Over 1,000 pupils and 125 teachers were treated with antibiotics after three cases of meningitis were reported in a Gloucestershire school early in 2003. Bacterial meningitis is a feared and serious infection that can cause brain damage, deafness and even death. The antibiotics were given as a precaution in case the infection had been transmitted to other pupils and staff in the school.

Meningitis describes any infection to the cerebrospinal fluid that surrounds the brain and spinal cord. It is contained within protective membranes called the meninges and any infection can cause serious damage to the nervous system. There are several types of meningitis caused by viruses and bacteria. Viral meningitis is relatively mild and sufferers generally recover without the need for medical treatment. Bacterial meningitis can be caused by a range of bacteria but perhaps the most serious is caused by a group of bacteria known as Meningococcus. Four of these (types A, B, C and W135) are capable of causing epidemics and can be fatal within 48 hours of developing the symptoms of infection.

Bacterial meningitis first starts as a fever which may also be accompanied by a headache and sore neck. These symptoms can develop very quickly, over several hours, or more slowly over one to two days. Vomitting, sensitivity to bright light, confusion and seizures can develop as the disease progresses.

Perhaps the most well known symptom is a skin rash like the one shown in the picture. In the later stages of the disease, bacteria can infect the blood and release toxins that damage tiny capillaries in the skin and cause blood to leak into the skin. The tumbler test is often described as a method for diagnosing meningitis because if a glass tumbler is pressed against the skin, the rash does not fade. This should not be the only diagnosis as a rash does not develop in all cases of meningitis. The only certain way to identify bacterial meningitis is to take a sample of fluid from the spinal cord and test for the presence of Meningococcus.

Meningococcus is found in the nose and throat of 10-25% of people. Most of the time it does not cause any symptoms but it does mean that it can be spread by droplets in coughs, sneezes and when kissing. Young children and teenagers are the groups that are most at risk from the disease.

Occasionally, the bacteria are able to invade the bloodstream and spread to the central nervous system. This allows the infection to develop and it must be treated immediately because bacterial meningitis proves to be fatal in 5-10% of cases.

Cases of bacterial meningitis in the United Kingdom are rare and tend to be in places like schools and colleges, where many people spend time close together. Although this is serious, outbreaks can be quickly brought under control by prescribing antibiotics to anyone who may have come into contact with an infected person to kill the Meningococcus before infection happens. However, this is not always possible in countries where healthcare is not so easily obtained.

In west Africa, meningitis is a major killer. In 1996, the largest ever reported outbreak of bacterial meningitis infected over 213,000 people and resulted in 21,830 deaths. Vaccination programmes aim to improve the situation but factors such as overcrowded housing, dusty conditions and population movements mean meningitis is a serious threat.

Antibiotics such as penicillin and chloramphenicol are medicines that kill bacteria. In cases of bacterial meningitis these are given as quickly as possible once the infection has been diagnosed. Antibiotics may be given to friends, family and other close contacts of the infected person. Emergency vaccinations can be given to others in the area to prevent the spread of the infection into the wider population.

Bacterial meningitis is so serious that a person showing the symptoms will be admitted to hospital. It is difficult to get antibiotics into the cerebrospinal fluid and medicines often need to be given using a needle directly into the bloodstream or spinal cord.

Menningococcus type A is the main cause of epidemics in western Africa whilst outbreaks of the type C infection have been seen in Europe, North America and Australia. Vaccinations contain carbohydrate molecules from the Meningococcus bacteria that stimulate the immune system so that it can quickly kill any living Menigococcus that enter the body. Current vaccinations are active against Meningococcus types A and C. They give protection for 3 - 5 years and are given to the groups that are most at risk; young children and teenagers. When an outbreak of meningitis happens, emergency vaccination programmes are an effective way to stop the infection spreading into an epidemic.

Currently there is no vaccine against the type B Meningococcus which is known to cause meningitis in the UK.