In children, meningitis is an absolute medical emergency. PAmong invasive meningococcal infections, it is those caused by serogroup B that mainly affect infants. This is why the High Authority for Health (HAS) recommends generalization of vaccination, as is already the case for meningococcal meningitis of serogroup C.
What is meningitis?
Meningitis is an inflammation of the meninges, these membranes that surround and protect the central nervous system – brain, spinal cord … In the majority of cases, meningitis is acute, which means that it has lasted for less than a month. : the inflammation then comes from an infection of the cerebrospinal fluid (which circulates between the meninges).
What are the causes of meningitis?
- Viral meningitis are the most frequent and also the least serious: in patients who do not suffer from an immune deficiency (AIDS, for example), recovery generally occurs within a few days, without treatment. Viral meningitis is most often caused by a virus from the enterovirus family.
- Bacterial meningitis are rarer and represent around 20% of cases: in France, 1448 bacterial meningitis were diagnosed in 2012. They are most often linked to a bacterium such as pneumococcus, meningococcus, listeria, haemophilus influenzae or escherichia coli. After an ENT infection (for example: nasopharyngitis, tonsillitis, otitis, sinusitis …), these bacteria can pass into the blood and infect the cerebrospinal fluid: bacterial meningitis is a medical emergency.
To know : very rarely, we can also observe meningitis of parasitic origin (toxoplasmosis) or of fungal origin (fungi type candida albicans).
Meningitis: who is affected?
While viral meningitis can appear in many cases, bacterial meningitis targets fairly specific populations:
- Pneumococcal meningitis mostly affects adults and usually results from an ENT infection or immunosuppression.
- Meningococcal meningitis mainly affects children under the age of 4, with a peak in frequency in winter. It is also quite common in adolescents (between 15 and 20 years old).
- Listeria meningitis Rather occurs in pregnant women and the elderly.
- Haemophilus influenzae meningitis and escherichia coli meningitis primarily attacks children under 5 years of age.
To know : vaccination against meningococcal meningitis is compulsory in infants born from January 1, 2018 with a first dose at the age of 5 months.
Symptoms: how to recognize meningitis in a child?
In adults, the symptoms of meningitis (viral, bacterial or otherwise) are:
- A fever (over 37.5 ° C) which may be high,
- Severe headaches (such as migraines: headache),
- Intolerance to light (photophobia) or noise (phonophobia),
- Nausea and / or vomiting,
- A stiff neck,
- A complexion that appears grayish or “marbled”,
- Significant aches,
- Abnormal fatigue,
- Neurological symptoms: drowsiness, mental confusion (the person no longer knows where they are, what day it is …), eye paralysis or even convulsions.
In young children (before the age of 4), the symptoms are a little different:
- He is whiny: he is irritable, sobs, seems dejected, and / or cries more than usual,
- He screams when touched, when moved, and / or when moving his arms or legs (skin hyperesthesia),
- He refuses to eat: he refuses the bottle / breast on several occasions,
- He has seizures, even very short and apparently isolated ones,
- He has abnormal muscle weakness: he “holds” his head ache and seems “limp”,
- Her complexion appears grayish and “marbled”,
- He has (one or) red or blue “spots” on his skin which do not disappear with the pressure of the finger (purpura fulminans).
Attention : meningitis (and especially when there is a suspicion of purpura fulminans) is an absolute medical emergency. As soon as the first symptoms appear, it is essential to immediately call for help by dialing 15 or 112 on your telephone. Above all: do not wait!
Vaccine: can meningitis be prevented in children?
>> Vaccination against meningococcal serogroup C is mandatory in infants born since January 1, 2018 according to the following scheme:
- For infants, vaccination at 5 months with 1 dose of meningococcal C vaccine (Neisvac®23 vaccine) followed by a booster dose at 12 months of age (if possible with the same vaccine). A minimum interval of 6 months will be respected between the administration of the 2 doses. The 12 month dose can be co-administered with the ROP vaccine (measles, mumps, rubella).
- From the age of 12 months and up to the age of 24, for those who have not received a previous primary vaccination, the scheme includes a single dose.
>> Vaccination against meningococcal serogroup B has so far been recommended for children and adults at high risk of contracting an invasive meningococcal B infection and for populations targeted in specific situations (outbreaks of cases, epidemics, localized hyperendemia). However, these forms of meningitis more particularly affect infants and young children, in whom they represent more than 70% of cases of infection.
But the vaccine recommendations could possibly change because the High Authority of Health (HAS) has just recommended “de vaccinate all infants, who constitute the age group most vulnerable to these invasive meningococcal B infections, using Bexsero® according to the Marketing Authorization schedule (2 doses plus a booster dose) “. This generalized vaccination recommendation aims to promote a possible individual protection of all infants which would persist until the age of 4 years (according to the available data) and make it possible to remove the financial barrier, which is one of the sources of inequalities in access to this vaccine.
In 2019, in France, the number of cases of meningococcal meningitis serogroup B was 0.36 per 100,000 inhabitants, while during the period 2003 to 2011, it was around 0.60 per 100,000 The reason for this decline is not known. Lethality is between 9% and 12%. About 6% of cases presented with early sequelae. In 2019, among children under 5, 88 cases and 3 deaths were recorded.
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