Bacterial Meningitis 1

Running head: THE EPIDEMIOLOGICAL PROBLEM OF BACTERAIL MENINGITIS

The Epidemiological Problem of Bacterial Meningitis:

Risk Factors, Interrelatedness, Impact and Prevention

Mandy Stocks

University of South Carolina Spartanburg
Bacterial Meningitis 2

The Epidemiological Problem of Bacterial Meningitis:

Risk Factors, Interrelatedness, Impact and Prevention

Bacterial meningitis is an inflammatory condition of the meninges or membranes that form the lining of the brain and spinal cord. The most common pathogens responsible for bacterial meningitis include: Neisseria memingitidis, Haemophilus influenzae, Streptococcus pneumoniae, and Listeria monocytogenes. The disease in all ages continues to be a serious cause of morbidity and mortality, despite the introduction of effective antibiotics and preventative therapy. Bacterial meningitis is a serious disease that can result in brain damage and even death. The following will describe the epidemiology of bacterial meningitis and the effects it has on the individual, family and community, and the role of the community health nurse.
Epidemiological Problem

Description of problem

Bacterial meningitis is a common infectious disease that has been diagnosed throughout the world. In general, it affects the very young and the very old and favors males over females. “According to the Centers for Disease Control and Prevention (CDC), more than three hundred people die each year from this disease” (Barker, 2002, p. 133). Bacterial meningitis is a medical emergency that can progress rapidly, and therefore it demands rapid diagnosis and intervention to save the patient’s life and prevent disability.

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Agent

Of the previously stated infectious agents, Neisseria meningitidis, also known as Meningococcal meningitis, is the most common agent. “Meningococcal disease occurs sporadically and in epidemics; in many parts of the world, it is the leading cause of bacterial meningitis” (Chin, 2000, p. 340). Meningococcal meningitis is commonly caused by an infection elsewhere in the body such as the respiratory system, ear or nasal sinuses, and invades the central nervous system (CNS). Epidemics often occur in the winter and early spring, however it is not limited to these two seasons. Meningococcus does not become dormant once it invades the body. Once the agent enters the cerebral blood supply and cerebral spinal fluid (CSF), they multiply rapidly. Meningococcus can be transmitted through air droplets from the nose and throat of infected individuals, direct contamination, the blood stream, or direct invasion of the meningeal membranes. Because this agent is readily transmitted by direct contact between individuals trough saliva and nasal secretions, Meningococcus can be contracted through daily contacts. Young adults who live in group situations, such as in dormitories or military barracks, the elderly, children, and the immunocompromised are at high-risk of developing meningitis.
Host
Humans are the only recognized natural host of meningitis. “Recent studies indicate that factors such as close living; sharing utensils, cups, cigarettes, lip gloss; lowered immune levels due to fatigue or recent illness; and other environmental and behavioral factors may play a significant role in who gets meningococcal disease” (NMA, 2004, p. 2). “Meningococcal disease, while primarily a disease of very small
Bacterial Meningitis 4 children, occurs commonly in children and young adults; in many countries in males more than females, and more commonly among newly crowded living conditions such as in barracks and institutions” (Chin, 2000, p. 341). Meningitis also has a higher incidence in the black versus white population. Prolonged, close contact with an infected individual increases the risk of infection. Certain vaccines have been licensed in the United Sates and other countries for use in adults and in older children. Vaccines to prevent meningitis are recommended for all persons at risk, and there is a new emphasis on college students who live in dormitories. Some states are requiring vaccinations for all college dormitory residents, who are at triple the risk of the general population. “The guidelines of the CDC Advisory Committee on Immunization Practices encourage university health centers to make vaccinations easily available and give students and parents information about the dangers of meningococcal disease and the benefits of vaccination” (Barker, 2002, p.141).

Environment

Meningococcal infections are universal and can occur at any time of the year, but the incidence of meningococcal disease peaks in late winter to early spring. Community outbreaks of the disease have been observed with increasing frequency in the United States and Canada since nineteen ninety. These outbreaks have particularly affected school and college aged persons, and transmission has occasionally occurred among persons congregating in bars or nightclubs. Lifestyle factors such as lack of sleep, poor nutrition, exposure to passive and active smoking and excessive alcohol consumption
Bacterial Meningitis 5 weaken the immune system so greatly that it leaves the body vulnerable (Dunlap, 2004). Poverty and lack of medical care also pose risks. In parts of Africa, widespread epidemics of meningococcal meningitis occur regularly. “In 1996, the biggest wave of meningococcal meningitis outbreaks ever recorded hit West Africa. An estimated 250,000 cases and 25,000 deaths in Niger, Nigeria, Burkina, Burkina Faso, Chad, Mali, and other countries paralyzed medical care systems and exhausted vaccine supplies” (Directors of Health Promotion and Education, 2003, p. 3). Bacterial meningitis is endemic, being ever-present in everyday life. Meningococcal meningitis is a continuing threat in day-care centers and schools. Healthy children and young adults are susceptible, and death can occur within a few hours of onset.

