Prevention of Meningitis

Meningitis, the acute inflammation of the protective membrane around the brain and spinal cord caused mainly by bacteria and other conditions, can be avoided with vaccination, good hygiene, and other preventive practices.

By doing so, you can avoid a disease that affects around 4,000 people in the United each year, causing death in one of seven of those affected.

Identifying Risk Factors

Depending on the underlying cause of meningitis, some people may be at greater risk of the condition than others. The main cause of meningitis are infections (bacterial, viral, fungal, parasitic), but it can also be the result of non-infectious causes, such as inflammatory autoimmune diseases, drug reactions, or cancer.

Getting an infection (even ones strongly linked to meningitis) does not mean you will get meningitis. The same applies to non-infectious causes.

There are, however, risk factors that place you at increased risk of meningitis. Recognizing these risk factors provide you the means by which to build a personal preventive strategy.

The risk factors for meningitis include:

• Younger age, with infants, teens, and adults 23 and under being at highest risk of bacterial meningitis
• Older age, with people 65 and over at the highest risk of death from infectious meningitis
• Living in crowded spaces, including dormitories, camps, and military installations where infections are more readily spread
• Having a compromised immune system, such as occurs with organ transplant recipients, people with advanced HIV infection, and children with primary immunodeficiency (PID)
• Travel, including foreign travel to endemic areas of mosquito-borne infections and domestic travel to endemic areas of fungal or tick-borne infections
• Being under-vaccinated, including the avoidance of childhood vaccines as well as those recommended for adults

Vaccination

The predominant cause of meningitis is bacteria. The five most common bacteria associated with meningitis are (by order of frequency): Streptococcus pneumoniae, group B Streptococcus, Neisseria meningitidis, Haemophilus influenzae type b, and Listeria monocytogenes.

Viral causes, while less common, include non-polio enteroviruses, measles, mumps, herpesviruses (including chickenpox and shingles), and even influenza viruses.

Vaccination remains crucial to preventing many of the infections associated with meningitis. These include:

• Pneumococcal vaccination, using Prevnar (for primary vaccination) and Pneumovax (for ongoing protection) to prevent Streptococcus pneumoniae and pneumococcal disease
• Meningococcal vaccination, using the Menactra, Menveo, MenQuadfi, Bexsero, or Trumenba vaccines to prevent different serogroups (species) of Neisseria meningitides
• Haemophilus influenzae type b (Hib) vaccination, using the Engerix, Recombivax HB, and Heplisav-B vaccines to prevent Hib in children and adults
• Measles and mumps vaccination, using the measles, mumps, and rubella (MMR) vaccine in children as well as adults who have no evidence of immunization
• Varicella vaccination, using the Varivax vaccine to prevent the varicella-zoster virus (chickenpox) in children
• Zoster vaccination, using the Shingrix vaccine to prevent the herpes-zoster virus (shingles) in adults
• Influenza vaccination, given annually to anyone 6 months of age and older using one of nine different flu vaccines

Vaccines for other causes of meningitis, including Listeria monocytogenes, Staphylococcus aureus, and Escherichia coli, are not available.

Lifestyle 

The infectious organisms that cause meningitis are fairly common in the environment. They are readily transmitted by coughing, sneezing, kissing, and touching contaminated objects. 

To reduce your risk of meningitis, particularly if you are in a high-risk group:

• Practice good hygiene. Routine handwashing and regularly disinfecting counters and surfaces are key to preventing many infections. This includes the cleaning of commonly-touched surfaces that are likely to host germs (called fomites).
• Avoid close contact. Steer well clear of friends, co-workers, or family members who are sick, encouraging them to stay at home and quarantine if necessary. This is especially true if there is an outbreak of infection in schools, universities, or the community-at-large.
• Choose your residence wisely: Living in closes quarters, such as residence halls or military barracks, can create a hotbed of infections. While moving is not always possible, you should motivate for change if you are immunocompromised, particularly during outbreaks of meningococcal meningitis that frequently occur at universities.

