The Shaker school community is deeply saddened by the death of Elena Steinberg, a first-grader at Boulevard Elementary School. Our thoughts are with Elena's family and friends at this difficult time.

On February 27, the Shaker Heights Health Department announced that the cause of death has now been determined to be bacterial meningitis caused by the bacterium pneumococcus (streptococcus pneumoniae), not meningococcus as was previously suspected.

Following is a statement from Scott Frank, MD, MS, Director of the City of Shaker Heights Health Department:

Growth of bacterial cultures reveal that the bacterial meningitis in a Boulevard student last week was caused by the bacteria pneumococcus (streptococcus pneumoniae), not meningococcus as was previously suspected.  As we mentioned in previous communication, the probable diagnosis in this case was meningococcus, but the final diagnosis can only be made through growth in bacterial cultures, which require 48 to 72 hours.  Further cultures are pending.  A decision about preventive treatment had to be made during the first 24 hours, prior to the culture results becoming available.  Waterhouse-Friderichsen syndrome, an infectious complication present in this case, is usually associated with meningococcal infections.  Only one case was identified in the medical literature in which an otherwise healthy child developed Waterhouse-Friderichsen syndrome of as a result of pneumococcal septicemia and meningitis. 

Preventive antibiotics are not required for pneumococcal meningitis. The incubation period for pneumococcus is 1 to 3 days, much shorter than for meningococcus, indicating that we are now likely past the period of risk.  No new or additional action should be taken at this time, but in the interest of accuracy, we are informing you of this finding. 

An immunization (Prevnar) is available that protects against about 80% of the common strains of pneumococcus.  This standard immunization is routinely administered to children by physicians.  Because the victim of this infection was properly immunized, the strain causing this infection appears to be one not covered by the vaccination. 

In adults, pneumococcus more often causes pneumonia than meningitis.  An additional vaccine, pneumovax is available for prevention of pneumococcal infections for at risk adults (chronic illness, age).  The use of these vaccines is recommended on a routine basis, but is not considered an important aspect of controlling the spread of the infection in emergency situations.

Scott Frank, MD, MS
Director of Health Department
City of Shaker Heights
February 27, 2006

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