Meningitis: Are Campers and Camp Staff at Risk?

by Mary Dagley

Two cases of meningitis in camps last year has created some concern regarding the threat of this disease to the camp community. Are campers and camp staff at a higher risk than the general population of contracting mening-ococcal disease (meningitis)? Is there a vaccine that campers and camp staff should consider?

A thorough review of the disease indicates that campers and camp staff are not at a higher risk of exposure to infection. However, following precautionary measures can prevent the spread of this contagious disease. Early assessment and detection of meningitis is of vital importance for successful treatment.

Background

Meningitis is an inflammation of the meninges (the lining surrounding the brain and spinal cord) and the cerebrospinal fluid (the fluid that circulates in the spaces around the brain and spinal cord). Meningitis can be caused by several different organisms, including bacterial and viral. The etiologic agent (organism) responsible for meningococcal infection determines the course of action in treatment and control of the disease.

  • Viral meningitis, the most common form of meningitis found in the 
    United States, is a virus. Like the common cold, antibiotic treatment is
    not effective. Most cases of viral meningitis are short in duration and
    resolve without any specific treatment or adverse consequences.
  • Bacterial meningitis, however, can be very severe and may result in permanent hearing loss, brain damage, learning disability, or sometimes death. The 
    occurrence of bacterial meningitis in the U.S. is considerably lower than viral meningitis.
  • The leading cause of bacterial meningitis before the 1990s was Haemophilus influenzae type b (Hib). Hib vaccines are routinely given to all children as part
    of their regular immunization schedule. As a result, the incidence of meningitis
    by this bacterial agent has been dramatically reduced.
  • Streptococcus pneumoniae and Neisseria meningitidis (also known as 
    meningococcal meningitis) are now the leading causes of bacterial meningitis.
  • A polysaccharide meningococcal vaccine is in production. However, it is not
    used in routine immunization schedules and is only recommended for use with
    high risk groups (persons with weakened immune systems, college freshmen
    living in dorms).

Approximately 3,000 cases of meningococcal disease are documented in the U.S. each year. About 10 percent of these patients die even after receiving early antibiotic treatment. Approximately10 percent have serious after-effects of the infection.

Transmission

Some forms of bacterial meningitis are contagious. The bacteria is transmitted through direct contact with respiratory and throat secretions (e.g., kissing, coughing, sneezing, or sharing eating utensils, drinks, and food). Meningococcal bacteria cannot survive for more than a few minutes outside of the body. Therefore, it is generally not trans-mittable through water supplies, swimming pools, or routine contact.

Though meningitis is considered contagious, most people who come into contact with a carrier of meningitis do not develop the disease. An individual's health status (the strength of the immune system) plays an important role in contracting the disease. Many infected persons become symptomless carriers. A person with meningitis is generally no longer infectious after the first twenty-four hours of antibiotic treatment.

Signs and Symptoms

Symptoms of meningitis are usually sudden and initially resemble the flu. Common symptoms include:

  •  Sudden onset of intense headache
  •  Fever
  •  Nausea
  •  Vomiting
  •  Stiff neck
  •  Sensitivity to light
  •  Confusion
  •  Sleepiness/tiredness
  •  Sometimes a reddish-purple rash develops that looks 
     like bruises, is flat and smooth, does not itch, and spreads quickly.

Because symptoms of meningitis can easily be mistaken as the flu, it is important to pay close attention to the progression of symptoms when an individual becomes ill. With the flu, symptoms generally improve after twenty-four hours, and the fever is usually respondent to acetaminophen or ibuprofen.

In contrast, symptoms of meningitis usually progress quite rapidly. The fever is generally not respondent to medication, and additional symptoms may appear. Meningococcal disease spreads rapidly in the body; therefore, it is very important to see a physician immediately if symptoms suggesting meningitis are present.

Treatment

Medical treatment of meningitis takes place in a hospital setting for at least the first twenty-four hours. Depending on the bacterium responsible and the progress of the disease, antibiotics are given orally (by mouth) or intravenously (IV). Early detection is important for effective treatment and to lessen potential neurological side effects. The level of progress of the disease in the body plays an important role in treatment.

Prevention

Large epidemics of meningitis do not occur in the U.S. Localized outbreaks, however, have the potential to develop into an epidemic if proper control steps are not taken. In certain cases of meningitis, physicians may decide to administer antibiotic treatment to close contacts of the case (i.e., cabin mates) to prevent other persons from becoming ill. Administering antibiotics to large groups of people, such as the whole camp, is not recommended to prevent or control an outbreak. In some cases, though rarely, inoculation with polysaccharide meningococcal vaccine is recommended.

The following measures should be reinforced to prevent the spread of contagious diseases such as meningitis:

  • Do not share eating utensils, water bottles, toothbrushes, 
    lip gloss, cigarettes, etc.
  • All players should have individual water or drink containers for team sports.
  • Always cover the mouth when coughing. Cover the mouth and nose when 
    sneezing.
  • Wash hands regularly, especially when ill.
  • Appropriately discard used tissues or other items that have been contaminated
    with secretions from the nose or mouth.

When Meningococcal Disease Is Confirmed

Laboratory testing for meningococcal disease is performed on cerebrospinal fluid or blood. Meningococcal disease is potentially fatal and should be treated as a medical emergency. Health care providers (doctors, laboratories) are required to report any confirmed infection to local and state health departments. Meningitis, because of the mode of transmission, does not require a quarantine situation. The camp is not shut down and/or quarantined.

A medical decision may be made to administer antibiotics to the patient’s roommates and others who may have come into contact with the patient’s respiratory secretions. The incubation period of the disease is one to ten days, though it is usually less than four days. Individuals who have been in contact with the patient should be observed for signs of the illness for at least ten (10) days.

The camp should alert staff and parents/guardians of all campers and minor staff persons that a case of meningitis has occurred. The local or state health department can provide literature to the camp, including an overview of the disease and the associated symptoms, and help with preparing a letter to parents and staff regarding the situation.

Parents should be made aware of the signs and symptoms and the possible need to contact the child’s pediatrician for recommendations on how to proceed. The letter should also include information regarding specific actions the camp is taking such as administering antibiotics to the high risk group.

Information Sources

  • Centers for Disease Control and Prevention
  • American Academy of Pediatrics
  • World Health Organization
  • Morbidity and Mortality Weekly Report
  • The Nemours Foundation
  • Morgan County Health Department

 

Originally published in the 2000 Spring issue of The CampLine.

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