Meningitis

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Meningitis

Topic Overview

What is meningitis?

Meningitis is inflammation of the coverings around the brain and spinal cord. It is usually caused by an infection.

The infection occurs most often in children, teens, and young adults. Also at risk are older adults and people who have long-term health problems, such as a weakened immune system.

There are two main kinds of meningitis:

  • Viral meningitis is fairly common. It usually does not cause serious illness. In severe cases, it can cause prolonged fever and seizures.
  • Bacterial meningitis is not as common but is very serious. It needs to be treated right away to prevent brain damage and death.

The two kinds of meningitis share the same symptoms. It’s very important to see a doctor if you have symptoms, so that he or she can find out which type you have.

What causes meningitis?

Viral meningitis is caused by viruses. Bacterial meningitis is caused by bacteria.

Meningitis can also be caused by other organisms and some medicines, but this is rare.

Meningitis is contagious. The germs that cause it can be passed from one person to another through coughing and sneezing and through close contact.

What are the symptoms?

The most common symptoms among teens and young adults are:

  • A stiff and painful neck, especially when you try to touch your chin to your chest.
  • Fever.
  • Headache.
  • Vomiting.
  • Trouble staying awake.
  • Seizures.

Children, older adults, and people with other medical problems may have different symptoms:

  • Babies may be cranky and refuse to eat. They may have a rash. They may cry when held.
  • Young children may act like they have the flu. They may cough or have trouble breathing.
  • Older adults and people with other medical problems may have only a slight headache and fever.

It is very important to see a doctor right away if you or your child has these symptoms. Only a doctor can tell whether they are caused by viral or bacterial meningitis. And bacterial meningitis can be deadly if not treated right away.

How is meningitis diagnosed?

Your doctor will ask questions about your health, do an examination, and use one or more tests.

Lumbar puncture is the most important lab test for meningitis. It is also called a spinal tap. A sample of fluid is removed from the spine and tested to see if it contains organisms that cause the illness.

Your doctor may also order other tests, such as blood tests, a CT scan, or an MRI.

How is it treated?

Treatment depends on the cause. See your doctor right away if you or your child has symptoms, because bacterial meningitis can be deadly if not treated right away.

Bacterial meningitis is treated with antibiotics in a hospital. You may also get dexamethasone. And you will be watched carefully to prevent serious problems such as hearing loss, seizures, or brain damage.

But viral meningitis is more common, and most people with this form of the illness get better in about 2 weeks. With mild cases, you may only need home treatment. Home treatment includes drinking lots of fluids and taking medicine for fever and pain.

Can meningitis be prevented?

The best way to protect your child from meningitis is to make sure he or she gets all the standard immunizations for children. These include shots for measles, chickenpox, Haemophilus influenzae type B (Hib) disease, and pneumococcal infection.

Talk to your doctor about whether you or your child also needs the meningococcal vaccine, which is a shot to prevent bacterial meningitis. Each province and territory has its own age guideline for the vaccine. Check with your local health unit for the guideline in your area.

The National Advisory Committee on Immunization (NACI) recommends the meningococcal vaccine for:1, 2, 3

  • Children younger than 5.
  • Children 2 and older who have a high risk for getting and having severe problems from meningitis.
  • Adolescents (ideally at age 12).
  • Young adults.
  • People who plan to travel to countries known to have meningitis outbreaks, such as the countries in Africa south of the Saharan Desert.
  • People without a spleen.
  • People who have HIV.

Frequently Asked Questions

Learning about meningitis:

Being diagnosed:

Getting treatment:

Ongoing concerns:

Cause

Meningitis is a disease that can be passed from person to person (contagious). It is caused most often by viruses or bacteria that infect the tissues (meninges) and sometimes the fluid (cerebral spinal fluid, or CSF) that surround the brain and spinal cord.

Viral meningitis

Enteroviruses are the most common cause of viral meningitis. They can live in your intestines without causing illness. But they can cause meningitis when they are passed from one person to another through food, water, or contaminated objects. Meningitis caused by enteroviruses occurs most often in babies and young children.

In rare cases, other viruses, such as human immunodeficiency (HIV) or mumps, may cause meningitis.

