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Meningococcal Disease

Meningococcal disease is a bacterial illness caused by the bacteria Neisseria meningitides. The illness can manifest as bacteremia (infection of the blood), pneumonia (infection of the lung) and most seriously, meningitis (infection of the spinal fluid surrounding the brain and spine).

There are 5 major groups of meningococcus bacteria that cause illness; serogroups A, B, C, Y and W-135.

While it commonly causes isolated infections; it is frequently associated with local community outbreaks (crowded environments like military barracks, colleges or pilgrimages – Hajj) or epidemics (in sub-Saharan Africa). It is also commonly seen in individuals without a spleen.

Even with early, appropriate and aggressive treatment there is a 10 –15% fatality rate with this disease and the potential for long term side effects of brain damage, hearing loss or amputated limbs. .

What if I had close contact with an infected person?

If you had close contact (>4 hours sitting next to them, sleeping in the same room, shared eating dishes and cutlery etc) you can take antibiotics to prevent illness. The choices are:

 Rifampin 600mg twice a day for 2 days

Ciprofloxacin 500 mg once

Ceftriaxone 250 mg injection once

Check with your physician for contraindications, risks, side effects, pregnancy issues etc.

Where does it occur?

For travelers the primary region of concern is the ‘meningitis belt’ of sub-Saharan Africa:

Senegal/Gambia/Mali/BurkinaFaso/Ghana/Benin/Nigeria/Chad/Cameroon/ Central African Republic/Sudan/Ethiopia/ Uganda/Kenya

The bacteria are present worldwide and can cause sporadic disease anywhere, especially during the winter months. Travelers should be alert for current epidemics and can go to outbreaks and www.cdc.gov/travel for updates.

How is it transmitted?

Meningococcus bacteria is transmitted by close person to person contact through nasal, oral and respiratory secretions of a person that is infected or is a carrier of the bacteria without symptoms.

Is it contagious from person to person?

It is contagious from person to person through close contact with an infected person via their nasal, oral and respiratory secretions. Close contact includes sharing the same room, being on the same airline flight, eating & drinking out of the same dishes, or medical personnel involved in the care of an infected person etc.

Once the person has had antibiotics for 24 hours, they are no longer considered contagious.

What is the risk for travelers?

Travelers to the ‘meningitis belt’ of Africa during the winter months (Dec –June) are at the greatest risk. Otherwise the risk is limited to travel in crowded surroundings like pilgrimages (hajj), stays in camps and dormitories DURING a sporadic outbreak.

How soon after exposure will one develop symptoms?

One usually develops symptoms within 3-4 days after exposure, but can be as late as 10 days after exposure.

What are the signs and symptoms?

One develops sudden onset of fever, headache, stiffness of the neck, joint and muscle aches sensitivity to bright light, nausea and vomiting. Most people will develop a rash ranging from small flat or raised red spots to irregular purple blotches. In severe cases one can progress to confusion, seizures, coma, bleeding complications, collapse and death.

Are there any lab tests to diagnose the illness?

The bacteria can be cultured from blood, spinal fluid and biopsies of the skin rash. Blood or spinal fluid antibody tests are not entirely reliable or accurate.

Is there any treatment?

There are numerous Antibiotics (penicillin G, ampicillin, ceftriaxone etc) that are effective in treating meningococcal disease. You need intravenous administration and possibly intensive care treatment.

Infected individuals must be in isolation till 24 hours of antibiotic treatment are completed.

If the treatment was with penicillin antibiotic alone, you need to take a course of treatment with the antibiotics Rifampin or Ciprofloxacin to eradicate any bacteria that you could potentially carry harmlessly in your respiratory system (asymptomatic carrier state). This eliminates the risk of you spreading the bacteria inadvertently to others.

What preventive measures can be taken?

A meningococcal vaccine that covers strains A, C, Y & W-135 is available, but no current vaccine covers the B strain.

Travelers to the ‘meningitis belt’ of Africa during the winter months are advised to take the vaccine at least 14 days before the trip. The vaccine is also recommended for individuals with immune deficiency, had their spleen removed or whose spleen is not working (sickle cell, leukemia etc).

The vaccine is now recommended for all children greater than 11 years of age.

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