Considerations

There are two Aeromedical concerns following meningitis of encephalitis:

Neurological sequelae: The ME should in all cases complete a thorough neurological examination, inclusive of an audiogram. Anyone who has suffered from an episode of meningitis or encephalitis should also undergo a neurologist evaluation unless the infection was documented to be uncomplicated viral (other than herpetic) or bacterial meningitis, occurring more than 12 months previously, in the absence of any sequelae or seizure episode.

Risk of unprovoked seizures: This risk is significant and was found in one study to be 6.8 % over 20 years in one study. The ratio of observed to expected case of unprovoked seizures was 6.9. The risk was highest during the first 5 years but remained elevated for the next 15 years of follow up. It was dependent on the type of infection. This is summarised in the table below – adapted from Annegers (1988):

Condition Risk of unprovoked seizure Comments
Viral encephalitis (nonHerpes) with early seizures 22% over 20 years  
Viral encephalitis (nonHerpes) without early seizures 10% over 20 years  
Viral meningitis (non-Herpes) 2.1% over 20 years No significant increase over general population
Bacterial meningitis with early seizures 13% over 20 years  
Bacterial meningitis without early seizures 2.4% over 20 years No significant increase over general population

Thus the ME must remain cautious in assessing any applicant with a history of meningitis or encephalitis.

Information to be provided

  • Copy of the GP notes for the past 5 years or since the acute illness if more recent;
  • Copy of any discharge summary and any neurologist report;
  • A recent neurologist report unless the illness was an uncomplicated viral (nonHerpes) or bacterial meningitis occurring more than 5 years prior.

Disposition

  • An applicant with a history of encephalitis should be considered as having a condition that is of aeromedical significance;
  • An applicant with a history of Herpes Virus meningitis or encephalitis should be considered as having a condition that is of aeromedical significance.

An applicant with a history of uncomplicated, viral (non-Herpes), or uncomplicated bacterial meningitis should be considered as having a condition that is aeromedical significance unless:

  • There has been no seizure activity;
  • Full recovery has occurred and there are no sequelae of any sort;
  • More than five years has lapsed since the acute illness.