Bacterial meningitis

Immunizations continue to help prevent childhood bacterial meningitis. Most people who get bacterial meningitis get it from one of two types of bacteria: Streptococcus pneumoniae or Neisseria meningitidis.4

These bacteria often live in the body, most often in the nose and throat, without causing illness. But the bacteria can cause meningitis if they spread from infected tissue or get into the bloodstream and travel to the cerebrospinal fluid or the tissues (meninges) that surround the brain and spinal cord. These bacteria also can be passed from one person to another, usually through infected saliva or mucus.

Two other bacteria that sometimes cause meningitis are group B streptococci and Listeria monocytogenes. Meningitis caused by group B streptococci bacteria occurs most often in newborns, who can become infected during or after birth. Meningitis caused by Listeria monocytogenes bacteria occurs most often in newborns and in older adults.

The Society of Obstetricians and Gynaecologists of Canada (SOGC) recommends screening for group B streptococci in all pregnant women at 35 to 37 weeks. Women who have the bacteria are given antibiotics during labour in order to prevent infection in their newborns, and this practice has worked well.5

In rare cases, other bacteria cause meningitis, usually in people with long-term medical conditions.

Meningitis also can be caused by other organisms and conditions. It can be a complication of an illness, an injury (particularly to the skull or face), or brain surgery.

How meningitis is spread

Organisms that cause meningitis can be passed from one person to another or passed from rodents and insects to people. But exposure to an organism that causes meningitis does not mean you will get the infection.

Organisms can be passed from one person to another:

  • During birth. A mother can pass organisms that cause meningitis to her baby even if the mother does not have symptoms. Delivering a baby by caesarean section rather than through the birth canal does not always protect the baby from getting the infection. Both bacteria and viruses can be transmitted this way.
  • Through stool. Stool could have enteroviruses or certain types of bacteria in it. Washing hands on a regular basis can help prevent you and your children from getting infected this way. More children than adults get meningitis this way.
  • Through coughing and sneezing. Infected people can pass certain bacteria that are normally found in saliva or mucus in their noses and throats.
  • Through kissing, sexual contact, or contact with infected blood. The human immunodeficiency virus (HIV) also can cause meningitis and can be passed from an infected person to another person through blood or sexual contact but not through kissing.

In rare cases, some organisms that cause meningitis can be passed to people from rodents and insects. The most common of these are arboviruses (including the St. Louis encephalitis and West Nile viruses), which are transmitted through dust and food contaminated by the urine of infected mice, hamsters, and rats.

Symptoms

Symptoms of bacterial meningitis usually appear suddenly. Symptoms of viral meningitis may appear suddenly or develop gradually over a period of days. For example, the symptoms of viral meningitis after mumps may take several days or weeks to develop.

The most common symptoms of either form of meningitis include:

  • Fever.
  • Severe and persistent headache.
  • Stiff and painful neck, especially when trying to touch the chin to the chest.
  • Vomiting.
  • Confusion and decreased level of consciousness.
  • Seizures.

Other symptoms of meningitis include:

  • Sluggishness, muscle aches and weakness, and strange feelings (such as tingling) or weakness throughout the body.
  • Eye sensitivity and eye pain from bright lights.
  • Skin rash.
  • Dizzy spells.

The incubation period—the time from exposure to the infection to when the first symptoms develop—depends on the type of organism causing the infection.

Babies, young children, older adults, and people with other medical conditions may not have the usual symptoms of meningitis.

  • In babies, the signs of meningitis may be a fever, irritability that is difficult to calm, decreased appetite, rash, vomiting, and a shrill cry. Babies also may have a stiff body and bulging soft spots on their heads that are not caused by crying. Babies with meningitis may cry when handled.
  • Young children with meningitis may act like they have the flu (influenza), cough, or have trouble breathing.
  • Older adults and people with other medical conditions may have only a slight headache and fever. They may not feel well and may have little energy.

Other conditions with similar symptoms to meningitis include viral hepatitis and flu.

What Happens

The course of meningitis often depends on your age, general health, and the organism causing the infection. The illness can range from mild to severe.

Viral meningitis is more common in the late summer and early fall. It usually does not cause serious illness. But it is important to see your doctor if symptoms of meningitis develop so that he or she can rule out bacterial meningitis, which is more serious. With mild cases of viral meningitis, you may need only home treatment and can recover within 2 weeks. But some people may feel light-headed and tired for several months after the illness.

