Disease of the month: Meningitis

This is a common illness that strikes people in different ways, though its effects can last a lifetime. Mary Randell explains the underwriting implications of meningitis.

Meningitis is the inflammation and swelling of the lining around the brain and spinal cord. There are two main types of meningitis: viral and bacterial, with occasionally fungal infections causing this disease.

Viral Meningitis

Viral meningitis is fairly common and can affect anyone, although it occurs mostly in children. It is more common during the summer and in most cases the disease is relatively mild, with symptoms of headache, fever and general ill feeling.

Viral meningitis sufferers usually recover quickly, needing only simple medication to ease their symptoms. Occasionally, the disease may cause more significant ­symptoms such as vomiting, stiff neck, sore throat, muscle pain, photophobia and altered consciousness.

There are many viruses that can cause viral meningitis. Most people are exposed to a number of them during their life without ever developing the disease. The two most common causes are:

•  Enteroviruses – these live in the lining of intestines, noses and throats, accounting for most cases of viral meningitis, and

• Mumps and measles viruses – before the arrival of the MMR vaccine, mumps was the most common cause of viral meningitis in the UK. However, the jab now prevents these types of meningitis.

These viruses usually enter the body through the hand-to-mouth route. It can also be passed on by respiratory contact. However, most people infected have no, or very mild symptoms, and although a person with viral meningitis may pass on the virus, it is unlikely to cause the other person to develop the disease themselves.

Bacterial Meningitis

Bacterial meningitis is caused by different types of bacteria. It is much more serious and is often associated with septicaemia (blood poisoning). The majority of cases in the UK are caused by meningococcal bacteria.

These bacteria can cause either meningitis, septicaemia or both. Most people have symptoms of both and this form of the disease is known as meningococcal disease.
Septicaemia is the more life-threatening form of the disease and can be even more dangerous when there are no typical signs of meningitis.

It is estimated that about 3,400 people suffer from bacterial meningitis and ­septicaemia in the UK each year. This is more than nine people a day, with six fatalities a week – 1.2 million cases of meningitis are reported worldwide each year.

The bacteria that cause meningococcal disease are common and live naturally in the nose and throat. One in ten of us will carry the bacteria for weeks or months without knowing it. Due to natural resistance, most of us will not suffer any harmful effects.

The germ is passed from person to person through close contact such as sneezing, breathing someone’s breath or kissing. Fortunately, the bacteria is so fragile it cannot survive outside the human body for more than a few moments. Therefore, they cannot be carried on things, such as cups or items that have been touched by someone else carrying the germ.

The illness occurs when the bacteria breaks through the protective lining of the nose or throat and enters the bloodstream, where the germs multiply quickly.

In some cases the bacteria is carried to the meninges – the membranes that surround and protect the brain and spinal cord, causing meningitis. However, ­sometimes septicaemia happens so quickly there is no time for meningitis to develop.

Meningococcal disease in the UK tends to be seasonal, with a peak during the winter months. Very young children and babies are most at risk of the disease because their immune systems have not developed fully. 

However, there is also a smaller increased risk for older adolescents, usually for social and behavioural reasons, such as when starting university. 

The symptoms of meningitis and septicaemia can be hard to recognise at first and can occur in any order. But generally, the first symptoms include fever, vomiting and headache. Limb pain, cold hands and feet also precede the well-publicised and associated red rash.

Once the meningococcal bacteria has infected the meninges, it multiplies freely in the CSF, the cerebrospinal fluid contained in the meninges that cushions and protects the brain. 

The bacteria then releases poisons, causing inflammation and swelling, which in turn increases pressure in the brain. Along with a headache, typical symptoms are a stiff neck and dislike of bright lights.

As the disease progresses, an individual becomes drowsy and confused. They may also have seizures, eventually losing consciousness. In very serious cases, meningitis may destroy nerve cells, causing permanent brain damage.

Septicaemia

Septicaemia attacks the lining of the blood vessels so they leak. It is this blood leaking that shows up on the skin as the typical non-blanching meningococcal rash.  

As the blood continues to leak into the body, there is not enough liquid left to carry oxygen to all parts of the body.

The lungs also have to work harder and in order to maintain sufficient oxygen to vital organs, the circulatory system has to reduce the blood supply to hands, feet and the surface of the skin.

In most cases, rapid treatment prevents the disease progressing further. In other occasions, septicaemia has also caused blood clots to form in the blood vessels in skin and muscle tissue.

Tissue is then starved of oxygen and dies, which in turn can lead to scarring or ­amputation of limbs being necessary. In severe cases, this can also happen to vital organs, such as the kidneys, causing renal failure. About one in five cases are still fatal, but quicker and better treatment is now improving chances of survival.

Treatment usually includes a lumbar puncture to confirm the illness and determine the right type of antibiotics required. Individuals with septicaemia may need large amounts of resuscitation fluids to bring their blood volume back to normal. Steroids and other medication may also be prescribed to reduce inflammation and lower pressure around the brain.

Most people recover well from ­meningococcal disease with no long-term effects. However, it can cause permanent ­neurological damage, ranging from minor problems with co-ordination and movement or mild learning difficulties, to epilepsy, paralysis and severe mental impairment.

Deafness is the most common residual condition of meningitis due to bacterial poisons damaging the cochlea in the inner ear, with scarring, amputations and organ damage sometimes resulting from septicaemia.

The introduction of vaccines against some infections has decreased the risk to babies, but there are still types of meningitis and septicaemia for which there is no vaccine.

Several strains of ­meningococcal bacteria exist, but the majority of cases in the UK usually involve meningitis B and meningitis C. There is now a very effective vaccine for the latter bug, however, the former – which affects 85% of sufferers in the UK – is a much more complex bacteria (mutating and tricking the immune system). Research for a vaccine to prevent meningitis B still continues.

Underwriting considerations

Underwriting is relatively straightforward. Once a full recovery has been made, standard terms can be offered for both life and critical illness. Otherwise, terms should be based on the severity of any residual impairments.  

Mary Randell is underwriting training & development manager at PruProtect