Website of the Department of Health
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Progress on policy
Preventing meningitis
- 1. What is meningitis
- 2. Types of meningitis
- 3. Recognising meningococcal disease
- 4. Improving recognition
- 5. Protecting young children
- 6. Raising awareness among young people and students
- 7. The meningitis C campaign
- 8. Reducing the impact of group C meningococcal infection in young people
- 9. Group B meningococcal infection
- 10. Group A and Group W135 strains of meningococcal disease
- 11. Travellers to Hajj or Umrah
- 12. Links
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2. Types of meningitis
Meningitis can be caused by a number of organisms, viruses, bacteria, fungi and even amoeba.
a) Viral meningitis
Viral meningitis is the most common form of meningitis, caused by a viral infection. It occurs mostly in the summer. Viral infections are spread from person to person, some by coughing and sneezing and others by poor hygiene (e.g. not washing your hands after going to the toilet), and cause a wide spectrum of diseases. Only a small minority of individuals with a viral infection will develop meningitis.
The commonest forms of viral meningitis are caused by the coxsackie virus and echoviruses (or enteroviruses). Infection with measles, chickenpox, mumps, and herpes simplex can also lead to viral meningitis. The incubation period for viral meningitis can be up to three weeks. Before the introduction of MMR vaccine, mumps was the commonest cause of hospital admission for viral meningitis.
Viral meningitis is generally a much less severe illness than the bacterial form of the disease. However, viral infection can also affect the substance of the brain (encephalitis). The symptoms of encephalitis can include high fever, confusion, speech and behaviour abnormalities and coma. On occasion, meningitis and encephalitis may exist together and symptoms of both illnesses may be present (meningoencephalitis).
Viral meningitis cannot be treated with antibiotics although anti-viral treatment may be required for some forms of encephalitis.
b) Bacterial meningitis
The less common form of the disease, bacterial meningitis, is always associated with serious and severe illness. Infection with the meningococcal bacteria is the most common cause. Other forms of bacteria that can cause meningitis include Haemophilus influenzae and streptococcal infection.
Meningococcal disease
Meningococcal bacteria can cause meningococcal meningitis and meningococcal septicaemia (blood poisoning), either presenting with meningitis, septicaemia or a mixed picture. Together these are known as meningococcal disease. Many people who get the infection have some symptoms of both meningitis and septicaemia. People can have predominantly symptoms of meningitis (e.g. neck stiffness, sensitivity to light), septicaemia (e.g. red or purple spots that do not fade, cold hands and feet and rapid breathing) or symptoms of both meningitis and septicaemia. Both meningitis and septicaemia can be fatal.
There are more than 13 known groups of meningococcal bacteria, but one group — B — accounts for almost all cases in the UK. Other types of meningococcal disease that sometimes occur in the UK include A, Y, W135, 29E and Z. Group C used to account for one third of cases but vaccination now prevents almost all cases.
Meningococcal bacteria are very common and are usually carried harmlessly in the nose and throat of individuals, particularly teenagers and young adults. The bacteria can be spread by these carriers through prolonged close contact, coughing, sneezing and kissing. Only in a small number of individuals do the germs overwhelm the body's defences to cause meningitis or septicaemia.
The bacteria cannot live outside the body for long and consequently, they cannot be caught from water supplies, swimming pools, buildings or factories. Certain groups of bacteria (for example, meningococcal groups B and C) can cause clusters of cases as well as single cases.
Both meningococcal meningitis and meningococcal septicaemia are extremely serious, and can kill in hours. Approximately 10 percent of those who get meningococcal disease will die, although more deaths are caused by septicaemia than by meningitis.
Meningococcal septicaemia
Septicaemia – or blood poisoning - can be caused by bacteria other than the meningococcus. In the case of meningococcal septicaemia, meningococcal bacteria multiply in the blood stream, releasing toxins that damage the blood vessels, tissues and body organs. If this process is not reversed through the correct medical treatment, the person will go into shock, leading to heart failure, multiple organ failure and death.
Meningococcal septicaemia is the more life-threatening form of meningococcal disease. It can present alone or with meningitis, but is more dangerous when it occurs alone and causes most deaths from meningococcal infection.
Less than 5 per cent of people with meningococcal meningitis will die from the disease, but the death rate for meningococcal septicaemia with no symptoms of meningitis is around 20 per cent, rising to 50 per cent or more if the patient goes into shock before they get medical help.
Symptoms of meningococcal meningitis and septicaemia differ, and early signs of infection are non-specific and similar to flu and other viral infections. Early recognition, treatment and stabilisation is crucial to the outcome because individuals who appear relatively well can deteriorate rapidly without warning.
Because acting fast is critical to saving a life, in both cases, knowing the signs to look for is essential in ensuring that the affected person gets medical help as soon as possible.
Antibiotics are of great benefit to treating meningococcal infection, and the earlier that the person is treated, the greater their chance is of survival.
People who have had meningococcal disease may suffer from a range of after effects from problems with co-ordination, concentration and memory, post-traumatic stress disorder to conditions which can be very serious and permanent, e.g. limb amputations, or lung, kidney and brain damage.
There are currently 2 vaccines available in the UK that protect against meningococcal C disease.
Pneumococcal meningitis
Pneumococcal bacteria are the second largest cause of bacterial meningitis in the UK. Like meningococcal bacteria, many people carry the Streptococcus pneumoniae bacteria in the throat, without resulting in illness. However, occasionally they penetrate the body’s defences causing a range of conditions from earache to bronchitis or pneumonia. Pneumococcal infection can develop into septicaemia and meningitis.
The symptoms are similar to other forms of bacterial meningitis, except that people do not usually get the rash that is associated with meningococcal disease.
Young children, the elderly, those with weakened immune systems or certain other health conditions are at higher risk of contracting pneumococcal disease.
The disease has around a 20 percent death rate, and in survivors can lead to serious and permanent neurological damage such as deafness.
There are currently two vaccines available in the UK that protect against pneumococcal disease.
Haemophilus influenzae type b meningitis (Hib meningitis)
Hib meningitis is caused by the Haemophilus influenzae type b bacteria. This was the main cause of meningitis in young children in the UK, before the introduction of the Hib conjugate vaccine in 1992. Following its introduction, there was a 95% fall in cases in children under one year of age.
The method of transmission is the same as other types of meningitis and the symptoms are similar to meningococcal disease.
There are currently two vaccines available in the UK which protect against Hib disease.
c) Other forms of meningitis
Whilst the bacteria and viruses discussed above are responsible for most cases of meningitis, there are a number of other organisms that can cause meningitis.
In newborn babies Group B Streptococcal bacteria, E. Coli and listeria can each cause meningitis. Premature babies and those with a birth weight lower than 2 Kgs are at highest risk.
Rarely, the bacteria responsible for TB can cause meningitis. In 2005, there were 168 cases of TB meningitis reported through Enhanced Tuberculosis Surveillance in England & Wales. Treatment involves a prolonged course of antibiotics.
There are a number of fungal forms of meningitis, which occur very rarely, caused by:
- Candida albicans, which causes thrush;
- Cryptococcus neoformans, commonly found in the soil, almost exclusively affects people with impaired immunity;
- Histoplasma, which can affect people with impaired immune immunity.
Another rare form of meningitis is caused by Salmonella bacteria. Again, premature babies and those with low birth weight, and people with compromised immune systems are most at risk.
Amoebic meningitis is a very rare illness that is very serious, nearly always ending in death.
Useful links for further information on the different forms of meningitis
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