MENINGOCOCCAL MENINGITIS (MCM) AT DELHI

1
MENINGOCOCCAL MENINGITIS (MCM) AT DELHI INDIA
Dr. A. K. AVASARALA MBBS, M.D. PROFESSOR
HEAD DEPT OF COMMUNITY MEDICINE
EPIDEMIOLOGY PRATHIMA INSTITUTE OF MEDICAL
SCIENCES, KARIMNAGAR, A.P. INDIA
91505417 avasarala_at_yahoo.com
2

• PART - I
• MCM PROBLEM AT DELHI
• AND REST OF INDIA

3
PROMPT

• THIS JUST IN TIME (JIT) LECTURE IS DEVELOPED AS
  DELHI IS SUFFERING FROM 405 CASES AND 48 DEATHS
  DUE TO MCM. (AS ON JUNE 14TH 2005)
• MCM IS NOT NEW FOR DELHI. SINCE 1966, DELHI IS
  FACING THE BRUNT OF REPEATED EPIDEMICS OF MCM.
• WHY? IS DELHI BECOMING A HOME TOWN FOR MCM?
• THIS AROUSED INTEREST IN ME TO DEVELOP THIS JIT
  LECTURE.

4
LEARNING OBJECTIVES

• LEARNER SHOULD KNOW THE ENTIRE NATURAL HISTORY
  OF THE DISEASE
• LEARNER SHOULD UNDERSTAND MCM PROBLEM IN DELHI
  AND IN REST OF INDIA
• HE SHOULD LEARN THE STRATEGIES TO CONTROL MCM
• HE SHOULD BE ABLE TO ANALYZE AND DISCUSS THE
  SITUATION

5
PERFORMANCE OBJECTIVES

• LEARNER CAN APPLY THIS KNOWLEDGE AND CONTROL
  STRATEGIES TO OTHER INFECTIOUS DISEASES OF
  SAME BEHAVIOUR.

6
MCM PROBLEMAT DELHI SINCE 1966
YEAR CASES DEATHS CFR
1966 616 129 20.9
1983 1204 414 34.2
1984 1731 569 32.9
1985 6133 799 19
1986 3801 587 15.4
1987 3067 617 20.1
1988 2630 501 19
14-6-2005 405 48 11.9
7
DELHI EPIDEMICS
8
DELHI 1966 FEATURES

• TOTAL CASES 616, MOSTLY MALE INFANTS
• ADMITTED IN 5 MAJOR HOSPITALS IN DELHI
• SEROGROUP NOT DETERMINED
• INCREASE IN PROPORTION OF LABORATORY CONFIRMED
  CASES FROM
• 4.8 IN JANUARY
• 10.6 IN FEB
• 44.9 IN MAY

9
DELHI 1985 FEATURES

• LARGE EPIDEMIC AFTER 20 YEARS GAP ,
• TOTAL CASES 6133
• DEATHS 799
• CASE FATALITY RATE 13

10
PRESENT EPIDEMIC AT DELHI
DEATHS (cumulative total CASE FATALITY RATE)
DURATION
CASES
15
187
42 DAYS 29-3-2005 TO 9-5-2005
ONE WEEK 9-5-2005 TO 16-5-2005
116
26 (8.6)
JUST 2 DAYS 16TH TO 18 TH MAY 2005
26
10
JUST 12 DAYS (18-05-2005 TO 30-5-2005)
37
55
48
37
From 30-5-05 to 8-6-05
48 (10.9)
405
Total as on 14-6-05
11
DELHI EPIDEMIC 2005
Deaths
Cases
12
AGE SEX DISTRIBUTION OF CASES DEATHS

• MORE CASES (44) AND MORE DEATHS (62) IN 15-29
  YEARS GROUP
• AGE GROUP lt5 YEARS 6
• AGE GROUP 5-14 32
• AGE GROUP 15-1944
• AGE GROUP 30-4410
• AGE GROUP 45 6
• SEX PREDILICTION MF 74 26
• CASES SEX DISTRIBUTION -MF7426

13
SERO GROUP TYPING

• PRESENT EPIDEMIC IS DUE TO
• SEROTYPE A
• MENINGOCOCCI

14
PLACE DISTRIBUTION

• PLACES AFFECTED ARE MOSTLY OVERCROWDED
• CITY,
• SHAHDARA NORTH,
• SADAR PAHAR GANJ,
• SHAHDARA SOUTH,
• CIVIL LINES,
• CENTRAL DELHI

