Viral meningitis: symptoms, is it contagious, treatment and recovery

The NHS says the symptoms of meningitis develop suddenly. Viral meningitis symptoms can be similar to those of bacterial meningitis, according to Meningitis Now, which is why it is essential to seek urgent medical help if you are concerned. The NHS adds that some early symptoms can be similar to flu, a stomach bug or a hangover.

NHS inform says the symptoms can appear in any order and some may not appear, and that the blotchy rash does not always develop, so you should trust your instincts and not wait for a rash.

The NHS lists extra symptoms in babies and children under 5: they may not want to feed, have a high-pitched, unusual cry, have a stiff body or be floppy or unresponsive, or have a bulging soft spot on top of the head.

• A high temperature (fever), sometimes with very cold hands and feet.

• A stiff neck and a severe headache that is getting worse.

• Joint and muscle pain, and eye pain when looking at bright lights.

• Vomiting (being sick) and diarrhoea.

• Confusion, being very sleepy or difficult to wake, or seizures (fits).

• Spots or a rash that does not fade when pressed with a glass (harder to see on brown or black skin).

The NHS says you need medical help immediately if you think you or your child might have meningitis. Call 999 or go to A&E if an adult or child aged 5 or over has a very high or very low temperature, feels hot or cold to the touch or is shivery, has a very painful headache, is confused or has slurred speech, has a stiff neck and cannot look at bright lights, has a rash that does not fade when you press it, has a seizure for the first time, or has symptoms you are worried might be meningitis.

For a baby or child under 5, the NHS says to call 999 or go to A&E if they have a very high temperature (38C or more in babies under 3 months, 39C or more in babies 3 to 6 months), a very low temperature (less than 36C) or feel cold or shivery, a weak, high-pitched or continuous cry, a rash that does not fade, are not responding as they normally do, are not feeding, are floppy, difficult to wake or more sleepy than usual, or you are worried.

The NHS says not to drive yourself to A&E and that the person you speak to at 999 will advise you. NHS inform says you can phone 111 or contact your GP practice urgently if symptoms could be meningitis but you are not sure, or you think you have been exposed to someone with meningitis. Do not wait: a rash may not develop.

Meningitis is an infection of the protective layers that cover the brain and spinal cord (the meninges), according to the NHS. NHS inform says it is usually caused by a viral or bacterial infection, that viral meningitis is the most common and least serious type, and that bacterial meningitis is rare but can be very serious if not treated quickly.

Meningitis Now describes viral meningitis as rarely life threatening but able to make people feel very ill, and estimates that there are thousands of cases each year in the UK. Anyone can get it, but it is most common in babies and young children.

The UK government factsheet says that viral meningitis will usually get better and rarely causes any long-term problems.

Meningitis Now says viral meningitis is not generally considered to be contagious: contact with someone who has the illness does not usually increase the risk of disease to others, and linked cases are extremely unusual, with almost all cases occurring alone.

The viruses that can cause meningitis do spread between people, though. NHS inform says the viruses and bacteria that cause meningitis can be spread through sneezing, coughing, kissing, sharing utensils, cutlery and toothbrushes, close contact with other people and sharing vapes. It says the infection is usually spread by people who carry these germs in their nose or throat but are not ill themselves, and that the risk of someone with meningitis spreading it to others is generally low.

NHS inform says people at high risk of infection, for example those in prolonged close contact with someone who developed meningitis, may be given a dose of antibiotics as a precaution. This is mostly relevant to bacterial meningitis, and public health teams or your GP will advise if it applies to you.

Many different viruses can cause meningitis. Meningitis Now says the most common are a group called enteroviruses, which live in the intestines and can commonly cause colds, sore throats, stomach upsets and diarrhoea, and that only rarely do these viruses spread through the body to the meninges. Other viruses that cause meningitis include mumps and measles.

NHS inform lists enteroviruses, the mumps virus and the herpes simplex virus (a virus that usually causes cold sores or genital herpes) among the causes. Meningitis Now adds that Mollaret's meningitis is a rare, recurrent form that is believed to be caused in many cases by infection with a member of the herpes family of viruses.

The NHS says it is possible to get meningitis more than once. It is more common in babies and young children, teenagers and young adults, older people, and people with a weakened immune system, for example those with HIV or having chemotherapy.

NHS inform says people with suspected meningitis will usually need tests in hospital to confirm the diagnosis and check whether it is caused by a viral or bacterial infection. These may include a physical examination, blood tests that look for signs of infection, a lumbar puncture (a sample of fluid from the spine, checked for bacteria or viruses) and a CT scan to check for problems with the brain such as swelling.

Because bacterial meningitis can be very serious, NHS inform says treatment with antibiotics will usually start before the diagnosis is confirmed, and will be stopped later if tests show a virus is the cause. Meningitis Now says the same: antibiotics may be started on admission until the cause is identified and are usually stopped once viral meningitis is diagnosed.

The NHS says viral meningitis tends to get better on its own within 7 to 10 days and can often be treated at home with plenty of rest, painkillers and anti-sickness medicine. NHS inform says you will usually be able to go home from hospital if you or your child have mild meningitis and tests show it is caused by a virus.

Meningitis Now says there is no specific treatment for most cases of viral meningitis: patients need to be hydrated with fluids, given painkillers and allowed to rest. Antibiotics are not effective against viruses.

NHS inform says severe viral meningitis may also be treated in hospital, where treatment can include fluids and antibiotics given into a vein, oxygen through a face mask if there are breathing difficulties and, in some cases, steroid medication to reduce swelling around the brain.

Most people feel better within 7 to 10 days, according to NHS inform, although it says it may be a while before you feel completely back to normal after going home. The NHS says viral meningitis does not usually cause any long-term problems and most people make a full recovery.

Meningitis Now takes a more cautious view: although most people make a full recovery, the recovery process can be slow, and some can be left with life-changing after-effects, which can include headaches, exhaustion and memory loss. It says these are not usually as severe as after bacterial meningitis but can be long-lasting for some.

NHS inform says people who have had meningitis will usually have a hearing test after a few weeks to check for problems, and that complications are much rarer after viral meningitis. If you have lasting symptoms such as headaches, tiredness or poor concentration, speak to your GP.

The two cannot be told apart by symptoms alone, which is why every suspected case is treated as an emergency. The table summarises what the NHS and NHS inform say about the differences once the cause is known.

Meningitis Now says there are not vaccines to prevent most cases of viral meningitis, but the MMR vaccine, given as part of the routine UK schedule, protects against measles, mumps and rubella and, before it was introduced, mumps was a common cause of viral meningitis in children.

The NHS says vaccines are one of the safest and most effective ways to protect against meningitis, and that children and teenagers are offered vaccines for the main causes, such as MenB, MenACWY, pneumococcal, 6-in-1 and MMRV. Most of these protect against the bacterial causes. If you are not sure your or your child's vaccinations are up to date, the NHS says you can use the NHS App or ask your GP surgery.

Suspected meningitis is assessed through 999, A&E, NHS 111 or an urgent GP appointment, and tests and treatment are given on the NHS. Charities such as Meningitis Now and the Meningitis Research Foundation offer information and support, and the NHS lists them as sources of help after meningitis.