Interrelatedness

“Communicable diseases are transmitted by the successful interaction of the infectious agent, host, and environment” (Stanhope, 2002, p. 399). Environmental temperatures, immunity of the host, and potency of the agent influence the transmission of the disease. Bacterial agents require special virulence factors to enhance their invasiveness and produce disease. The agent must gain access to the host, avoid normal host protective mechanisms, and multiply in the host. “Two defense processes can alter the ability of the body to fight bacterial meningitis effectively: (1) deficient CSF complement levels, which directly interferes with opsonization and the efficient phagocytosis of bacteria; and (2) low serum immunoglobulin G (IgG) concentrations, which decreases the brain’s ability to protect
Bacterial Meningitis 6 itself” (Barker, 2002, p. 135). These processes contribute to host deficiency at the onset of bacterial meningitis. Environment refers to all that is outside the human host, including physical, biological, social and cultural factors (Stanhope, 2002). Certain environmental factors aid in the transmission of an infectious agent and changes in these environmental factors can reduce the disease risk. Reducing overcrowding in living quarters and workplaces can reduce the risk of transmission of bacterial meningitis.

Data

Meningitis has a prevalence rate that is pandemic. An area of high incidence has existed for many years in the sub-Saharan region of mid-Africa. The largest recorded epidemic of meningococcal disease occurred in west Africa, with close to 250,000 cases reported (Chin, 2000). “In the United States the prevalence rate is smaller, averaging three thousand cases a year” (NMA, 2004, p. 2). South Carolina has an average of thirty cases per year. In Spartanburg County the prevalence is very small, averaging one case per year (DHEC, 2002).
Impact of Problem

Individual

Meningitis mimics the flu or a migraine and progresses quickly. High fever, headache, and stiff neck are common symptoms of meningitis. Other symptoms include nausea, vomiting, photosensitivity, fatigue, and altered level of consciousness. The petechial rash, which occurs in seventy percent of the patients, means that blood poisoning is underway. Bacterial Meningitis 7 The inflammatory infectious process of bacterial meningitis can produce a variety of associated complications. With acute bacterial meningitis, cerebral edema occurs and the entire surface of the brain becomes covered with a layer of pus. If left untreated the disease leads to extensive destruction of brain tissue, causing disabilities such as blindness, deafness, mental retardation, and may result in death. If the patient is fortunate enough to be diagnosed and treated early, only a follow-up visit is required. If there was a delay in treatment, the patient’s condition may lead to loss of extremities, a vegetative state, or early death.

Family client system

The associated complications and the possibility of death have major impacts on the family and client as a system. If the primary care giver or primary financial provider of the family is affected by the disease, then roles may have to be altered. The roles may only have to be altered for a short time, but if brain damage or loss of extremities occurs, the roles may have to change forever. Psychologically, the family and client may undergo increased levels of stress, fear, and depression. The family may be seen as social outcastes by those who are uneducated about bacterial meningitis. Financially the family may have to seek alternative support such as, disability and Medicaid. The cost of hospitalization, treatments, and rehabilitation will quickly diminish the funds of the family. The caregivers are also at high risk of contracting the disease, due to prolonged and close contact. Antibiotics are administered to these close contacts to help prevent the spread of the disease.

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Community

The community is at a high risk of an epidemic outbreak of the disease if a number of families in the community are diagnosed with bacterial meningitis. The entire community may need to be vaccinated and a large number may need to receive antibiotics. These services, along with increased education may put a strain on the health and welfare systems of the community. The local health department and area hospitals will be needed in an epidemic outbreak. With the current nursing shortage and budget cuts; personnel, vaccinations, and available resources may not be able to cope with the demand.
Role of Community Health Nurse

Individual

The role of the nurse working with the individual involves treatment, referrals, and education. Key nursing implications during the acute phase include: isolation precautions, intravenous fluid administration, antimicrobial therapy, and comfort. Health care must be immediate and aggressive to prevent death or serious complications. One role of the community health nurse (CHN) is to assess the client and close contacts. Once a history is obtained, identified close contacts need to be educated on the spread of the disease and preventative oral antibiotics need to be started. The CHN will also be needed after the acute phase is over and the patient returns home. If complications include brain damage or physical disabilities, the CHN will need to collaborate with rehabilitation services. Aggressive treatment and rehabilitation will improve the client’s outcome.

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Family as client

During the acute phase of the infection, patients and families are in crisis, causing fear and anxiety. The clinician’s ability to direct and manage care and to establish trusting therapeutic relationships with both the patient and the family help mobilize coping strategies and reduce the fear and anxiety that surround unknown situations (Barker, 2002). Developing the patient care plan should be a collaborative effort among all members of the health care team, the patient, and the family. It is necessary to include in the teaching a careful explanation of the disease process, interventions, and outcomes. It is important for the nurse to encourage questions from the patient and the family and to encourage their participation in the patient’s care. The nurse should increase the family’s awareness of possible transmission through contact and inform the family of required treatment for household and daily care contacts.

