Meningococcal Meningitis
Introduction
Acute communicable disease caused by
N. meningitidis
Meningococcal meningitis is also known as
cerebrospinal fever
Meningitis is a part of a septicaemic
process
Case Fatality Rates
= 80% (typical untreated cases)
= less than 10% (early diagnosis &
treatment)
Problem Statement
Global
Distribution: worldwide
Occurrence: Sporadic; small clusters /
outbreaks
African meningitis belt (endemic alternates
with devastating, unpredictable epidemics) :
region in sub-Saharan Africa stretching from
Senegal in the west to Ethiopia in the east;
meningococcal epidemic is > 100 cases
per 100,000 population per year (WHO);
serogroup A
African meningitis belt
Continents Incidence (per Serogroup
100,000) strains
Europe 0.2-14 cases B
America 0.3-4 cases B, C, Y
Africa 10-100 cases A
In endemic countries
Endemicity Incidence per
100,000 population
per year
High > 10 cases
Moderate 2-10 cases
Low < 2 cases
SEAR
Predominant serogroup: A, Y
Predominant region: temperate & tropical
Korea, Thailand: low endemic rates;
higher in <5yrs age children
Meningococcal disease is endemic in
SEAR
Sporadic and incomplete data from India,
Bangladesh, Indonesia, Nepal, and
Pakistan preclude their classification as
high, moderate or low endemic countries
Temperate
Subtropical
Tropical
Geographical Confirmed
Regions Meningitis
Nepal
Mountain 185
Least Hill 2106
reported cases from
Mountain region Terai 461
National 2752
Total
Highest
reported cases
from Hill region
Source: Annual Report 2070/71
Development Confirmed
Regions Meningitis
Source: Annual Report Eastern 334
2070/71 Central 672
Western 1514
Mid Western 21
Rukum Far Western 211
7 Kathmandu
367
Gulmi
970 Solukhumbu
101
Kailali Banke
121 7
Epidemiology Epidemiology
- Agent: gram-ve diplococci N.meningitidis; serogroups A, B, C,
X, Y, W135
Agent - Source of infection: nasopharyngeal secretions of cases &
carriers
- Period of communicability: until no organisms in nose &
throat discharges; lost infectiousness of cases within 24 hrs of T/t
- Age and sex: children; young - Season: dry & cold months
adults; equal in male & female; (Dec-Jun)
infants aged 3-12 months - Overcrowding (schools,
(highest attack rate) barracks, refugee, camps)
- Immunity: younger age - Low socio-economic group
groups more susceptible due to living (poor housing conditions
lower antibodies; immunity with exposure to tobacco
acquired by subclinical infection smoke, asplenia, HIV infection)
(mostly), clinical disease, - Travel to endemic areas
vaccination, passively from
mother to infants
Host Environment
Clinical features
MOT: Droplet infection
Portal of entry: nasopharynx
I.P. : 2-10 days
Usually asymptomatic
If symptomatic: usually begins as
intense headache, fever, nausea,
vomiting, stiff neck, photophobia &
progresses to coma within a few hours
Fatal within 24-48 hrs in 5-10% cases
with prompt antimicrobial T/t
Permanent neurological sequelae seen in
15-20% individuals who survive
Meningococcal septicaemia: rapid
dissemination of bacteria into bloodstream,
less common form of meningococcal
disease, characterized by circulatory
collapse, haemorrhagic skin rash & high
fatality rate
Diagnosis
History
Physical examination (Brudzinski & Kernig
signs)
Diagnostic tests
- Blood culture (Grams stain)
- Spinal tap (lumbar puncture): CSF shows
low glucose level, increased protein, WBC
- Imaging: CT-scan or MRI of head may
show swelling or inflammation
Prevention & control
Management of Cases:
Treatment with antibiotics (DOC: penicillin;
3rd generation cephalosporins like ceftriaxone;
single dose of long-acting chloramphenicol)
Management of septicaemic shock and
raised intracranial pressure in meningitis
Reduce fatality rates
Can save lives of 95% pts if T/t started within
2 days of illness
Isolation of cases: less useful
Prevention & control
Management of carriers:
Use of powerful antibiotics like rifampicin
T/t with penicillin does not eradicate carrier state
Management of contacts:
Avoid close contacts (household, child care,
preschool contacts) with confirmed cases
Start T/t within 24 hrs of identification of index case
(rifampicin, ciprofloxacin, ceftriaxone or azithromycin)
Most secondary case occurs within 72 hrs after
presentation of index case, risk of secondary disease
decreases to near baseline by 10-14 days)
Prevention & control
Mass chemoprophylaxis:
Mass medication of total population some
of which are not infected
DOC: Ciprofloxacin, minocycline,
spiramycin, ceftriaxone
Causes an immediate drop in incidence
rates & proportion of carriers
Recommended that its restricted to closed
& medically supervised communities
Prevention & control
Vaccine:
Two types of vaccines (polysaccharide &
conjugate) are available
Both are safe when used during pregnancy
Both vaccines are available against
meningococci of serogroup A,C,W135,Y
Recommended vaccination in high,
moderate endemic & frequent epidemic
areas (WHO)
Vaccine storage: 2-8 degree Celsius
Polysaccharide vaccine Conjugate vaccine
less immunogenic more immunogenic
less preferred more preferred (potential
for herd protection &
increased immunogenicity in
< 2 yr children)
mostly given S/c I/M injection in deltoid or
(subcutaneously) anterolateral aspect of
upper thigh in children <12
months of age
Eg: bivalent (A,C), trivalent Eg: monovalent (A or C),
(A,C,W135), quadrivalent quadrivalent (A,C, W135,
(A,C,W135, Y) Y), HibMenC
Polysaccharid Conjugate vaccine
e vaccine
Dosage: Dosage:
Single dose - Monovalent Men A: single I/M
S/cly to persons dose to 1-29 yrs age
2 yrs old - Monovalent Men C: single I/M
dose to 12 months children,
teenagers, adults
- Children 2-11 months require 2
dose 2 months apart & a booster
dose 1 yr thereafter
- Quadrivalent vaccine: single I/M
dose persons 2 yrs old
THANK YOU!!!
Any questions, queries &
comments are highly
welcomed
