One in 3 children diagnosed with bacterial meningitis will have long-term neurological disabilities: Study

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A new study from Sweden shows that one in three children who developed bacterial meningitis will live with long-term neurological disabilities.

The study, conducted by the Merck and the Karolinska Institutet and published in the Journal of the American Medical Association, analyzed data from Sweden's national patient register of people who developed bacterial meningitis between 1987 and 2021. Researchers were able to compare more than 3,500 cases of people who developed bacterial meningitis in childhood against a control group of more than 32,000 from the general population. The median age of meningitis diagnosis was 1.5 years; 55.8 per cent were men while 44.2 per cent were women. The average follow-up time was 23.7 years.

Bacterial meningitis is a rare but life-threatening infection that causes inflammation of the tissue surrounding the brain and spinal cord. Symptoms of bacterial meningitis include fever, headaches, stiff neck, confusion, irritability, seizures (particularly in children) and vomiting.

The study found that people who survived bacterial meningitis had an increased-risk of neurological disabilities such as cognitive disabilities, seizures, hearing loss, visual impairment, motor function disorders, behaviour and emotional disorders and structural head injuries.

"When children are affected, the whole family is affected. If a three-year-old child has impaired cognition, a motor disability, impaired or lost vision or hearing, it has a major impact. These are lifelong disabilities that become a major burden for both the individual and society, as those affected need health care support for the rest of their lives," says Frederico Iovino, an associate professor in Medical Microbiology at the Department of Neuroscience, Karolinska Institutet who co-authored the study.

According to the study's findings, one in three people diagnosed with bacterial meningitis in childhood will experience at least one long-term neurological impairment, particularly when they are diagnosed with pneumococcal meningitis.

Bacterial meningitis in Canada

Dr. Ron Gold, the former chief of the Division of Infectious Disease at the Hospital for Sick Children in Toronto and the medical advisor to the Meningitis Foundation of Canada, says the latest study from Merck and Karolinska Institutet is a rarity given the amount of data available in Sweden's national patient registry.

"The data is not terribly unusual, but it's a larger number of patients followed for a longer period of time, Gold tells Yahoo Canada. "Their estimates of the frequency of various kinds of damage from meningitis are perhaps more accurate than smaller studies that would have been done over the years at a single hospital."

Although, if diagnosed early enough, bacterial meningitis can be treated with antibiotics, Gold says brain damage can occur very quickly before antibiotics begin taking effect.

"The infection is occurring inside a bony skull that limits blood flow," he says. "In the course of an infection, you get damage to blood vessels and you get swelling in any part of the body. The same thing happens inside the skull, but the skull limits what can expand so there's the risk of damage occurring to the brain."

Should parents be worried about bacterial meningitis?

The Karolinska Institutet's findings highlight the severity and potentially devastating effects of bacterial meningitis. While the results are undoubtedly concerning for any parent, vaccines are the best way to protect yourself and your child.

According to the National Advisory Committee on Immunization (NACI), as of 2021, 89 per cent of 17-year-old adolescents in Canada had received at least one dose of meningococcal vaccine.

Gold says that although vaccines are evolving, they don't protect against all strains of bacteria and don't have long-lasting immunity. Canadians should check with their healthcare providers or pharmacists to see if they are up to date on their vaccines.

"The measles vaccine, for example, those produce very long if not lifelong immunity. The vaccines against these bacteria behave differently," he explains. "They produce very strong immunity, but that immunity decreases over time."

Are meningococcal and pneumoccocal vaccines free in Canada?

In Canada, infants are eligible to receive free primary meningococcal and pneumococcal vaccines when they're at least 2 months old, with boosters typically given before their second birthday (provincial guidelines vary).

Aside from children, college students and teens are at an increased risk for developing bacterial meningitis. Meningococcal boosters are given to teens and preteens when they reach 12 years of age (guidance varies by province) with some provinces offering boosters to university age students.

Earlier this month, Prince Edward Island announced it would provide free meningitis B to all post-secondary students, not just those who live in residence, after two cases of meningococcal meningitis (both serotype B) were reported in two students from Ontario who did not live on campus but "participated in school activities."

Nova Scotia offered a similar program in 2023, after three students died from meningitis B in the last three years.

Gold says, pneumococcal vaccines are important for Canadians over 65, since pneumococcus can cause pneumonia.

Despite vaccines being best way to protect Canadians from a majority of strains of bacterial meningitis, the cost of the vaccines outside of the free provincial programs can be a barrier to access. Some meningococcal vaccines can cost $160 per dose, although prices vary across the country.

Gold says the cost of vaccines and the rarity of bacterial meningitis play a factor in province's decision to provide them for free to the public. Given the high mortality rate of bacterial meningitis, Gold hopes that provinces will make vaccines more readily available to the public, rather than making them an out of pocket expense.

"These are rapidly moving diseases," he says. "You go from being perfectly well to being at death's door within 24 hours or less."

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