Bacterial meningitis occurs most often from late winter to early spring. It usually causes serious illness and can be life-threatening. The symptoms of bacterial meningitis usually develop suddenly and last for 2 to 3 weeks. A person with bacterial meningitis is treated with antibiotics in a hospital.

Complications during illness and long-term complications are more common with bacterial than with viral meningitis. Newborns and young children with bacterial meningitis, people with impaired immune systems, and older adults with long-term medical conditions are more likely than others to develop immediate and/or long-term complications of meningitis.

People who have bacterial meningitis run the risk of death if they are not treated promptly. Newborns, children younger than 2, older adults, or people with weakened immune systems are at a greater risk of death than other people.

The likelihood of death from bacterial meningitis in adults is highest in those who are older than 50, have seizures during the first 24 hours of illness, delay getting treatment, are in a coma when admitted to the hospital, are in shock, or cannot breathe without help from a machine.4 Most survivors recover completely.6

Meningitis caused by Streptococcus pneumoniae is more likely to cause death than meningitis caused by other bacteria.4 Getting the pneumococcal conjugate vaccine (PCV) usually protects people from diseases (including meningitis) caused by most strains of the bacteria.

What Increases Your Risk

Factors that may increase the risk for meningitis include:

  • Genetics. Some people may inherit the tendency to get meningitis. If they come in contact with organisms that can cause the infection, they may be likely to get infected.
  • Being male. Males get meningitis more often than females.
  • Age. In general, babies, young children, young adults, and older adults are at highest risk of getting meningitis.
  • Crowded living conditions. People in camps, schools, and university dormitories are more likely than others to get meningitis caused by organisms that can spread easily from one person to another. For example:
    • University freshmen. Freshmen who live in dormitories have a slightly greater chance of getting meningitis compared with other people their age. But the risk in university students overall is as low as in people their age who are not going to university.
    • Children attending daycare centres. Children who attend daycare centres are more likely than other children to get meningitis caused by organisms that are easily spread through stool or contaminated hands or water.
  • Exposure to insects and rodents. People who live in or visit areas of the world where insects or rodents carry organisms that cause meningitis risk getting the disease.
  • Not getting the mumps (MMR), Haemophilus influenzae type b (Hib), and pneumococcal conjugate (PCV) immunizations before age 2.
  • Being an older adult who has not gotten the pneumococcal polysaccharide (PPSV) immunization and/or does not have a working spleen, which is part of the body's immune system.
  • Travel to areas where meningitis is common. For example, people travelling to the "meningitis belt" in sub-Saharan Africa should receive the meningococcal vaccine.

Medical conditions that increase the risk of meningitis include:

  • Poor overall health. People who are in poor health or have other medical conditions may be more likely to get meningitis because their bodies' natural defences may be weak. For example, children who have sickle cell disease or cancer are at higher risk than other children.
  • Having a birth defect of the skull, a head injury, or brain surgery.
  • Having treatment with a kidney dialysis machine.
  • Having other infections, such as upper respiratory infections, mumps, tuberculosis (TB), syphilis, Lyme disease, and illnesses caused by herpes viruses.
  • Having a cochlear implant for severe hearing loss. Studies indicate that children with cochlear implants have an increased risk for bacterial meningitis.7, 8
  • Being born to a mother infected with an organism that causes meningitis. Viruses such as the enteroviruses and herpes viruses, and some bacteria can be passed from an infected mother to a baby during birth.
  • Having had meningitis in the past. Some people who have had meningitis are more likely than others to get it again. These include people with birth defects or injuries to their skull and face, impaired immune systems, or unexpected reactions to some medicines.

When To Call a Doctor

Call 911 or other emergency services immediately if:

  • You or your child has symptoms of severe meningitis, such as fever, seizures, and confusion.
  • Your baby has signs of severe meningitis such as trouble breathing or fever with a bulging soft spot on the head not caused by crying.

