Meningococcal Disease

Meningococcal disease is caused by bacteria (germs) called meningococci, also known as Neisseria meningitidis. Although meningococcal disease is uncommon, it is a very serious disease. The infection can develop quickly and can be fatal in about 10 per cent of cases. If infection is diagnosed early and the right antibiotics are given quickly, most people make a complete recovery.

Meningococci bacteria commonly cause:

There are many strains of meningococci, but the strain that causes almost all disease in Victoria is known as serogroup B.

Most common in winter and spring
Meningococcal disease can occur all year round and in all age groups. However, it is more common during winter and early spring. In Victoria, the highest risk is in children under five years of age and young adults aged 15 to 24 years. About one-third of cases are in people 25 years of age or older.

A common bacteria that usually causes no harm
Meningococci bacteria live naturally in the back of the nose and throat in about 10 per cent of the population without causing illness. People of any age can ‘carry’ the germs without becoming ill and carriers develop immunity to the strains they carry. Rarely, people who are infected with the bacteria may develop the disease before immunity develops.

Although everyone is a carrier at some time, carriers are most common among young adults, especially men and smokers.

The bacteria are difficult to spread
The meningococcal bacteria are difficult to spread. They are only passed from person to person by regular, close, prolonged household and intimate contact with secretions from the back of the nose and throat. They cannot be picked up from water supplies, swimming pools, buildings or factories.

Some research shows that low levels of salivary contact is unlikely to transmit meningococci bacteria. In fact, saliva has been shown to slow down the growth of meningococci.

Meningococcal disease is uncommon but serious
Meningococci bacteria are only found in humans and cannot live for more than a few seconds outside the body. You cannot catch meningococcal germs from the environment or animals.

Most cases occur ‘out of the blue’ and are unrelated to any others. Outbreaks where more than one person is affected are rare.

Signs and symptoms – infants and young children
Signs and symptoms of meningococcal disease in infants and young children can include:

• Fever
• Refusing to take feeds
• Irritability, fretfulness
• Grunting or moaning
• Extreme tiredness or floppiness
• Dislike of being handled
• Nausea and/or vomiting
• Diarrhoea
• Turning away from light (photophobia)
• Drowsiness
• Convulsions or twitching
• Rash of red–purple pinprick spots or larger bruises.

Signs and symptoms – older children and adults
The signs and symptoms of meningococcal disease in older children and adults can include:

• Fever
• Headache
• Loss of appetite
• Neck stiffness
• Discomfort when looking at bright lights (photophobia)
• Nausea and/or vomiting
• Diarrhoea
• Aching or sore muscles
• Painful or swollen joints
• Difficulty walking
• General malaise
• Moaning, unintelligible speech
• Drowsiness
• Confusion
• Collapse
• Rash of red–purple pinprick spots or larger bruises.

Get further medical help if you are still worried
If somebody close to you has some of these signs and symptoms, and you are worried that they are much sicker than usual, seek medical help immediately.

In the very early stages, meningococcal disease can appear to be like other, less serious illnesses. Your doctor may not immediately recognise this illness. Do not hesitate to seek medical help again – even if it has only been an hour or two since you last sought help.

If the person seems to be sicker, has suddenly developed a rash or becomes drowsy – seek medical help urgently.

Young adults should not be left alone if they suddenly develop a fever – they may become seriously ill very quickly.

Early antibiotic treatment is vital
If meningococcal disease is suspected, an antibiotic (usually penicillin) is given immediately by injection. People with meningococcal disease are always admitted to hospital and may require admission to an Intensive Care Unit.

The sooner that antibiotic and other treatments begin, the less damage the disease will cause. However, this is a very serious infection, which can progress very rapidly despite the best treatment.

Close contacts are offered antibiotics
Most people who have had contact with an affected person, like school and work friends, do not need antibiotics. Very close contacts of an infected person are offered a short course of ‘clearance’ antibiotics in accordance with the Australian guidelines. These antibiotics are effective at getting rid of meningococci bacteria from the throat. They are not a treatment for meningococcal disease, nor do they necessarily prevent anyone from developing the disease.

Close contacts may include:

• Members of the same household
• A girlfriend or boyfriend
• Anyone who has stayed overnight with the person who is unwell in the seven days before the illness
• Children in a child care facility who have spent at least four hours or more in the same room as the affected person.

