What Is Meningitis? Vaccines, Symptoms, and Reports of Increasing Cases in Schools

Why Are We Discussing Meningitis Now?

Recent reports describe an increase in meningitis cases, particularly among school-age children. Families are concerned, and the question "Is there an outbreak?" is frequently raised on social media. This is keeping pediatricians and family physicians busy while creating public confusion. Which vaccine should be given? At what age? Is there an outbreak? This article explains meningitis from all angles using the latest information.

What Is Meningitis?

Meningitis is inflammation of the membranes (meninges) surrounding the brain and spinal cord. It is generally caused by infection, and both viruses and bacteria can be responsible. Bacterial meningitis generally follows a more aggressive course and requires emergency medical care.

How Is Meningitis Transmitted?

Meningitis can spread through close contact, particularly in crowded settings. Germs enter through the mouth, nose, or throat via coughing, sneezing, or kissing. Transmission risk is higher in communal settings such as nurseries, schools, dormitories, and military units.

What Are the Symptoms of Meningitis?

Meningitis can progress rapidly and become life-threatening, so recognizing the symptoms is vital:

• High fever

• Severe headache

• Neck stiffness (inability to bend the head forward)

• Sensitivity to light

• Vomiting

• Altered consciousness

• In infants, a bulging fontanelle, irritability, and refusal to feed

Is There a Meningitis Vaccine?

Yes, vaccines against meningitis are available, but different bacteria and viruses can cause it. The most common and dangerous cause is meningococcal bacteria. There are two groups of meningococcal vaccines:

1. MenACWY Vaccines (Nimenrix, Menveo)
   — Protect against meningococcal serogroups A, C, Y, and W.

2. MenB Vaccine (Bexsero)
   — Protects against serogroup B.

All three of these vaccines are available in Turkey.

Does the State Provide Meningitis Vaccination in Turkey?

Unfortunately, meningococcal vaccines are not yet included in Turkey's routine vaccination schedule. Families must obtain them at their own expense. In contrast, 58 European countries offer these vaccines free of charge to different age groups according to epidemiological data relevant to their populations.

Is There a Meningitis Outbreak in Schools?

There is currently no general meningitis outbreak in Turkey. However, isolated cases in schools have increased, with particular attention to infections caused by meningococcal serogroup B .

According to a prominent expert from the Division of Pediatric Infectious Diseases at Hacettepe University Faculty of Medicine, Prof. Dr. Mehmet Ceyhan:

If a meningitis case has occurred at the child's school or in the family, or if the child has an immunosuppressive illness or takes immunosuppressive medicine, the group B meningitis vaccine (Bexsero) should definitely be given.

How Many Doses of Meningitis Vaccine Are Given?

If the child has never received a MenB vaccine:

• 2 doses of Bexsero should be given 6 months apart.

If the child has been vaccinated before:

• For children under 7, 3 years afterward, a booster dose is recommended;

• For children over 7, 5 years afterward, a booster dose is recommended.

Which Type of Meningitis Is Most Common in Turkey?

The state has provided Hib vaccination since 2006 and pneumococcal vaccination since 2008. Consequently, 90% of meningitis is now caused by meningococcal bacteria . According to surveillance across 33 centers in Turkey, serogroup B is the most common.

Who Should Receive Meningitis Vaccination?

• Infants and young children

• School-age children, particularly in schools where cases have occurred

• People without a spleen

• People taking immunosuppressive medicines such as eculizumab or ravulizumab

• People traveling abroad, for example for Hajj

• Young people entering military service

Are Meningitis Vaccines Safe?

Yes. Meningococcal vaccines have been given to hundreds of thousands of people over many years and are safe, with serious adverse effects very rare. Temporary effects such as fever or injection-site pain may occur.

How Long Does Protection From Meningitis Vaccination Last?

Protection varies with age, number of doses, and immune function. It generally lasts several years, but in higher-risk situations, booster doses are recommended.

Conclusion: What Should You Do?

• Consult your doctor if a meningitis case has occurred at your child's school.

• Check the child's vaccination history.

• Vaccination is particularly important for children aged 0–5, immunocompromised people, and those attending mass gatherings abroad.

• Because meningitis types and prevalence differ by country, vaccination recommendations from other countries should not be applied directly.

Remember: Meningitis can progress rapidly, but it is vaccine-preventable . Prevention is much easier and more effective than treatment.

Further Information: Current Approaches to Acute Meningitis Management

• Clinical vigilance matters: Without rapid intervention, meningitis can cause serious neurological sequelae or death. Clinicians should therefore maintain a low threshold for suspicion and avoid delaying diagnosis and treatment.
• Perform lumbar puncture within 1 hour if possible: According to current British guidance, lumbar puncture should be performed within the first hour, before antibiotics, unless contraindicated.
• CT imaging is not always necessary: Contrary to common belief, brain CT is often unnecessary before lumbar puncture. However, CT should be performed if there are focal neurological signs, papilledema, or persistent seizures.
• Start steroids with antibiotics: For suspected bacterial meningitis, steroids (IV dexamethasone 10 mg) are recommended at the same time as, or immediately before, antibiotics.

Pathogen-Specific Risk Factors and Antibiotic Selection

• In patients at risk of Listeria (age >60, diabetes, chronic illness, alcoholism): Add ampicillin/amoxicillin.

• For patients with a travel history and a risk of penicillin-resistant pneumococci: Consider vancomycin or rifampicin.

• For HSV/VZV viral meningitis with signs of encephalitis: Start acyclovir.

Key Diagnostic Findings After Lumbar Puncture

PCR Testing Is the Diagnostic Gold Standard

• CSF PCR has particularly high diagnostic value in patients who have already started antibiotics.

• In the UK, more than 50% of meningococcal disease is diagnosed by PCR alone.

• Multiplex PCR tests can screen for several pathogens simultaneously.

• Culturesshould be obtained early because they can rapidly become negative after antibiotics.

Time Is Critical in Meningitis Treatment!

According to a meta-analysis, delaying antibiotics for more than 2 hours in bacterial meningitis doubles mortality. Rapid decisions and treatment are therefore essential in every suspected case.