15
ACTION PLAN

• SECRETARY LEVEL (HEALTH) MEETING
• DIRECTOR GENERAL HEALTH SERVICES TECHNICAL
  INCHARGE AND DAILY MONITORING
• WHO TECHNICAL ASSISTANCE
• COORDINATION EXPERTS COMMITEE
• PUBLIC EDUCATION
• SURVEILLANCE
• RISK COMMUNICATION
• MEDIA BRIEFS

16
CONTROL MEASURES TAKEN

• DIAGNOSIS AND TREATMENT OF ALL CASES
• CONTACT TRACING OF ALL CLINICALLY SUSPECT CASES
• CHEMO PROPHYLAXIS FOR 305 HOUSE-HOLDS
• 12000 VACCINATIONS OF QUADRIVALENT MENINGO COCCAL
  VACCINE
• 35 CSF SAMPLES TESTED VE FOR TYPEA
  MENINGOCOCCI
• RISK COMMUNICATION

17
INITIAL LETHARGY IN FIRST
42 DAYS OF EPIDEMIC 2005

• FROM MARCH 29-3-2005 TO 9-5-2005,
  (42 DAYS) 187 CASES ARE ALLOWED TO
  ACCUMULATE. WHY?
  ( on average almost 4-5 cases
  per day)
• IS IT DUE TO DELAYED INITIATION OF ACTION?
• IS IT DUE TO DELAYED NOTIFICATION?
• IS IT DUE TO DELAYED CASE FINDING?
• OR REDUNNDANCY OT THE PART OF HEALTH
  AUTHORITIES AS MCM EPIDEMICS ARE COMMON TO
  DELHI

18
THREE FOLD DAILY INCREASE 2005

• NEXT WEEK ANOTHER 116 CASES (16 CASES/DAY)
  CLEARLY INDICATES THAT ACTION INITIATED IS NOT
  ADEQUATE OR PROPER.
• IS THE STRATEGY WRONG OR IS IT DUE TO
  INSUFFICIENT OR INEFFICIENT APPLICATION OF
  CONTROL MEASURES.

19

• REST OF INDIA

20
OTHER INDIAN STATES AFFECTED IN 1985

• HARYANA (FARIDABAD, GURGAON, ROTHAK)
• UTTAR PRADESH
  (GHAZIABAD, AGRA, MATHURA,
  ALIGARH, MUZAFFARNAGAR, BULANDSHAHAR, MEERUT)
• RAJASTHAN (BHARATPUR, JAIPUR, BIKANEER)
• SIKKIM (GANGTOK)
• GUJARAT
• JAMMUKASHMIR
• WEST BENGAL(CALCUTTA)
• KERALA
• ORISSA

21
OTHER INDIAN STATES AFFECTED IN 1989

• MADHYA PRADESH
• ORISSA
• ANDHRA PRADESH

22
1989 MADHYA PRADESH FEATURES

• TOTAL CASES 249 (AS ON 20-3-1989)
• DEATHS 67
• MENINGO COCCUS TYPE A OUTBREAK
• IN DISTRICTS OF SAGAR, DAMOH, CHATTARPUR,
  MANDSAUR, UJJAIN, SATNA, SHAHJAHANPUR, INDORE
• 1989 ORISSA FEATURES
• CASES 2951
• DEATHS 344
• DISTRICTS AFFECTED KALAHANDI, KOHLAPUR,
  PHULBANI

23
1989 ANDHRA PRADESH FEATURES

• TOTAL CASES 475
• TOTAL DEATHS 108
• MENIGOCOCCAL TYPE A EPIDEMIC
• DISTRICTS OF VISAKHAPATNAM, VIJAYANAGARAM,
  SRIKAKULAM

24
1989 PERSONAL EXPERIENCE - 1

• WE HAVE VISITTED A RESIDENTIAL SCHOOL AT
  PACHIPENTA, VIZIANAGARAM DISTRICT TO SEE FOUR
  BOYS BEDRIDEN WITH FEVER, HEADACHE, NECK
  STIFFNESS AND TYPICAL PETICHIAL RASH SKIN RASHES
• 42 BOYS ARE LIVING IN THAT OVERCROWDED HALL

25
PERSONAL EXPERIENCE - 2

• ON INVESTIGATION, WE DIAGNOSED IT AS MCM AND
  FOUND THAT TWO CASES PER YEAR HAVE OCCURRED IN
  THE PAST TWO YEARS REVEALING ITS USUAL SPORADIC
  INITIATION
• 1989 EPIDEMIC INVOLVED NEIGHBOURING DISTRICTS OF
  VISAKHAPATNAM, AND SRIKAKULAM RESULTING IN 475
  CASES AND 108 DEATHS