Call your doctor immediately if:

  • You or your child has symptoms or signs of meningitis, such as severe and persistent headache, stiff neck, fever, rash, nausea, and vomiting.
  • You or your child has viral meningitis and does not get better with home treatment after 3 days.
  • You or your child is being treated for viral meningitis and develops signs of complications during illness (for example, a fever that lasts longer than 3 full days and does not go down during home treatment).
  • Your baby has a fever that comes and goes, diarrhea, vomiting, swollen abdomen, and a shrill cry.

Call a doctor promptly if you believe you may have been exposed to meningitis. You can be treated with antibiotics, which may keep you from getting the illness.

Watchful Waiting

Watchful waiting is a period of time during which you and your doctor observe your symptoms or condition without using medical treatment. Bacterial meningitis, especially in a newborn, is a medical emergency. Watchful waiting is not appropriate if you think that you or your child has meningitis, especially because you will not know whether the infection is bacterial or viral. Call your doctor as soon as symptoms or signs appear.

Who To See

The following health professionals can diagnose and treat meningitis:

You may be referred to a specialist who can help treat meningitis, especially if you have complications:

To prepare for your appointment, see the topic Making the Most of Your Appointment.

Examinations and Tests

Diagnosis of meningitis is based on a medical history, a physical examination, and tests.

Lumbar puncture

Your doctor will almost always do a lumbar puncture test (also known as a spinal tap) if he or she thinks you have meningitis.

A lumbar puncture takes samples of the fluid around the spine and brain, known as cerebral spinal fluid (CSF). A culture of the spinal fluid is done to check for organisms known to cause illness. It often takes several days to several weeks to get results from a spinal fluid culture. But other tests also can be done on the spinal fluid to determine which organism is causing the infection. The results of these tests may be ready before the results of a culture.

Other tests

A doctor also may do the following tests to see if there are other causes for your symptoms:

Treatment Overview

Treatment for meningitis depends on the organism causing the infection, your age, the extent of the infection, and the presence of other medical conditions or complications of meningitis.

Most people with viral meningitis usually start getting better within 3 days of feeling sick and recover within 2 weeks. But it is important to see your doctor if symptoms of meningitis develop so that he or she can rule out bacterial meningitis, which is more serious. With mild cases of viral meningitis, you may only need home treatment, including fluids to prevent dehydration and medicine to control pain and fever. If you do not get better or if symptoms get worse, you may need further testing to check for other causes of illness.

Bacterial or severe viral meningitis may require treatment in a hospital, including:

  • Antibiotics. These medicines usually are given through a vein (intravenously, or IV) to treat meningitis. Antibiotics are given only when bacteria are causing the infection. Giving antibiotics when they are not needed may cause drug resistance.
  • Measures to reduce pressure within the brain. If meningitis is causing pressure within the brain, corticosteroid medicines such as dexamethasone may be given to adults or children.
  • Measures to reduce fever. Medicines such as acetaminophen (Tylenol), fluids, and good room ventilation reduce fever. If you have a high fever, you also may need a device such as a cooling pad placed on the bed.
  • Measures to prevent seizures. If you have seizures, your surroundings will be kept quiet and calm. Medicines such as phenobarbital or phenytoin (Dilantin) can help stop seizures. For more information, see the topic Seizures.
  • Oxygen therapy. Oxygen may be given if you have trouble breathing and to increase the amount of oxygen in all parts of the body. Oxygen may be delivered by a hood or tent placed over the body, a face mask placed over the nose and mouth, a nose piece (nasal cannula) held loosely under the nose, or, in severe cases, a tube through the mouth into the trachea (windpipe).
  • Monitoring fluids. You may need to drink extra liquids because infections increase the body's need for fluids. Increasing liquids also reduces the possibility of dehydration. Liquids are given into a vein (IV) if you have an infection and are vomiting or are not able to drink enough. Doctors control the amount of fluids given because people with meningitis may develop problems if they have too much or not enough fluid.
  • Monitoring blood chemicals. Frequent blood tests are done to measure essential body chemicals, such as sodium and sugar in the blood.

A person who has severe meningitis may need to be treated in the intensive care unit (ICU) of a hospital. Doctors watch the person closely and provide care if needed. See the Other Treatment section of this topic for more information on intensive care in a hospital.

What To Think About

Most healthy adults who have recovered from meningitis do not need follow-up care. But adults who have existing medical conditions that make them more likely than others to develop long-term complications or get meningitis again should see their doctors after recovery. Babies and children treated for meningitis always need follow-up care after recovery and need to be checked for long-term complications such as hearing loss.

