Spotlight on meningitis: Q&A with Dr. Louise-Marie Dembry

Recent news about a Yale College student who was diagnosed and treated for bacterial meningitis raised questions about this rare but serious infection. To get more detail and insight about the disease, YaleNews talked to Dr. Louise-Marie Dembry, professor of medicine and epidemiology at Yale School of Medicine. It is important to remember, she said, that while transmission of the infection can occur, a single case of meningitis is most often sporadic and does not typically lead to an outbreak. At the time of this writing, no other Yale College student had come down with the infection, but YaleNews offers this Q&A in the hope that having the facts can help prevent further cases.

Dr. Louise-Marie Dembry

What is the difference between meningitis and meningococcal disease?

Meningitis is a broad term that refers to infection of the lining around the brain. It’s caused by bacteria, viruses, or fungi. Neisseria meningitides, or meningococcus, is just one of the bacteria that can cause meningococcal disease.

How is it spread?

The transmission occurs when there is really close contact with an individual’s respiratory droplets or saliva. Transmission can occur, but it doesn’t happen in a widespread manner like an airborne disease.

I think the thing to remember is when talking about Neisseria meningitidis, most of the cases are sporadic. In only 2% of the cases, there is a cluster. Ninety-eight percent of the time, there’s just a single case.

Why is the meningitis vaccine recommended for college-age adults?  Are they more at risk?

The age group 16-21 seems to have a higher risk of meningococcal infection. Any group of people who live in close environments, such as  college students who live in dorms, have a higher risk.

Does the vaccine cover all strains of meningitis?

No. The vaccine covers four strains of meningococcus (A, C, W, Y).  Strains B, C, and Y are the three major causes of meningococcal  meningitis in the United States; there’s a separate vaccine for group B that has very recently become available in this country. Yale Health is now offering this vaccine. The meningococcal vaccines do not, however, protect from other types of bacterial meningitis; they are specific for meningococcus.

Do you recommend that individuals get the new vaccine?

I would consider it for young adults age 16-21, especially if they live in a dorm setting. The new vaccine covers type B meningococcus and the risk factors for getting this infection are similar to those of the other strains of meningococcus. It is a two- to three-dose vaccine series, depending on the manufacturer.

There has been a lot of talk about vaccine safety in the news. Are the vaccines for meningitis safe?

Yes. When you get any kind of vaccine you can have local soreness, but there are no known major side effects to these vaccines.

If the symptoms are similar to cold or flu, how do you know if you should go to the doctor?

It’s more than cold or flu. Signs include fever, chills, prominent headache, light sensitivity. One might get a rash or stiff neck. People become confused, less alert. These are symptoms that don’t happen with flu. Symptoms of flu — fever, chills, sore throat, runny nose — go on for several days but don’t typically get worse. With meningitis, it progresses over hours and gets worse quickly.

If you have these symptoms and 12 hours later you are very sleepy and have difficulty waking up, that tells you something is else going on.

What is the treatment for meningitis?

It depends on what’s causing the meningitis. If we’re talking about bacterial meningitis such as that caused by Neisseria meningitidis, the treatment is antibiotics. It should be treated very rapidly, initially with antibiotics that target the most likely bacterial causes. Often we start antibiotics before we have tested for meningitis or gotten test results back. There are also viral causes of meningitis. Although there is no treatment for most types of viral meningitis, most cases are self-limited, meaning people get better on their own after several days.

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