Meningitis—Child Care and Schools

What is meningitis?

• Meningitis is swelling or inflammation of the tissue covering the spinal cord and brain.

• Three types of bacteria most commonly cause bacterial meningitis in young children after the newborn period.

  • ? Neisseria meningitidis (meningococcus)

  • ? Streptococcus pneumoniae (pneumococcus)

  • ? Haemophilus influenzae type b (Hib)

• With current immunizations, meningitis from these bacteria is rare.

• Most meningitis is caused by common viruses. Although most cases of viral meningitis resolve without antimicrobial treatment or complications, they can be confused with bacterial meningitis in early stages.

• Viral meningitis typically occurs during summer and early fall in temperate climates.

What are the signs or symptoms?

• Fever (may be associated with a blood-red rash of meningococcus)

• Headache

• Nausea

• Loss of appetite

• Sometimes, a stiff neck (ie, pain or discomfort when trying to touch the chin to the chest; child is unwilling to bend head forward enough to look at her or his belly button)

• Irritability

• Photophobia (ie, eye discomfort when looking into bright lights)

• Confusion

• Drowsiness

• Seizures

• Coma

What are the incubation and contagious periods?

• Incubation period

  • ? For the most common cause of viral meningitis (enterovirus): 1 to 10 days, usually 3 to 6 days.

  • ? For Hib: Unknown.

  • ? For meningococcus and pneumococcus: 1 to 10 days, usually less than 4 days.

• Contagious period

  • ? For enterovirus viral meningitis: Shedding of the virus in feces can continue for several weeks to months, but shedding from the respiratory tract is usually 1 to 3 weeks or less.

  • ? For Hib, meningococcus, and pneumococcus: Until after 24 hours of antibiotics.

Skin lesions of early meningococcemia (infection in the blood)

AMERICAN ACADEMY OF PEDIATRICS

Child's upper left thigh shows 7 prominent red skin lesions above the knee, each about the shape and size of a pea, and slightly raised.

Meningococcemia (infection in the blood) showing striking involvement of the arms

AMERICAN ACADEMY OF PEDIATRICS

Profile view of a shirtless child with red skin lesions across the body. The lesions are most prominent on the arms, moderately visible on the face, and there is 1 lesion on the chest.

How is it spread?

• Contact with respiratory secretions or contaminated objects from children who carry these germs, such as sharing of food utensils and drinking vessels (meningococcus, Hib).

• Fecal-oral route (enterovirus): Contact with feces from an infected person, typically when the person contaminates their fingers and touches an object another person then touches. Children who have contact with the contaminated surface may place their fingers into their own or another person's mouth.

How do you control it?

• Bacterial meningitis

  • ? Complete immunization of children and staff according to the most recent immunization schedule.

  • ? Preventive antibiotics may be indicated for close contacts.

• Viral meningitis

  • ? Use good hand-hygiene technique at all the times listed in Chapter 2 of Managing Infectious Diseases in Child Care and Schools: A Quick Reference Guide, 7th Edition and other routine infection control measures in Chapter 2 of Managing Infectious Diseases in Child Care and Schools: A Quick Reference Guide, 7th Edition.

  • ? Recommended immunizations prevent some viral meningitis in the United States from polio, measles, mumps, and chickenpox (varicella). However, these vaccine-preventable diseases are not common causes of viral meningitis.

  • ? Clean or sanitize surfaces that are touched by hands frequently, such as toys, tables, and doorknobs, according to the Routine Schedule for Cleaning, Sanitizing, and Disinfecting in Chapter 8 of Managing Infectious Diseases in Child Care and Schools: A Quick Reference Guide, 7th Edition.

What are the roles of the educator and the family?

• Report the condition to the staff member designated by the early childhood education (ECE) program or school for decision-making and action related to care of ill children and staff members. That person, in turn, alerts possibly exposed family and staff members to watch for symptoms and notifies the Child Care Health Consultant.

• In communication with health professionals and parents/guardians, distinguish between viral and bacterial meningitis, which may be important in determining which close contacts need additional care.

• If it is bacterial meningitis, report the infection to the local health department. The health professional who makes the diagnosis may not report that the infected child is a participant in an ECE program or school, and this could lead to delay in controlling the spread of some types of meningitis. Preventive antibiotic treatment may be appropriate for children who have been in contact with the ill child. Involve the Child Care Health Consultant.

• Prevent contact with respiratory secretions. Teach children and educators to cough or sneeze into a disposable tissue or their inner elbow/upper sleeve and to avoid covering the nose or mouth with bare hands. After coughing or sneezing, practice hand hygiene to prevent the spread of respiratory droplets. Ensure that anyone who contacts mucus or debris on their skin or surfaces washes their hands and any other contaminated skin immediately. Change or cover clothing soiled with mucus. Dispose of facial tissues that contain nasal secretions after each use.

Exclude from educational setting?

Yes, as soon as meningitis is suspected.

Readmit to educational setting?

Yes, when all the following criteria are met:

• When the child is cleared to return by a pediatric health professional

• When the child is able to participate and staff members determine they can care for the child without compromising their ability to care for the health and safety of the other children in the group