Prevention

Immunization against some of the organisms that can cause meningitis is the most effective way to prevent the illness. Some causes of meningitis that can be prevented by vaccines include the following:

  • Measles, mumps, and rubella viruses. The measles, mumps, and rubella (MMR) vaccine is routinely given to children at 12 months of age and a second dose after 15 months. To make it easy on parents, some provinces and territories may recommend that the second shot is given with other vaccines at 18 months or between 4 and 6 years of age, before starting school.
  • Varicella (chickenpox) virus vaccine is recommended for all children 12 months of age and older who have not had chickenpox should get one dose at 12 to 18 months of age. Another dose may be given at a later time in some provinces.
  • Haemophilus influenzae type b (Hib) virus. Hib vaccine is recommended for all children starting at 2 months of age and ending by 18 months of age. Children who are older than 5 and have certain health conditions such as sickle cell disease or an impaired immune system may also need this shot.
  • Neisseria meningitidis and Streptococcus pneumoniae bacteria. Immunizations against these bacteria are recommended for people who have medical conditions such as impaired immune systems or people who have had meningitis in the past. Canada's National Advisory Committee on Immunizations (NACI) recommends routine vaccination for children younger than 5, teens, and young adults to protect against certain strains of Neisseria meningitidis. 1 Another type of meningococcal vaccine is recommended for children 2 and older and adults who may have a higher-than-normal risk, such as travellers to countries known to have outbreaks of meningitis, people without a spleen, and those with HIV.2, 3 Routine vaccination with pneumococcal conjugate vaccine (PCV) is recommended for children age 2 and younger to help prevent infection from Streptococcus pneumoniae.

University students

Although university students' overall risk of meningitis from Neisseria meningitidis bacteria is low, freshmen, especially those who live in dormitories, have a moderately higher risk than other people their age. If you are a university freshman living in a dormitory, the NACI recommends the meningococcal conjugate vaccine. University freshmen who do not live in dormitories may also be vaccinated to reduce their risk of infection.1

Cochlear implants

A link has been found between meningitis and cochlear implants for severe hearing loss. To help protect against meningitis from Streptococcus pneumoniae, experts recommend that people with cochlear implants get the pneumococcal conjugate vaccine (PCV). Also, some people with implants have ear infections before they get meningitis, so people with implants should receive prompt antibiotic treatment for ear infections.

Breast-feeding

Breast-feeding may protect children ages 2 to 5 months against meningitis caused by Haemophilus influenzae type b (Hib) bacteria. But it is still important to give breast-fed babies the Hib vaccine.

For more information about immunizations, see the topic Immunizations.

Reduce your risk

You can take steps to reduce your risk of infection and prevent the spread of meningitis by:

  • Avoiding people who have meningitis.
  • Separating people with meningitis from other people in the home.
  • Washing your hands often if you have meningitis or are caring for someone with meningitis. Wash your hands after using the toilet or helping a sick child use the toilet, after changing a sick baby's diaper, and after handling used bedsheets, towels, clothes, or personal items of a person who has meningitis.
  • Avoiding insects and rodents that carry organisms that cause meningitis. If you live in or visit an area of the world where there are insects (such as mosquitoes and ticks) and rodents (such as mice and rats) that carry organisms that cause meningitis, take steps to avoid contact with them. For example, use insect repellent and keep all rodents out of your home and other buildings.

If you come in close contact with someone who has bacterial meningitis, taking antibiotics may keep you from getting the illness. For example, a person who has come in contact with the saliva or mucus of someone with meningitis caused by Neisseria meningitidis bacteria may be given antibiotics to prevent infection.

If you have only casual contact with someone who has meningitis—for example, at school or at work—you do not need to take antibiotics.

