Cases of Viral Meningitis on the Rise, Report Says

Cases of highly infectious viral meningitis have more than quintupled in Ventura County this year and more than tripled in Southern California, health officials reported Friday.

But the dramatic increase of the potent, flu-like disease is not a cause for heightened public concern, they said.

This more benign viral form of meningitis, an inflammation of the membrane of the nervous system, sometimes leads to hospitalization so patients can recover food and fluids lost through vomiting, experts said. But sufferers nearly always fully recover within a week or so, they said.

“There is a much higher incidence of viral meningitis this year, but it’s still a rare condition,” said Dr. Robert Schechter of the state Department of Health Services. “Patients should seek care, but they should be assured that this is unlikely to affect their family in the long term.”

Experts blame a particularly virulent strain of meningitis for the uptick in cases--especially Southern California--in 1998.

So far this year, Ventura County health officials have reported 86 cases of viral meningitis, compared with 16 during the same period in 1997. Statewide, cases are about double that of last year--up to 1,900 as of Sept. 5.

In all, the six large Southern California counties increased from 409 in the first eight months of 1997 to 1,284 over the same period this year. That represents the highest rate of the illness in the region and the state in the 1990s, according to state data.

In total numbers, the hike was greatest in Orange County, where cases rose from 125 to 340 through Sept. 5. The last time Orange County experienced a surge of cases was 1992.

“It is cyclical,” said Dr. Hildy Meyers, medical director of the Orange County Health Care Agency. “It is a seasonal occurrence, mostly in the summertime, but it also cycles over a period of years. We don’t really know why that is.”

In Los Angeles County, cases increased from 109 to 325. They climbed from 71 to 313 in San Diego County, from 54 to 148 in Riverside County and from 34 to 72 in San Bernardino County.

“These things tend to be very geographic,” said Dr. Robert Levin, health officer in Ventura County. “Illness spreads by proximity. For instance, there’s lots of whooping cough in the Bay Area, but we don’t have much down here. It’s like politics, things are regional.”

The illness--marked by pounding headaches, stiff necks and nausea--also tends to strike children rather than adults. Of the Ventura County cases analyzed last month, more than one-third of the patients were under age 18, and none were over age 65.

The illness is often passed at school or at day-care facilities.

“It is very difficult to prevent transmission from child to child and from child to family because of the close contact,” said Schechter of state health services. “It’s harder for children to have good hygiene all the time than it is for adults.”

But after peaking in the first two weeks of August, the incidence of new cases leveled off and now appears to be dropping, at least in Ventura County, Levin said.

Unlike the more dangerous bacterial meningitis, which can kill, viral meningitis is an extremely uncomfortable but low-level swelling of the membranes that surround the brain and spiral column.

“This makes you feel horrible when you get it,” Levin said, “but you get better. There are some severe forms of viral meningitis, but this does not appear to be one of them. And luckily they’re very unusual.”

Viral meningitis is commonly spread by airborne viruses that not only cause fever and headaches but sometimes cause vomiting and diarrhea, officials said.

Patients have had to be hospitalized to replenish their liquid level, said Ventura County public health nurse Linda Vrtis. “They have anorexia and don’t feel they can eat,” she said. “But they generally recover without complications.”

Viral meningitis cases are probably higher this year statewide because the strain of the virus--a so-called Echovirus 30--is so potent, Levin said. Some of the cases tested in Ventura County have revealed strains linked to that virus, he said.

“So what’s happening here is the same thing that’s happening all over the state,” he said.

Spread of the virus can be slowed by washing hands with soap and water before eating or cooking and after using the toilet--and by not sharing drinking glasses, authorities said.

While recovery from viral meningitis is usually rapid, doctors said patients should consult a physician because the illness could be something more serious and harmful if left untreated.

“They need to distinguish this from the garden-variety summer flu and from bacterial meningitis, which would require antibiotic treatment and has a higher risk of long-term damage,” Schechter said.

Levin said patients should at least call their doctors to discuss symptoms.

At home, patients may gain relief by drinking lots of fluid, taking over-the-counter painkillers and getting extra rest, officials said.

Affected students should stay out of school until they are well, doctors said. Some schools quarantine students with bacterial meningitis, but viral meningitis is usually taken in stride.

“It’s just a matter of keeping sick kids at home,” Schechter said, “and in a week or two they are as good as new.”

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Reports of Viral Meningitis

(by year, through first 35 weeks)*--*

1990 1991 1992 1993 1994 1995 1996 1997 1998 County Los Angeles 183 138 276 366 208 116 162 109 325 Orange 92 107 306 172 110* 94 126 125 340 Riverside 30 36 101 70 35 37 32 54 148 San Bernardino 48 34 50 93 40 25 36 34 72 San Diego 89 84 279 157 138 118 60 71 313 Ventura 23 7 55 29 12 22 18 16 86 California 849 694 1,520 1,462 976 771 746 1,044 1,900

*--*

*Note: State did not receive all reports from Orange County for 1994.

Source: California Department of Health Services

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Viral Meningitis

Meningitis is an inflammation of the membranes that surround a person’s spinal cord and brain. The viral form of the infection is very common and relatively mild, requiring no treatment except for rest, drinking of fluids and use of over-the-counter painkillers.

* Symptoms: Severe headache, fever, stiff neck, sensitivity to light. Occasionally, nausea and vomiting.

* Diagnosis: Sample of fluid is removed from the liquid surrounding the spinal cord and examined.

* Outlook: Clears up within two to five days; has no long-term effects. Sometimes patients are hospitalized for rehydration.

* Prevention: Watch basic hygiene rules, such as washing hands often and covering mouth when sneezing or coughing.

Source: County Health Department