A laboratory technician notifies your Director of Infection Control of a preliminary laboratory test result for a college student admitted with headache, fever, and stiff neck. Preliminary test results identified the dreaded gram-negative diplococcus…a characteristic finding associated with the bacteria Neisseria meningitides, the bacteria responsible for a potentially deadly form of meningitis. Even though there are fewer than 1,000 cases (10% to 15% of which are fatal) of this form of meningitis annually in the United States, your healthcare facility must be prepared to step into action immediately when a case comes through its doors.
Because this form of bacterial meningitis is spread through direct contact, it can be spread from person-to-person through contact with respiratory and throat secretions. It is usually spread when there is close or prolonged contact with the infected person, or direct contact with the person’s oral secretions. Fortunately, the bacteria aren’t as contagious as viruses that cause the common cold or influenza; but your facility must institute Droplet Precautions immediately to protect others from the spread of infection.
Meningococcal meningitis affects infants less than 1 year of age and adolescents and young adults ages 16 to 21 more frequently than other age groups. Military recruits, first-year college students living in college dormitories, people who have had their spleen removed, and people traveling to a country where the disease is common are most at risk.
It typically takes 3 to 4 days for a patient infected with Neisseria meningitides to experience symptoms. Symptoms of this form of bacterial meningitis include:
These common findings associated with meningococcal meningitis may be difficult to identify in an infant; instead the infant may be less alert, irritable, vomiting, and feeding poorly. A young infant may have a bulging fontanel and abnormal reflexes.
The bacteria can quickly spread to the patient’s bloodstream, causing a more serious condition, meningococcal sepsis, which is characterized by:
The fatality rate increases to 40% when a patient develops sepsis, so prompt recognition and treatment are key to improving the patient’s chance of survival.
When meningitis is suspected or diagnosed, the patient should be placed on Droplet Precautions. Droplet Precautions include placing the patient in a private exam room or patient room, if available. Wear a mask before close contact with the patient; put the mask on before entering the patient’s room. Wear goggles or a face shield if splashing of respiratory secretions is likely. Perform hand hygiene before and after touching the patient and after contact with respiratory secretions and contaminated objects. Use soap and water to perform hand hygiene when hands are visibly soiled.
Because prompt treatment is the key to improving the patient’s chance of survival, antibiotics should be administered immediately after cultures have been obtained. In addition, supportive care may be necessary.
All cases of meningitis must be reported to the local health department. They’ll provide recommendations about who should be given preventative antibiotics and provide guidance to the patient’s close contacts. Because close contacts of the patient are at higher risk for getting the disease, they may need preventative antibiotics.
Prevention is the key to fighting meningococcal meningitis. The Centers for Disease Control and Prevention recommends vaccination with the meningococcal conjugate vaccine for all children 11-12 years old, followed with a booster dose at age 16. Adolescents who receive the first vaccine dose at age 13-15 should receive a booster dose at 16-18. A booster dose isn’t required for adolescents who receive their first dose at or after age 16. For college students, who are required by most colleges to get the vaccine, a booster dose is recommended if they received their first dose more than 5 years ago.
Remember, prompt recognition and treatment and prevention are key to protecting patients from the effects of meningococcal meningitis. Is your staff prepared to recognize the sign and symptoms? Are they prepared to respond appropriately? Do they know the appropriate infection prevention strategies to prevent the spread of the infection?