Fever, headache and neck pain, nausea, stiff neck. Sometimes it feels like the flu or a cold, usually when it’s a viral condition. In other situations, it can also lead to difficulty resting the chin on the chest or red spots on the body. According to the Ministry of Health, this is a sign that the risks of generalized infection are great.
From time to time, meningitis takes over the news due to outbreaks in certain locations. Now, the alert is because, after two years of underreporting due to the covid-19 pandemic, from January of this year until last 10, there has been a 197% increase in confirmed cases of all types of meningitis in Bahia compared to last year’s entirety (396 versus 133). Deaths from the disease have also grown: they went from 25 in 2021 to 66 in 2022, which represents a 164% increase.
At the basis of this increase, according to the Secretary of State Health (Sesab), there is precisely the underestimation, which also occurred with other pathologies in the most acute period of the pandemic.
“In addition to the isolation measures, among all the measures to minimize transmission, we also had an underreporting of cases online. There was a time when the whole world was more focused on controlling covid-19”, says the coordinator of the body for vaccinations and vaccine-preventable diseases, Vânia Rebouças. “When we compare to the years before the pandemic, there is no increase,” adds.
According to the Ministry of Health, meningitis is considered an endemic disease in Brazil, which means that there are cases throughout the year, but with occasional outbreaks and epidemics. In general, bacterial meningitis is more frequent in autumn and winter, while viral meningitis occurs more in spring and summer.
«What matters most for surveillance is the topic of bacterial meningitis, due to the potential seriousness and transmissibility of the diseases. After them, the viral ones. For the bacterial ones we have vaccines. Not for viral ones. With them, the treatment is the same symptoms,” explains Vânia.
However, compared to the pre-pandemic period, he points out that there has not been a significant increase. In fact, in 2018 and 2019, the total number of cases was 381 and 409, respectively. Meningococcal meningitis, which is an acute, life-threatening bacterial infection, would be one example: in 2022, confirmed cases in the state were 10, while between 2018 and 2019 they were respectively 25 and 41.
“Constant vigilance must be maintained because cases of meningitis can be potentially serious. So, (the increase) is an endemic disease, which means that, today, there are no meningitis outbreaks in Bahia. With the years of the pandemic , because it is atypical, in addition to the social isolation measures themselves, such as the use of masks, which have had a decrease in the circulation of viruses and bacteria”, guarantees the coordinator.
That is, measures to prevent covid-19 may also have contributed to reduced notifications of some types of meningitis, according to neurologist Roberta Kauark, neurology residency preceptor at Professor Edgard Santos University Hospital (Hupes) and science doctoral candidate of health.
“In bacterial infections, in general, the contagion is respiratory, by droplets. So, if you do this prevention through the masks, in addition to the complaints it is also reduced”explains the neurologist.
Meningitis is inflammation of the meninges, which are membranes that cover and protect the central nervous system, including the brain. While bacterial and viral are best known, they can also be caused by fungus and even trauma. Children are usually the most affected by the disease, although they are not the only ones.
When meningitis is bacterial in origin, it can cause permanent brain damage, explained pediatrician Reinan Tavares, a doctoral candidate in pediatrics at the University of São Paulo (USP).
“The brain is a vital organ, which regulates many of our functions, such as walking, running, talking, communicating, eating, leading to consequences for the rest of our lives. Furthermore, (the infection) has the potential to generate disorganization in other organs, with the loss of the entire functioning of the body, which can lead to death,” explains.
In the case of children, this age group is more likely to have an immune system that may develop, depending on age. This means that a child would not necessarily be able to deal with the infection in the same way that an adult would. “A child with severe meningitis may have cerebral palsy. That’s one of the things that differentiates (the disease) in adults from children.”
A possible drop in vaccination coverage, according to the pediatrician, could impact both the incidence of cases and their severity. “This is very worrying in terms of public health, because our population is more vulnerable overall,” adds Tavares.
The lethality of bacterial meningitis is higher, as neurologist Roberta Kauark explained. “It can develop and culminate in death in a very short time, so much so that we use it when we suspect its etiology. Meningococcus is the one with the highest lethality, but pneumococcus can lead to more permanent sequelae, such as deafness. Therefore, the concern is great.”
types and treatment
There are five types of meningitis identified by experts: viral meningitis, bacterial meningitis, fungal meningitis, eosinophilic meningitis, and aseptic meningitis. However, the infectious disease specialist Clarissa Cerqueira believes that infectious meningitis can be classified into two large groups, which are viral meningitis and bacterial meningitis, given the frequency of events.
