The brain is an important organ, serving as the command center that allows the body to function normally. Besides having the skull as a crucial barrier, we all have three layers of meninges that cover the brain tissue. However, if inflammation occurs from the meninges to the brain tissue, it is considered an emergency that requires immediate treatment. Dr. Chidchanok Thianphat, a pediatric neurologist at the Healthy Child Clinic, Phyathai 3 Hospital, stated that because the mortality and disability rates are very high, parents and caregivers should observe the initial symptoms in their children and take them to a doctor immediately if symptoms are found.
These symptoms indicate meningitis
Dr. Chidchanok explained that the symptoms depend on the child’s age. In older children, fever is accompanied by neurological abnormalities such as headache, lethargy, confusion, seizures, and neck stiffness due to inflammation of the meninges.
For younger children, especially infants under 12 months old, neurological symptoms may not be clear. The child may be lethargic, feed less, be irritable, or have seizures. Doctors diagnose based on the illness history from parents or caregivers, neurological examination, and cerebrospinal fluid analysis.
Infection… the cause of meningitis
The main cause of meningitis and encephalitis is infection, primarily by bacteria and viruses. Other causes such as fungi, parasites, and worms are occasionally found.
How to treat meningitis in children
Patients diagnosed with meningitis will receive antibiotics that cover the causative pathogens. The treatment duration is about 7-21 days depending on the type of infection. During treatment, doctors will assess for possible complications such as hydrocephalus, brain swelling, or control seizures. After discharge, doctors will continue to monitor the child’s development, hearing, and learning progress.
Meningitis can be prevented with “vaccines”
- Viral causes Prevention measures include “eat hot food, use separate spoons, wash hands”, avoid taking children to crowded places, and keep children home from school when they are sick to prevent spreading and acquiring infections. One of the viruses causing meningitis is “influenza”, which can be prevented by seasonal influenza vaccination. Another virus is Japanese Encephalitis virus (JE), which is included in the Ministry of Public Health’s basic vaccination program, starting with the first dose at 9-12 months old, followed by a second dose at 2 years and 6 months.
- Bacterial causes The common pathogen is Invasive Pneumococcal Disease (IPD), which is found in the nasal and throat cavities of children. It can cause pneumonia and spread infection into the bloodstream and nervous system, leading to meningitis symptoms. In Thai children, 35% carry this bacteria in the upper respiratory tract, mostly infants and young children aged 2-3 years. Among Thai children under 5 years old, 60% are infected.
Vaccination is highly effective and can be started at 2, 4, and 6 months of age with a booster at 12-15 months. It is widely used abroad, but in Thailand, it is not yet included in the basic vaccination program and is expensive. Studies on cost-effectiveness in Thai children are ongoing, and vaccination should be considered on a case-by-case basis, especially for high-risk children such as those who have had a splenectomy or have immunodeficiency.
- Haemophilus influenzae (HIB) causes HIB is another important cause of meningitis in children. It resides in the human respiratory tract and spreads through direct contact with respiratory secretions. Severe HIB infections are common in children aged 6-18 months. Therefore, vaccination is recommended starting at 2 months old, with boosters at 4 and 6 months, and a final booster at 12-18 months. The vaccine can reduce HIB disease incidence by 95%.
Currently, the HIB vaccine is not included in the basic vaccination program due to its high cost. However, children with immunodeficiency or who have had a splenectomy should consult a doctor about receiving the HIB vaccine.
Families with children at risk should consult a doctor to get vaccinated as prevention is better than cure. The consequences of this disease can be more severe than expected.
References
1. Clinical Practice Guideline of Acute Meningoencephalitis, Pediatric Infectious Diseases Society of Thailand
2. Pneumococcal Disease. Available at: http://www.cdc.gov/nip/diseases/pneumo/