Home Treatment

Home treatment usually is all that is needed for most people who have viral meningitis. It includes:

  • Resting. Rest promotes healing and provides relief from symptoms such as headache. Quiet activities, such as reading books, playing board games, watching videos, or listening to music, help pass the time.
  • Reducing fever. Sometimes no treatment is needed for fever. Cool face cloths to the forehead, cool baths, and medicines such as acetaminophen (Tylenol) or ibuprofen (Advil) can be used to reduce fever. For more information on fever, see the topics Fever, Age 11 and Younger and Fever, Age 12 and Older.
  • Relieving minor pain. Headache is a common symptom of meningitis. Some people also have muscle aches and pains. Minor pain usually can be relieved with medicines such as acetaminophen (Tylenol) or ibuprofen (Advil).
  • Preventing dehydration. Common signs of dehydration include a dry, sticky mouth and urinating only small amounts of dark-coloured urine. You can prevent dehydration by drinking extra liquids such as water, juices, teas, and rehydration drinks. Children may enjoy frozen juice bars or snow cones. If a person vomits, he or she needs to avoid solid food and take frequent small sips of water or other liquids.
  • Watching for signs of complications during illness. The most common complications include fever lasting for longer than expected and seizures. Some people with complications during illness may need to be treated in a hospital.

Home treatment also is necessary after recovery. It is important to look for signs of long-term complications of meningitis, such as hearing loss.

Medications

Medicines for meningitis are used to treat:

  • Bacterial infection.
  • Seizures.
  • Pressure on the brain.
  • Fever.
  • Muscle aches.

The decision about what medicine to use depends on the organism causing the infection, the extent of the infection, and the person's age and general health.

Medication Choices

Antibiotics to treat bacterial infection
Medicines to treat seizures
Medicines to treat pressure on the brain
Medicines to treat fever and muscle aches. The most commonly used medicines are non-steroidal anti-inflammatory drugs (NSAIDs) and acetaminophen (Tylenol). Common side effects include nausea or upset stomach. Also, NSAIDs may cause ringing in the ears and blurred vision.

What To Think About

Your doctor will want to know which bacterium is causing your infection before prescribing antibiotics. A sample of spinal fluid or blood is tested to find out about the organism.

The type of antibiotic used and the length of treatment depend on the bacteria, the extent of the infection, your age, and how likely you are to develop severe meningitis or complications during illness. Often two antibiotics are given together.

Antibiotics are not given for viral meningitis.

Surgery

There is no surgical treatment for meningitis.

Other Treatment

People with severe meningitis or complications during illness may need to be treated in the intensive care unit of a hospital. They may need:

  • Oxygen therapy, to help ease breathing and reduce the amount of work on the heart. A pulse oximeter often is used to measure the amount of oxygen in the blood. Also, if people are too sick to breathe on their own, they may need a machine called a ventilator.
  • Suctioning, to remove mucus from the bronchial tubes. A small plastic tube is inserted into the mouth or nose. The tube is attached to a machine that gently sucks out mucus. Other treatments, such as breathing exercises and massage, also can be used to remove mucus.
  • Liquids given through a vein (intravenous, or IV). Sometimes people are too sick to drink liquids.

Other Places To Get Help

Organizations

Canadian Paediatric Society
2305 Saint Laurent Boulevard
Ottawa, ON  K1G 4J8
Phone: (613) 526-9397
Fax: (613) 526-3332
Email: info@cps.ca
Web Address: www.cps.ca
 

The Canadian Paediatric Society (CPS) promotes quality health care for Canadian children and establishes guidelines for paediatric care. The organization offers educational materials on a variety of topics, including information on immunizations, pregnancy, safety issues, and teen health.


Meningitis Research Foundation of Canada
P.O. Box 28015 R.P.O. Parkdale
Waterloo, ON  N2L 6J8
Phone: (519) 664-0244
1-800-643-1303
Web Address: www.meningitis.ca
 

The Meningitis Research Foundation of Canada raises funds to promote education and research in order to prevent death and disability from meningitis and other infections of the central nervous system.


Public Health Agency of Canada (PHAC)
130 Colonnade Road
A.L. 6501H
Ottawa, ON  K1A 0K9
Phone: Telephone numbers for PHAC vary by region. For your regional number, go to the listing on the PHAC website at www.phac-aspc.gc.ca/contac-eng.php.
Web Address: www.phac-aspc.gc.ca/index-eng.php
 

The Public Health Agency of Canada (formerly the Population and Public Health Branch of Health Canada) is primarily responsible for policies, programs, and systems relating to disease prevention, health promotion, disease surveillance, community action, and disease control.