Viral meningitis usually occurs in the summer, is more common, and is usually milder. They are caused by viruses, the main ones being enteroviruses, such as Coxsackie and poliovirus, Epstein-Barr virus and herpes virus. In the latter, the infection caused is called herpetic meningitis, being a little more serious than other types of viral meningitis.
Bacterial meningitis is caused by inflammation of the meninges due to the action of bacteria such as Neisseria meningitidis, Streptococcus pneumoniae, Mycobacterium tuberculosis And Haemophilus influenzae. Clarissa Cerqueira warns that this is the most serious meningitis. “The patient can progress to death within hours or days,” she points out.
To differentiate viral meningitis from bacterial meningitis, examination of the cerebrospinal fluid (cerebrospinal fluid) should be done. This is because, despite having different severity, the symptoms of both meningitis do not present a significant difference.
“The symptoms are basically fever, neck pain with headache. And there is a sign, which is what we see in the physical exam that the doctor does. It’s the sign we call neck stiffness, which is difficulty in do neck flexion or pain when flexing the neck.So,the patient having headache,pain in the back of the neck and fever,this is a suspicious condition of meningitis.With a suspicious condition,you should get tested the cerebrospinal fluid to find out if it is viral or bacterial,” advises the infectious disease specialist.
Clarissa emphasizes that the main form of prevention is vaccination. She requests that parents bring their children to get the meningococcal, pneumococcus, and Haemophilus influenzae type B vaccines, which are part of the children’s immunization schedule, to protect them from more severe cases of meningitis. The treatment of the disease in its viral type uses antivirals in the most serious cases, while the bacterial type usually makes use of antibiotics.
If you have fungal meningitis, usually caused by fungus Cryptococcus sp. And Coccidioids sp and common in people with low immunity and advanced age or chronic disease, the medical recommendation, in addition to rest, may include the use of antimicrobials. Eosinophilic meningitis, considered rare and caused by the ingestion of meat from parasitic animals Angiostrongilo cantonensis, it can lead to other symptoms, in addition to the traditional ones related to meningitis, such as nausea and vomiting. Treatment should also include the use of antimicrobials and strengthening the immune system.
Finally, aseptic meningitis, considered non-infectious, is a benign, self-limiting disease usually caused by a virus contained in the organisms. It can include all types of meningitis that don’t involve bacteria. “Viral meningitis is a type of aseptic meningitis. It’s one for which we can’t find an etiological agent, which can also be drug-induced, resulting from an inflammatory condition. The changes in CSF are very similar,” Clarice clarifies. The disease is treated only with rest and medication to control symptoms.
In other states, declining immunizations have been cited as one of the reasons for the increase in meningitis cases in 2022. However, in Bahia, as the occurrence profile has remained the same as in pre-covid years, there is no none of the main causes, in the evaluation of Vânia Rebouças, of Sesab. In recent years, vaccination coverage of children has generally decreased, causing concern for pediatricians and epidemiologists.
“Today, in the public network, we have two types of vaccine. One is meningitis C, which is in the basic calendar, with the first dose at three months of age, the second at five months and a booster after a year,” says Vânia. In Bahia, 71.37% of children under one year are immunised.
The Ministry of Health has extended this strengthening to people up to 10 years of age, if they have no history of vaccination, but, in Bahia, the age range has been extended to 19 years, 11 months and 29 days, according to an assessment of the health profile. population… Healthcare workers are also being considered with the expansion, even if they have already received a few doses previously.
Also, since last year, there is the ACWY immunizer, which protects against four serotypes of meningitis, in the Unified Health System (SUS). This vaccine is also indicated for adolescents aged between 11 and 12, considered “potential transmitters”. Among this audience, immunization coverage in the state is 36.09%.
“The vaccine program protects the children and the response is very effective in the first five years, but then it starts to have a small relapse. Therefore, the Ministry of Health noted that a booster dose for adolescents would be important, also because they end up being asymptomatic carriers. continues.
The meningitis B vaccine, which is currently only available on the private network, is also indicated for children from six months.
In El Salvador, the vaccines contained in the federal childhood immunization program are available at 161 health posts in the municipal network, according to information from the Municipal Health Secretariat (SMS).
In addition to the vaccine, another form of prevention is chemoprophylaxis, but only for contacts with confirmed cases. “Diagnosis is made through CSF collection. It can be suspected, but only through the defined sampling, when there is an analysis and the presence of the pathogen is detected”, says neurologist Roberta Kauark.
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