Meningococcal Disease

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Meningococcal Disease
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What is Meningococcal Disease

• Meningococcal disease is a potentially
  life-threatening bacterial infection.
• Expressed as either
• Meningococcal meningitis, or
• Meningococcemia
• Meningococcal disease was first described in 1805
• when an outbreak swept through Geneva,
  Switzerland.
• The causative agent, Neisseria meningitidis
• (meningococcus), was identified in 1887.
  
• WHO

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Public Health Significance?

• Leading cause of bacterial meningitis in children
  and young adults in the U.S
• 2,400 to 3,000 cases each year in U.S.
• 5 to 10 of patients die, typically within 24-48
  hours of onset of symptoms.
• 10 to 20 of survivors of bacterial meningitis
  may result in brain damage, permanent hearing
  loss, learning disability or other serious
  sequelae.
• Meningococcal septicemia - rapid circulatory
  collapse.
• WHO

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Meningococcal Disease

• Etiologic Agent
• Neisseria meningitidis (Gram-negative diplococcus
  bacterium) with multiple serogroups ( A, B, C, D,
  29E, H, I, K, L, W-135, X, Y, and Z).
• Strains belonging to groups A, B, C, Y and W-135
  are implicated most frequently in invasive
  disease.

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Clinical Presentation

• gt 2 Years
• High fever, headache, and stiff neck.
• Other symptoms include nausea, vomiting,
  discomfort looking into bright lights, confusion,
  and sleepiness.
• Newborns and small infants
• Classic symptoms may be absent or difficult to
  detect.
• In babies under one year of age, the soft spot on
  the top of the head (fontanel) may bulge upward.
• Infant may only appear slow or inactive, or be
  irritable, have vomiting, or be feeding poorly.

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Meningococcal Disease

• Incubation Period
• The incubation period is variable, 2-10 days, but
  usually 3-4 days
• Infectious Period
• An infected person is infectious as long as
  meningococci are present in nasal and oral
  secretions or until 24 hours after initiation of
  effective antibiotic treatment.

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Case Definition

• Clinical Description
• Meningococcal disease manifests most commonly as
• meningitis and/or meningococcemia that may
  progress
• rapidly to purpura fulminans, shock, and death.
  However,
• other manifestations might be observed.
• Laboratory criteria for diagnosis
• Isolation of Neisseria meningitidis from a
  normally sterile site
• (e.g., blood or cerebrospinal fluid (CSF) or,
  less commonly,
• joint, pleural, or pericardial fluid)

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Case Definition

• Case Classification
• Probable a case with a positive antigen test in
• cerebrospinal fluid or clinical purpura fulminans
  
• in the absence of a positive blood culture.
• Confirmed a clinically compatible case that is
• laboratory confirmed.

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Epidemiology

• Reservoir
• Humans are the only known reservoir of
  Neisseria
• Meningitidis.
• Mode of Transmission
• Person to person through droplets of
  respiratory
• or throat secretions.
• Close and prolonged contact e.g.,
• (kissing, sneezing and coughing on someone,
• living in close quarters or dormitories
  (military recruits,
• students), sharing eating or drinking
  utensils, etc.)

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• MMWR Morb Mortal Wkly Rep.
  200049(RR-7)13-20

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Public Health Actions

• Education
• Public
• Providers
• Laboratories

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Public Health Actions

• Upon receiving a report of invasive meningococcal
  
• disease
• 1. Determine if reported case is probable or
• confirmed.
• 2. Assure that isolates are forwarded to the
  Office of Laboratory Services for serogrouping.
• 3. Determine if contacts need prophylaxis.
• 4. Recommend prophylaxis if indicated.
• 5. Complete appropriate report form(s).
• 6. Send completed forms to IDEP

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Comparison of incidence of meningococcal
meningitis in Maryland college students to
similar age group in the general population.

• The average annual incidence among students
• enrolled in four-year schools 1.74 per
  100,000
• The average annual incidence in the general
• population of the same age 1.44 per
  100,000
• Incidence in students who were on-campus
• residents 3.24 per 100,000
• Incidence in students in students living
• off-campus .96 per 100,000
• Harrison LH, Dwyer DM, Maples CT, Billmann L
  Risk of Meningococcal Infection in College
  Students.
• JAMA. 1999281(20) 1906-1910

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• QUESTIONS