References

Citations

  1. National Advisory Committee on Immunization (NACI) (2006). Menningococcal vaccine. In Canadian Immunization Guide, 7th ed., pp. 237–250. Ottawa: Public Health Agency of Canada.
  2. National Advisory Committee on Immunization (NACI) (2009). Update on the invasive meningococcal disease and meningococcal vaccine conjugate recommendations. Canada Communicable Disease Report, 36(ACS-3): 1–40. Also available online: http://www.phac-aspc.gc.ca/publicat/ccdr-rmtc/09vol35/acs-dcc-3/index-eng.php.
  3. National Advisory Committee on Immunization (NACI) (2009). Statement on meningococcal vaccination for travellers. Canada Communicable Disease Report, 35(ACS-4): 1–22. Also available online: http://www.phac-aspc.gc.ca/publicat/ccdr-rmtc/09vol35/acs-dcc-4/index-eng.php.
  4. Roos KL, Tyler KL (2008). Meningitis, encephalitis, brain abscess, and empyema. In AS Fauci et al., eds., Harrison's Principles of Internal Medicine, 17th ed., vol. 2, pp. 2621–2641. New York: McGraw-Hill.
  5. Money DM, Dobson S (2004). The prevention of early-onset neonatal group b streptococcal disease. SOGC Clinical Practice Guidelines No. 149. Journal of Obstetrics and Gynaecology Canada, 26(9): 826–832.
  6. Hirschmann JV (2006). Bacterial infections of the central nervous system. In DC Dale, DD Federman, eds., ACP Medicine, section 7, chap. 36. New York: WebMD.
  7. Reefhuis J, et al. (2003). Risk of bacterial meningitis in children with cochlear implants. New England Journal of Medicine, 349(5): 435–445.
  8. Biernath KR, et al. (2006). Bacterial meningitis among children with cochlear implants beyond 24 months after implementation. Pediatrics, 117(2): 284–289.

Other Works Consulted

  • American Academy of Pediatrics (2009). Meningococcal infections. In LK Pickering et al., eds., Red Book: 2009 Report of the Committee on Infectious Diseases, 28th ed, pp. 455–466. Elk Grove Village, IL: American Academy of Pediatrics.
  • Biernath KR, et al. (2005). Bacterial meningitis among children with cochlear implants beyond 24 months after implantation. Pediatrics, 117(2): 284–289.
  • Centers for Disease Control and Prevention (2005). Prevention and control of meningococcal disease: Recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR, 54(RR-7): 1–21.
  • Feigin RD, Cutrer WB (2009). Bacterial meningitis beyond the neonatal period. In RD Feigin et al., eds., Textbook of Pediatric Infectious Diseases, 6th ed., vol. 1, pp. 439–471. Philadelphia: Saunders.
  • Gilden DH (2008). Acute viral central nervous system diseases. In DC Dale, DD Federman, eds., ACP Medicine, section 11, chap. 16. Hamilton, ON: BC Decker.
  • National Advisory Committee on Immunization (NACI) (2007). Meningococcal C conjugate vaccination recommendations for infants. Canada Communicable Disease Report, 33(ACS-11): 1–12.
  • National Advisory Committee on Immunization (NACI) (2007). Statement on conjugate meningococcal vaccine for serogroups A, C, Y, and W135. Canada Communicable Disease Report, 33(ACS-3): 1–24. Also available online: http://www.phac-aspc.gc.ca/publicat/ccdr-rmtc/07vol33/acs-03/index_e.html.
  • Swartz MN (2008). Meningitis: Bacterial, viral, and other. In L Goldman, D Ausiello, eds., Cecil Medicine, 23rd ed., pp. 2754–2771. Philadelphia: Saunders Elsevier.
  • Tunkel AR, et al. (2004). Practice guidelines for the management of bacterial meningitis. Clinical Infectious Diseases, 39(9): 1267–1284.

Credits

By Healthwise Staff
Primary Medical Reviewer E. Gregory Thompson, MD - Internal Medicine
Primary Medical Reviewer Anne C. Poinier, MD - Internal Medicine
Specialist Medical Reviewer W. David Colby IV, MSc, MD, FRCPC - Infectious Disease
Last Revised April 13, 2010

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