is used to treat nausea and vomiting, often associated with chemotherapy.

See your doctor to discuss if this prescription is appropriate for your child for motion sickness. It hasn’t been shown to be effective for this use.

Prochlorperazine

Prochlorperazine is an antipsychotic that helps treat severe nausea and vomiting. It comes as tablets and suppositories.

Prochlorperazine should not be used in children under 2 years old or who weigh less than 20 pounds.

Prochlorperazine requires a prescription, and a full discussion of risks and benefits should be done with your doctor before taking this medicine.

See the attached link for full list of potential side effects as well as other drug interactions.

Metoclopramide

Metoclopramide has been used for treatment of motion sickness, but carries significant risks. Please see the attached link for details.

Scopolamine Patch

scopolamine patch can be considered for teens and adults but should not be used in kids under 12 years.

Some experts discourage any use in all children due to significant side effects, which include sedation, blurred vision, disorientation and mouth dryness.

See attached link for complete list of side effects. If it is used, the patch is placed behind the ear 4 hours before travel and left in place for up to 72 hours.

Alternative treatments:

Ginger

Ginger has been shown to help prevent motion sickness, but the specific dose is not clear. Kids can drink ginger tea or ginger ale or suck on a ginger lollipop or lozenge – only if old enough to not choke.

To make ginger tea: dissolve 1/8 – 1/4 teaspoon of powdered ginger in a cup of hot water or boil two slices of fresh ginger root (each about 1/8 of an inch thick)in one cup of water for about 10 minutes. Sweeten to taste, and offer small sips throughout the day.

Accupressure

Accupressure wristbands are sold in pharmacies and online, and though research is not conclusive, I have seen decent benefit from these.

They fall into the “it won’t hurt to try” category in my opinion.

I don’t know if it is the power of suggestion (placebo effect) or a real benefit, but I have seen several families rely upon these successfully.

Physical therapy

If your child suffers from motion sickness often, there are some studies that support vestibular training. It will not work for your vacation next week, but can be considered for children who suffer to help long term.

Have your child work with a physical therapist trained in vestibular training.

For more information:

CDC.gov page on Motion Sickness