Meningococcal

WHAT IS A MENINGOCOCCAL DISEASE?

Meningococcal Meningitis is an infection of the meninges.  The thin lining that surrounds the brain and the spinal cord.

Several different bacteria can cause meningitis but Nelsseria meningitides (Meningococcus) is the most important one because of its ability to cause epidemics.

HOW IS IT TRANSMITTED?

The bacteria can be carried in the pharynx and sometimes for reasons not fully known, can overwhelm the body’s defences allowing the infection to spread to the bloodstream and the brain.

The bacteria are transmitted from person-to-person through respiratory droplets, saliva and throat secretions when people get into close contact.

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. Facilitate the spread of the disease.

The average incubation period is 4 days (ranging between 2 – 10 days).

WHAT ARE SIGNS AND SYMPTOMS?

The most common symptoms are stiff neck, high fever, sensitivity to light, confusion, headache and vomiting.  Even when the disease is diagnosed early and adequate therapy is instituted, 5 – 10% of patients die typically within 24-48hours of onset of symptoms.

Bacterial meningitis may also result in brain damage, hearing loss or learning disabilities in 10 – 20% of survivors.

WHERE IS THE DISEASE MOST PREVALENT?

Meningococcal meningitis occurs sporadically in small clusters.  Throughout the world with season variations the highest burden of meningococcal disease occurs in Sub-Saharan Africa, which is known as the “meningitis belt”.  An area that stretches from Senegal in the West to Ethiopia in the East with an estimated population of 300 million people.  Travellers to the meningitis belt may be at risk for infection particularly in the dry season.

Increasing numbers of cases and outbreaks have been reported from other regions South of the Meningitis belt these areas include the Great Lakes (including Lake Kivid, Lake Tanganyika, Lake Victoria, Burundi, Kenya, Rwanda, Tanzania and Uganda.

In addition to regional variation in disease incidence, living conditions and social behaviour can also affect transmission o.  Overcrowding as occurs in colleges, dormitories, hajj camps and refugee camps can also contribute to infection.

Many universities in the UK and USA recommend vaccination against meningococcal disease, particularly for students travelling from countries where vaccination for meningococcal disease is not common.

For pilgrims to the HAJJ and Ramadan Omra, Saudi Arabia requires that visitors obtain a tetravalent vaccine against the A.C.Y.W. - 135 strains at least 10 days prior to their arrival in the country.

WHICH GROUPS ARE AT HIGH RISK OF MENINGOCOCCAL MENINGITIS?

          Routine vaccination is recommended for:

                Persons with certain immunodeficiency states.

          People whose spleen does not function properly or has been removed.

·                         Person who may have laboratory or industrial exposure to the meningococcus.

         Travellers to and residents of hyperendemic areas such as Sub-Saharan Africa.

·                         Pilgrims to Saudi Arabia for HAJJ and Umrah.

Vaccination should be considered for college students, household or institutional contacts of persons with meningococcal disease for medical and laboratory staff at risk of exposure to the disease.

ACIP recommends vaccination against meningococcal disease to person who travel to or reside in countries where N. Meningitidis is hyperendemic or epidemic, particularly if contact with the local population will be prolonged.

A quadrivalent vaccine containing the A.C.Y.W. - 135 strains is available in South Africa for use by all persons from 2 years of age and up.  Speak to your travel health consultant for more information.