Vaccines
There are no vaccines that protect against serogroup B disease. There are two different vaccines that protect against serogroup C disease. ‘Conjugate’ vaccines can be given to all people of all ages and provide long-lasting immunity against serogroup C disease.

‘Polysaccharide’ vaccines cover several serogroups. They are useful for people travelling to places such as Africa and Asia and for pilgrims to the Haj in Saudi Arabia, where these serogroups are more common. They cannot be given to children under the age of two and only provide protection for about three years.

What to do if you suspect meningococcal disease
If you think a person has symptoms that suggest meningitis or septicaemia, contact your doctor immediately, call triple zero (000) for an ambulance or go to the nearest hospital emergency department. Early diagnosis and treatment are vital.

Where to get help

• In an emergency, always call triple zero (000) for an ambulance
• Your doctor
• Emergency department of your local hospital

Things to remember

• Meningococcal bacteria are only passed from person to person by regular close, prolonged household and intimate contact with secretions from the back of the nose and throat.
• Meningococcal disease is uncommon, but serious.
• You are the expert in your family’s health – if you are worried, seek immediate medical assistance.
• It is important to go back to the doctor or hospital for more help if you are still concerned.
• Meningococcal C vaccine provides good protection from only one strain of meningococcal disease.

This page has been produced in consultation with, and approved by:

SHYNESS AND CHILDREN

A shy child is anxious or inhibited in unfamiliar situations or when interacting with others. A shy child is most likely to be nervously constrained if they feel they are 'on show', such as when meeting someone new or having to speak in front of others. A shy child is much more comfortable to watch the action from the sidelines rather than join in. Most children feel shy from time to time but the lives of some are severely curtailed by their shyness. Children who suffer from extreme shyness may grow out of it as they mature or else grow up to be shy adults. Parents can help their children to overcome mild shyness. In severe cases, professional help may be advisable.

Complications of shyness
Constant and severe shyness can reduce the quality of a child's life in many ways, including:

• Reduced opportunities to develop or practise social skills.
• Fewer friends.
• Reduced participation in fun and rewarding activities that require interaction with others, such as sport, dance, drama or music.
• Increased feelings of loneliness, unimportance and reduced self-esteem.
• Reduced ability to reach full potential because of their fear of being judged.
• High anxiety levels.
• Embarrassing physical effects such as blushing, stammering and trembling.

Shyness has positive aspects too
Shy behaviour is associated with a number of positive behaviours including:

• Doing well at school
• Behaving and not getting into trouble
• Listening attentively to others
• Being easy to look after.

Possible causes of shyness
Some of the possible causes of shyness, often working in combination, may include:

• Genetics - aspects of personality can be decided, at least in part, by the individual's inherited genetic makeup.
• Personality - emotionally sensitive and easily intimidated babies are more likely to grow up to be shy children.
• Learned behaviour - children learn by imitating their most influential role models: their parents. Shy parents may 'teach' shyness to their children by example.
• Family relationships - children who don't feel very attached to their parents or who have experienced inconsistent caregiving, may be anxious and prone to shy behaviour. Over-protective parents may teach their children to be inhibited and afraid, especially of new situations.
• Lack of social interaction - children who have been isolated from others for the first few years of their lives may not have the social skills that enable easy interaction with unfamiliar people.
• Harsh criticism - children who are teased or bullied by significant people in their lives (parents, siblings and other close family members or friends) may tend towards shyness.
• Fear of failure - children who have been pushed too many times beyond their capabilities (and then made to feel bad when they didn't 'measure up') may have a fear of failure that presents itself as shyness.

The vicious cycle
If a child acts shy in a social situation they may berate themselves for their behaviour afterwards. This self-reproach can make them more self-aware and self-judgemental and actually increase the likelihood of the child behaving shyly in future. As time goes on, their confidence and self- esteem may start to falter. The less confident a child feels, the more likely they are to behave in a shy way.

Parental attitudes are crucial
Parents are very influential in their children's lives - probably much more than parents realise. Suggestions include:

• Be careful not to label your child as 'shy'. Children (and adults) tend to live up to the labels others give them.
• Don't let other people label your child as shy either.
• Never criticise or mock your child when they are shy. Be supportive, empathetic and understanding.
• Encourage your child to talk about the reasons for their shyness - what are they afraid of?
• Tell your child about times in your life when you have been shy and how you overcame it. Since young children often see their parents as perfect, admitting to your own shyness can make your child feel better and reduce their overall anxiety.
• Be outgoing yourself. Model confident behaviour and lead by example.

