Alphabet of meningococcal disease
It’s a good thing that you advised that my grandnephews be given a shot of the meningococcal B vaccine.” The message had come from a colleague who learned about the outbreak in Kent.
Receiving it first in the morning brought on a mix of emotions. I was happy that a piece of advice provided them with needed protection, but at the same time, I was reminded of a question often asked in the medical community. “Why does news from other parts of the world seem to create more impact as compared to learning of periodic vaccine-preventable outbreaks in the country?” Think about the persistent problem of measles that seems to plague us despite concerted efforts to increase immunization coverage. Why doesn’t the message come across?
Recently, a patient asked, “Doctor, do we have meningococcal B in our country?”
The answer to this is yes. First of all, we have to understand that disease can be caused by different serogroups and can vary with time and place. Worldwide, invasive disease has been associated with serogroups A, B, C, Y, W, and X. While cases are for the most part sporadic, less than 10 percent have been associated with outbreaks.
From available but limited data, meningococcal disease is endemic in the country, with about 100 cases reported yearly. Meningococcal A was the serogroup that caused the largest epidemic in the years 2004 to 2006, with 418 cases. From the period of 1998 to 2011, two of the seven epidemics were due to meningococcal B.
How is it transmitted? The bacteria can be harbored in the nasopharynx and transmitted through respiratory droplets through close, intimate contact. Human asymptomatic carriers are the usual source. In a prospective study by Gonzalez, among 937 healthy students aged 5 to 24 years, 35 were found to be carriers, giving a prevalence of 3.7 percent. Carriage was highest for the 10 to 14 age group. Across all ages, the predominant serogroup was B, followed by serogroup C and Y.
Who is at risk? Known factors for susceptibility to invasive disease include the age of the individual. Incidence is highest among infants under a year old and in the 15 to 24 age group. Others include crowded living conditions, poverty, cigarette smoking, whether active or passive, previous respiratory infection, and known contact with an individual with meningococcal disease.
What are the signs and symptoms? The more common clinical presentations of invasive disease include sepsis or meningitis. Although fever and petechiae, while nonspecific can be due to other viral illnesses, rapid clinical deterioration and progression of rashes warrant a strong consideration for meningococcemia. In patients with meningitis, about two-thirds present with a petechial rash. Initial symptoms aside from fever may include headache, vomiting, irritability, neck stiffness, and seizures.
Course of action? Seek immediate medical consult. Empirical anti-infective therapy, which means giving of antibiotics even prior to identification of the offending agent, is imperative, as well as receipt of antimicrobial chemoprophylaxis for significantly exposed contacts regardless of meningococcal immunization status. Case fatality rates can be high, ranging from 30 to 50 percent, with development of long-term sequelae in 10 to 20 percent of survivors.
How can it be prevented? Fortunately, we have available meningococcal vaccines in the country. While it is not routine but recommended for those at risk, including travelers to endemic areas, the information shared could hopefully provide answers to lingering questions. Vaccination prevents acquisition of the bacteria thereby preventing disease and subsequent transmission.
Last week, in preparation for the supplemental measles rubella immunization campaign in the National Capital Region in June, stakeholders—medical societies, nongovernment and government agencies, including the Philippine National Police and the Armed Forces of the Philippines—were asked for their contribution. In all the public health campaigns that we have been part of, when asked to commit, we offered where our greatest strength lies: providing correct information.
Fortunately, despite the presence of individuals who believe that they know more from singular experiences and unfiltered information that is readily available, doctors are still viewed as the authority. However, mere knowledge or even awareness doesn’t always translate into doing. While anyone would know how important prevention is overall, just like leading a healthier lifestyle, we need to emphasize that vaccination should be regarded as an investment, not an unnecessary expense.
I would like to think that we can all learn from situations even unfortunate ones like the one in Kent. Timely reporting and contact tracing enabled immediate intervention that hopefully can contain the outbreak. This is where we see the importance of surveillance, the value of providing early and necessary information, plus the needed transparency, which can go a long way in building trust in the health system.
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timgim_67@yahoo.com
