Meningitis – the Institut Pasteur pledges its support to the "Ensemble contre les méningites" association

Bacterial meningitis is a severe, devastating and unpredictable infection (see the Institut Pasteur disease fact sheet in French) which can strike people at any age; even those in good health. The consequences of the infection are often dramatic with debilitating outcomes in 20% of cases. If left untreated, bacterial meningitis results in death in all cases. Vaccine prevention is crucial given that diagnosis is particularly complex.

Research, awareness-raising and prevention therefore play a critical role in collective efforts to tackle meningitis for all these reasons. On October 3, 2019, experts provided an update on meningitis at a press meeting held at the Institut Pasteur followed by a symposium under the high patronage of the French Ministry of Solidarity and Health. "There are various different types of meningitis, so it should not be viewed as just one disease!" notes Dr. Muhamed-Kheir Taha, an Institut Pasteur researcher who leads the Invasive Bacterial Infections Unit and the National Reference Center (CNR) for Meningococci and Haemophilus influenzae. "The term 'meningitis' relates to inflammations of the meninges – membranes that envelop the central nervous system, i.e. the brain and spinal cord. Viral meningitis is the more common form and is less severe in most cases. Although rarer, bacterial meningitis is very serious and can even result in death.”

This information day served as a reminder of advances in knowledge of this disease and the need to raise awareness of prevention, diagnosis and treatment. The meeting was coordinated by the Ensemble contre les méningites association, which is the union of two associations: Petit Ange - Ensemble contre les méningites, and Méningites France - Association Audrey. This association is supported by the Institut Pasteur, the mutual society Unéo, and the pharmaceutical company GSK.

Ensemble contre les méningites website

The effects of meningitis can be severe and irreversible. It is therefore vital to recognize the symptoms and take swift action, especially since meningitis is unpredictable and can affect anyone. Despite this, there is very little information on the disease: "Due to a lack of information and ignorance, my daughter was killed by a bacterium at the age of 12 in 1999," explains Jimmy Voisine, President of Méningites France - Association Audrey. "Only signs of terminal phase meningitis were known at the time." Although considerable progress has been made in the past 20 years on identifying early warning signs, many people are unaware of them. Here is a list of them:

• The initial symptoms are non-specific (fever, vomiting, headaches) indicative of influenza or gastroenteritis. While the initial signs in the first hours can be misleading, the child's behavior is a warning sign, i.e. if s/he is "not his/her usual self".
• More specific symptoms such as sensitivity to light, a stiff neck, and cold hands and feet are also warning signs. These other symptoms appear later, although not necessarily all of them, and they may not occur in any particular order, which may be misleading, especially in infants (see graphic below).
   

In all cases, red or purple patches on the skin that do not disappear when pressure is applied indicate purpura fulminans. It should be noted that this prodromal symptom is detectable on the mucous membranes (e.g. in the mouth) of black-skinned children.

This symptom always indicates a genuine emergency, and an ambulance (dial 15) or the closest emergency department should be called as quickly as possible.

"It is important to trust your instincts – if a child is not his/her usual self this may be a genuine warning sign," emphasizes Patricia Merhant-Sorel, President of the association Petit Ange - Ensemble contre les méningites.

"Vaccine prevention is the only way of tackling bacterial meningitis," affirms Muhamed-Kheir Taha from the Institut Pasteur, "especially since it is difficult to diagnose and progresses quickly." The 11 compulsory vaccines currently identified for infants cover three of the four most predominant forms of bacterial meningitis in children.

"The meningococcal C vaccine is a good example of how effective compulsory vaccination is at improving population coverage. The meningococcal C vaccine was introduced and recommended in France in 2010 as part of the general preventive strategy for all children aged one year, with a catch-up vaccination possible until the age of 24 years,", continues Prof. Joël Gaudelus (Paris XIII University, former head of the pediatric department at the Jean-Verdier University Hospital in Bondy), who spoke at the symposium held on October 3, 2019 at the French Ministry of Health. "In 2010, the vaccination strategy was not working, with insufficient coverage in the 16-24 year age bracket (approx. 35%). The meningococcal C vaccine has proved effective in the Netherlands where 97% of teenagers are vaccinated. Compulsory vaccination, which came into force on January 1, 2018 in France, was what it took to reduce the incidence of this type of meningitis." (see also our article Vaccines: life insurance for humankind).

According to epidemiological figures since the beginning of the year, just one case of meningococcal C meningitis was reported at the end of September 2019 in France in the under one year age bracket – a 2-month-old child who had not yet been vaccinated. This figure was confirmed by Muhamed-Kheir Taha, Head of the National Reference Center at the Institut Pasteur, which provides expertise on isolated strains in France and their sensitivity to antibiotics. The CNR is also actively involved in devising vaccine strategies against invasive meningococcal infections in France.

Magali Guégan, assistant deputy director of public health and chronic disease prevention at the French Ministry of Health emphasizes the challenge of communicating the benefits of vaccination, which appears to be in the process of being met since the implementation of compulsory vaccinations according to a recent survey (see Most French people favor vaccination – Ipsos). In a speech to the Petit Ange - Ensemble contre les méningites and Méningites France - Association Audrey associations on October 3, 2019, Magali Guégan thanked them for "their (your) unfailing support, especially on the introduction of compulsory vaccinations for children and infants."

A meningitis B vaccine is also available (this form accounts for 80% of meningococcal meningitis cases in infants). Although it is not (yet) recommended, it is believed that the French National Health Authority has begun work on examining the possibility of recommending this vaccine in France. This type of meningitis is already under control in the United Kingdom due to this vaccine.

Neisseria meningitidis bacteria adhering to the surface of epithelial cells. The diplococci are entangled in cellular microvilli.

Credit  : Institut Pasteur/Perrine Bomme, Plate-Forme Microscopie Ultrastructurale, Guillaume Duménil, INSERM U970, Paris Centre de Recherche Cardiovasculaire, HEGP - Colorisation Jean-Marc Panaud.