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Ask Dr. Sue
MENINGITIS
Dr. Sue,
I am absolutely terrified by the number of deaths I've
heard about lately that have been caused by the
meningitis with the purple, blotchy rash. I feel
like I need to check on my kids several times a night
just to keep them alive. Isn't there some way I
can protect them from this disease? What did those
other families do wrong to end up with their child
dying? What can I do to make sure mine don't?
Scared in Longview
Dear Scared,
You are not the only one who is frightened by this
disease, which is called meningococcal meningitis, or
meningococcemia, when the infection is in the blood but
not in the spinal fluid. All parents are afraid of
it, unless they've somehow missed hearing about
it. All physicians are also afraid of it, since
what they can offer their patients in this situation can
be frighteningly little.
As scary as it is, though, we need to keep this disease
in perspective. Although we have more of it in our
area than in most parts of the world, it is still a rare
infection. The best way you can protect your
children is by being informed and observant, and not
afraid to act promptly.
This disease never occurs in the absence of a fever,
and, while it can progress very rapidly, the likelihood
of putting a child to bed fever-free and finding them
dead from meningococcus the next morning is practically
zero. So forget about worrying about this disease
every night of your life The time to pay close attention
is when your child is sick with a fever.
Fever, headache, and stiff neck always need to be
investigated immediately, whether or not there is a
rash. When it doesn't cause meningitis, the early
signs of this disease can be mild, and can look a lot
like "the flu." Therefore, if your child has
fever, body aches and irritability, with or without
vomiting, start looking them over every few hours in a
good light for the hallmark rash that meningococcemia
causes.
The rash you are looking for looks like no other.
If you see it, you won't mistake it for anything else.
The problem can be seeing it in the first place, as it
can be subtle at first. The rash can appear
anywhere on the body. Look for little dots that
are under the surface of the skin, that are purple, red
or maroon in color, and that don't fade away when you
push on them with a finger (most rashes blanch when you
do this). Don't panic if you see one or two of
these dots, as many people have such skin marks
normally, and you may never have noticed them before.
If you start out with two and then look again in an hour
and see twelve, its time to act!
Your child needs to be seen immediately. Call your
doctor's office, but if your child can't be seen there
at once, I recommend starting out for the emergency
department. Don't worry about overreacting or
seeming foolish. As soon as you describe your
child as having fever and a purple rash you are going to
get everyone's attention. If there is no reason to
worry, no one will fault you for having played it safe
rather than being sorry later.
As the illness progresses, the rash turns into larger
spots, that look like bruises. The child may
become confused or lethargic, and his skin may be pale
or blotchy and cool to the touch, even if a fever
is present. At this point, the chance of a full
recovery is decreased. Parents who have lost a
child to meningococcemia have not done anything wrong.
They may not have seen the rash in its subtle stages, or
the disease may have progressed even more rapidly than
usual. It is known, however, that exposure to
cigarette smoke increases the likelihood of this
infection, so make sure that your children are not
around second-hand smoke at all!
Breastfeeding offers some protection against this as
well as other infections. Since the greatest
number of infections occur in children under five, you
can cover a fifth of that high-risk period by
breastfeeding for a full year.
People living in crowded conditions, including military
recruits and college freshmen (especially those living
in dorms) are also at increased risk. For the
young adults in the latter categories there is a vaccine
which protects against several of the subtypes of this
disease. This vaccine is also recommended for
children who have no spleen, and for children with a
certain specific immune deficiency.
Unfortunately, it does not protect against the subtype
we see most commonly in our area. It also is not
very effective in small children, as it does not give
them long-lasting immunity. It would only be given
to young children if there was an actual epidemic of one
of the subtypes covered by the vaccine (and there has
been no epidemic in the U.S. since 1946). There
is, however, a meningococcal vaccine that has recently
been added to the routine childhood immunization
schedule in the United Kingdom that is effective in
young children. This vaccine is being investigated
here, and may be approved for use in the U.S. in 2 to 4
years. While it still does not cover the subtype
we see most frequently in our area, it would effectively
prevent the occasional infection with type C that does
occur.
Webmaster's Note: A new conjugate meningococcal vaccine
(MCV4, Trade Name Menactra) has been licensed in the US
since this article was written, and is now routinely
given to children at
11-12 years of age.
 
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