Treatment

Meningitis is not a disease. Rather, it is a complication of certain infections as well as non-infectious causes, including autoimmune diseases like lupus and rheumatoid arthritis.

Meningitis may be the result of systemic inflammation (involving the whole body) or caused by diseases or conditions that specifically target the meninges (the protective lining surrounding the brain and spinal cord).

Any condition that can induce inflammation in the meninges can lead to symptoms of meningitis.

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If you have an acute infection or inflammatory condition associated with meningitis, you can reduce the risk of meningitis by getting it treated immediately. Among the examples:

• Bacterial infections are commonly treated with oral or intravenous (IV) antibiotics. These include broad-spectrum antibiotics commonly used in people with pneumococcal disease.
• Viral infections can sometimes be treated with antivirals but are often treated symptomatically to reduce fever and inflammation. People at high risk of influenza complications, for example, may preemptively be treated with flu antivirals like Tamiflu (oseltamivir) or Xolenza (baloxavir) to reduce the severity of symptoms.
• Fungal infections tend to cause meningitis in people with severe immunosuppression and are commonly treated with oral or IV antifungals. People with advanced HIV will also be placed on antiretroviral therapy to restore immune function.
• Parasitic infections are uncommon causes of meningitis but, when they occur, may be treated with antiparasitic drugs, if available, as well as supportive care and corticosteroids.
• Autoimmune diseases can be treated with corticosteroids, disease-modifying anti-rheumatic drugs (DMARDs), or biologic drugs, all of which target inflammation.

In cases of infectious meningitis, anyone who has been in close contact with the affected individual should be tested and provided prophylactic (preventive) medications if available.

Drug-Induced Meningitis

There are some medications that can cause meningitis. The condition, referred to as drug-induced aseptic meningitis (DISM), can be caused by a variety of medications (although the mechanism for this inflammatory reaction remains poorly understood).

In some cases, a drug might directly affect the meninges, particularly those delivered intrathecally (via an injection into the spine). Others may be the result of drug hypersensitivity in which the immune system over-responds to the presence of a drug.

The drugs most commonly associated with DISM include:

• Antibiotics, like Bactrim (trimethoprim-sulfamethoxazole), Cipro (ciprofloxacin), Flagyl (metronidazole), isoniazid, Keflex (cephalexin), Moxatag (amoxicillin), and penicillin
• Certain vaccines, most commonly the hepatitis B vaccine and the mumps component of the MMR vaccine
• Immunoglobulin (IG) replacement therapies, used to treat people with primary immunodeficiency (PID)
• Nonsteroidal anti-inflammatory drugs (NSAIDs), most commonly Advil (ibuprofen)
• Orthoclone OKT3 (muromonab-CD3), used to prevent organ rejection in transplant recipients
• Radiation contrast agents, including those made with gadolinium
• Tegretol (carbamepazine), an anticonvulsant drug
• Zantac (ranitidine), a histamine-2 blockers use to treat heartburn

The challenge with avoiding DISM is that there is often no way to know who will develop the adverse reaction.

With that said, DISM often occurs in people who have already been exposed to a drug. In some but not all cases, it is the re-exposure that triggers meningitis.

If available, an alternate drug may be used. If a doctor decides to rechallenge a person with a drug, the risks and benefits should be carefully weighed and the individual should be monitored so that treatment can be rapidly delivered should a reaction occur.

A Word From Verywell

Meningitis has many different causes. The most serious causes can be prevented with vaccinations, good hygiene, and the avoidance of infection.

If meningitis does occur, either infectious or non-infectious, it is important to recognize the symptoms. Call your doctor or seek emergency care if you experience any of the tell-tale signs of meningitis, including:

• Sudden high fever
• Neck stiffness
• Headache with nausea or vomiting
• Confusion
• Excessive sleepiness or difficulty waking
• Sensitivity to light
• Seizures

Early diagnosis and treatment almost invariably lead to better outcomes.