Community

The role of the nurse in the community is to educate and to identify high-risk groups. It is important for the nurse to recognize the high-risk groups and implement education and interventions. Healthcare providers play a key role in educating patients about measures to prevent bacterial meningitis, as well as assessment of signs and symptoms. “When an outbreak occurs, major emphasis must be place on careful surveillance, early diagnosis and immediate treatment of suspected cases” (Chin, 2000, p.344). It is also the role of the nurse to report the disease to the local health authority, so that the information is made available to the public. Many roles of the CHN include

Bacterial Meningitis 10 community assessments, prevention and control of epidemics, personal health care services and education on safe and healthy lifestyles.
Levels of Prevention
Primary
Primary prevention efforts help to reduce the incidence of disease through health promotion and education related to the individual, family and community. It is important to inform the public about the risks of crowded living conditions, malnutrition, and unhealthy lifestyles that can increase the risk of becoming infected with bacterial meningitis. Education regarding immunizations and universal precautions are also necessary. Vaccines to prevent meningitis are recommended for all persons at risk.
Secondary
“Secondary prevention seeks to reduce disease prevalence and disease morbidity through early diagnosis and treatment” (Stanhope, 2002). The CHN needs to collaborate with other health care professionals and set up screenings for the community, schools, and individuals in high risk areas. These screenings will help with early diagnosis and the availability of prompt treatment. The CHN also contacts individuals who have been in contact with other infected individuals. This allows individuals to be referred to proper health care officials to be screened and monitored. The nurse also contacts state and local authorities in the event there is a meningitis case since meningitis is a reportable disease.
Tertiary

Bacterial Meningitis 11 Tertiary prevention aims to reduce complications and disabilities of disease. The CHN during tertiary prevention tries to prevent the disease from becoming a disabling disease and tries to help infected individuals return to pre-disease state. Some actions taken by the nurse for bacterial meningitis include: continuation of antibiotic therapy, continuing education on preventive measures as well as how to perform daily activities while living with the disabilities caused by the disease. It may be necessary for individuals to undergo reconstructive rehabilitation to repair deformities. It is also essential to provide support groups for those who are currently undergoing the disease process and for individuals who are recovering.
Conceptual model Based on the above levels of prevention, the PRECEDE-PROCEDE model is appropriate to guide the CHN’s role in education and provide a sensible way of viewing the process of health education. “The PRECEDE-PROCEDE model focuses primarily on planning and evaluating the community health education programs” (Stanhope, 2002, 167). This model consistently involves the client in the problem solving process. It also focuses on helping communities change their behaviors and environment. “The model begins by assessing the environment in which the group lives and considering the social factors that influence health behaviors” (Stanhope, 2002, p.167). The model then examines both the internal and external environmental factors of the group that influence certain behaviors and health problems. Factors are then identified that will help the group implement healthy actions. The program is developed, implemented, and

Bacterial Meningitis 12 evaluated. The PRECEDE-PROCEDE model serves as a checklist for ensuring that all stages of the problem-solving process are followed (Stanhope, 2002). The bacterial form of meningitis is extremely dangerous, fast-moving, and has the most potential for being fatal. For many survivors the long-term effects also can be debilitating, recurrent, and include multiple amputations. Many, but not all types of bacterial meningitis can be prevented by vaccination. It is necessary to take proper precautions and preventative measures to decrease the risk for disease. It is important for all health care providers to collaborate together to ensure that proper education is given to the individual, family and community to decrease the risk for disease.
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References:

Barker, E., (2002). Neuroscience Nursing a Spectrum of Care (2nd ed.). Philadelphia: Mosby Co.

Chin, J & Ascher, M. S., (2000). Control of Communicable Diseases Manual (17th ed.). Washington D.C.: American Public Health Association.

DHEC, (2002). South Carolina 2002 Reportable Diseases. Retrieved March 22, 2004, From http://www.scdhec.net/HS/diseasecont/acuteepi/DOCS/morb2002.pdf.

Directors of Health Promotion Education. (2003). Bacterial Meningitis. Retrieved February 24, 2004, from http://www.astdhpphe.org/infect/bacmeningitis.html.

Dunlap, M. M. (2004, January). Adolescents & Young Adults… Bacterial Meningitis. Adolescents, Adults and Aging Adults, Vol. 9 # 1.

McCance, K. L., & Huether, S. E., (2002). Pathophysiology the biologic basis for disease in adults and children (4th ed.). Philadelphia: Mosby Co.

National Meningitis Association (NMA), (2004). About Meningitis. Retrieved March 22, 2004, from http://www.nmaus.org/about/index.htm.

Stanhope, M., & Lancaster, J., (2002). Foundations of Community Health Nursing Community-Oriented Practice. Philadelphia: Mosby Co.