Meningococcal Disease

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 1805when an outbreak swept through Geneva, Switzerland.

• The causative agent, Neisseria meningitidis (meningococcus), was identified in 1887.

WHO

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.sequelae: بيماري از ناشي بيماري ؛ درطب نتيجه پيرو،تابع،

ديگر

WHO

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.

• Implicate: بودن كردن،مستلزم بر،گرفتار كردن داللت

Meningococcal Disease

> 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. • Bulge: شدن بادكردگي،تحدب،برآمدگي،متورم

• Upward: باال بطزف ، روبباال

• Irritable: مزاج تند ، خلق كج ، پذير تحرك

Clinical Presentation

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http://www.nfid.org/

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.

Meningococcal Disease

Case DefinitionClinical Description:Meningococcal disease manifests most commonly asmeningitis 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)Manifest: كردن نمود باز و بارز آشكارساختن

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.

Case Definition

EpidemiologyReservoir:

• 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.)

MMWR Morb Mortal Wkly Rep. 2000;49(RR-7):13-20

Public Health Actions

Education:

» Public» Providers » Laboratories

Public Health ActionsUpon 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

http://www.nfid.org/

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. 1999;281(20) 1906-1910

JAMA. 1999 May 26;281(20):1906-10.

QUESTIONS