The death of the sociologist Giovanna Romano, 51 years old, in Pescara, and the hospitalization of a teenager from Chieti, who was then out of danger, have brought meningitis back into the spotlight. Two separate cases, not linked to each other, which arrive while in England there is an outbreak among young people in Kent, with over twenty suspected cases. Different episodes, but capable of fueling fears and questions. How justified is the concern?
We talked about it with the infectious disease specialist Gloria Talianifull professor of Infectious Diseases at Sapienza University of Rome.
Professor, these recent cases of meningitis have generated much concern. Should we really be alarmed?
«This is certainly not an emergency. Meningitis is a not very frequent infectious condition, but present in the epidemiology of our country, as well as in all advanced countries from a socio-health point of view. Sporadic cases represent a constant, however decreasing, even if the risk is never zero. The fact that very different people are involved (an adult and a boy) suggests that the underlying infections are not the same: pneumococcal meningitis prevails in adults, while meningococcal meningitis prevails in young people. This already allows us to limit cases as isolated episodes. The case of outbreaks observed, for example, in Great Britain is different, where the cases are concentrated among adolescents and young adults and are all meningococcal. The fact that these outbreaks have been identified and described is reassuring, because it indicates a good epidemiological capacity: it means that the containment system is active and working.”
Let’s clarify: what is meningitis and what are the differences between bacterial and viral forms?
«The main difference is gravity. Viral meningitis is generally less serious, leaves no consequences and heals. The exception is herpes virus meningitis, which can spread to the brain (becoming meningoencephalitis) and become more serious. Bacterial meningitis, on the other hand, can be very serious and even fatal. They are the ones that represent the real danger both for outcomes and for survival. Generally, vaccines are not used for viral forms because they have a benign course and a favorable prognosis.”
How dangerous is meningococcus?
«The meningococcus is a bacterium that can now be easily treated with antibiotics, to which it is still very sensitive. If identified quickly, it allows for effective therapy. However, it is difficult to control because it can be harbored completely asymptomatically in the throats of many people, and therefore easily transmitted. It is not an eradicatable germ and is widespread globally. In some cases it can have a fulminant course: in addition to meningitis it can cause a potentially fatal shock, which can lead to death in a very short time and also make effective therapeutic intervention difficult. This is why it represents one of the most serious risks.”
And how is it transmitted?
«By air, through close contact. Many people are asymptomatic carriers: they have, as mentioned, the bacterium in their throat without any symptoms. For them it does not represent a danger, but they can transmit it to others, who instead can develop the disease or meningococcal shock. Since it is not possible to easily identify carriers, the theoretical risk is always present: this is the reason for the sporadic cases.”
Should we be afraid of public places like schools or gyms?
“No. The risk concerns close contact, not simply presence in the same environment. For example, historically, beds were arranged “head-to-toe” in barracks precisely to reduce transmission between nearby people, and this measure has proven effective. There is therefore no reason to fear public places themselves: contagion occurs in close proximity, not at a distance.”
How important is vaccination?
«It’s fundamental. In Italy, the vaccine against meningococcal B is mandatory in childhood: it is administered in the third and fifth month and then around the age of one year, with boosters in adolescence (between 12 and 19 years), which are the groups in which the risk is greatest. There are also vaccines against other strains (A, C, W and Y) and also the hexavalent vaccine, which protects among other things from Haemophilus influenzae type B, another agent of meningitis. Therefore, for meningococcus B, for the ACWY strains and for Haemophilus there are effective vaccines that are well distributed throughout life.”
Are adults already protected?
«Not always. The current vaccination schedule is relatively recent, so many adults were not vaccinated as children. They can still do it: for example, the pneumococcal vaccine is recommended after the age of 65, because it is the most frequent form in adulthood. Even if it is not mandatory, it is offered free of charge and represents a very effective form of prevention.”
What are the symptoms not to be underestimated?
«The main signs concern the central nervous system: intense and unusual headache, fever, drowsiness or behavioral changes, significant malaise… In children, loss of desire to play, irritability, neck stiffness or fontanelle tension may appear in younger children. In adults, in addition to fever and headache, “jet” vomiting may appear, linked to increased intracranial pressure. Meningitis is not a trivial disease: the symptoms are acute and rapid. The patient perceives that “there is something different” and serious.”
How important is an early diagnosis?
«It is fundamental, especially in bacterial forms. Antibiotic therapy started early can completely change the course of the disease. This is why it is essential not to underestimate the symptoms and contact a doctor immediately.”
What happens, concretely, when a case is identified? How does the control of people who have been in contact with the patient work?
«The first thing is to identify the germ. In the case of meningococcus, we proceed with antibiotic prophylaxis of close contacts: family members, classmates, colleagues or anyone who has had significant proximity to the case. Prophylaxis can be oral for a few days or with a single injection, and is very effective in preventing any contagion from evolving into a disease. This is only necessary for meningococcus, not for viral or pneumococcal forms.”
How can prevention be promoted without triggering panic in people?
«Prevention is the opposite of panic. Those who follow the vaccination schedule correctly are protected: the risk of developing the disease is drastically reduced, to the point of being essentially eliminated. Promoting vaccination means preventing preventable events from having catastrophic consequences. Just remember smallpox, today eradicated thanks to vaccines: not due to the improvement of socio-health conditions, but due to vaccination. We therefore have an ethical duty: to spread the culture of prevention. If there was a vaccine against cancer, everyone would take it without hesitation. The same principle applies to preventable infections: we have effective tools and we must use them.”