Strategies for the parent
It is possible for the parent to encourage their child to be more outgoing; strategies depend on the individual child and circumstances but can include:

• Share personal coping strategies you've learned over the years on overcoming shyness. Practice these strategies with your child.
• Tell your child about the many advantages of not being shy. Offer examples from your own life.
• Encourage outgoing behaviour. Praise your child when they handle an unfamiliar situation or meet a new person without resorting to shyness.
• Try goal-setting with your child. Aim for small, incremental steps and praise them for their progress. For example, saying 'hello' to another child may be a big first step.
• Deliberately take your child into new situations. Aim for small changes in behaviour first and gradually build up. For example, reward a child if they greet someone who is new to them. Be supportive.
• Make sure your child is allowed to excel in what they do best. Praise them for skills they have mastered.

Professional help
If your child's shyness is especially debilitating, you may like to consider professional help from a counsellor or psychologist. Treatment options include:

• Stress management
• Relaxation strategies
• Counselling sessions
• Social skills training.

Where to get help

• Your doctor (for a referral to a specialist service)
• Psychologist
• Parent Line Tel. 132 289
• Kids Help Line Tel. 1800 551 800.

Things to remember

• A shy child is anxious or inhibited in unfamiliar situations or when interacting with others.
• Most children feel shy from time to time but the lives of some are curtailed by their shyness.
• In severe cases, professional help may be advisable.

It takes time for a child to grasp the connection between the urge to urinate and urinating itself. Once the child understands that urinating is under their control, toilet training can advance in leaps and bounds. However, bedwetting remains a problem for many children. Instead of waking up to go to the toilet, a bedwetting child sleeps on while the muscles of their bladder relax. It seems that the brain doesn't receive the urge to urinate from the bladder.

One in five preschoolers and around ten per cent of all children under the age of ten years still wet the bed. There may be as many as 100,000 bedwetting Australians at any given time, including a small proportion of teenagers and adults.

Your child might feel shame and distress
Bedwetting isn't a disease, a psychological problem or a response to allergies. It isn't caused by laziness or naughtiness either, so punishing a bedwetting child doesn't do any good at all. Bedwetting is part of a natural process of physical and emotional development. Some children develop control a little later than others. It is important to be patient and sympathetic, since your child can suffer distress and embarrassment about bedwetting. They might refuse to go to slumber parties, school camps or other social events.

Be supportive
Some suggestions on helping your child to stay dry at night include:

• Be patient, calm and relaxed.
• Never punish them, yell or show disgust or disappointment.
• Use a mattress protector.
• Get them to help you to remake the bed whenever they wet to foster a sense of responsibility.
• Praise them when they wake up with a dry bed.
• Don't restrict their fluids.
• Don't wake a sleeping child to take them to the toilet yourself.
• Don't embarrass your child by talking about their bedwetting to other people.

The pad and bell method
One way to help your child become aware of urinating during sleep is to use a pad and bell. With this simple system, a bell rings and wakes the child once the pad is wet. Over a period of a few weeks, the child gains greater bladder control until they are consistently waking up to go to the toilet. It is best to use this under the guidance and supervision of a doctor. There is also a special nasal spray that your doctor can prescribe that has been shown to be effective in helping children with bedwetting.

Relapses could be a sign of stress
If your child has been dry at night for some time and suddenly starts wetting the bed again, this could be a sign of stress. Children commonly wet the bed during times of emotional upheaval, such as divorce, death or the addition of a new baby to the family. This needs a different approach. Encourage your child to talk about their worries and try as a family to address their concerns.

Sometimes children who have been dry relapse for no apparent reason, and no source of stress can be identified. They may wet on an occasional night, or for a period of time, and then stop. If it persists, treatment may need to be started again.

Where to get help

• Your doctor
• Your paediatrician
• Local community health centre

Things to remember

• Bedwetting is common in young children and is part of their physical and emotional development.
• The child isn't deliberately wetting the bed, so don't punish them.
• A relapse of bedwetting is often a sign of stress in children.