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MENINGOCOCCAL MENINGITIS/

CEREBROSPINAL FEVER
Neisseria meningitidis

head ache, vomitting, stiff neck and coma

fatality rate 80%

with early diagnosis and treatment--- fatality rate

declined to 10%
PROBLEM STATEMENT:

worldwide distribution

occurs sporadically

epidemic in african meningitis belt which includes sub


saharan africa which stretches from Senegal in west to
Ethipa in East

inhabited by 400 million ppl


In African meningitis belt WHO definition of a
meningococcal epidemic is > 100 cases per 100,000
population per year

In endemic countries
> 10 cases---- high endemicity
2-10 cases---- moderate endemicity
<2 cases------ low endemicity

outbreak outside meningitis belt---- increase in invasive


meningococcal disease in a defined population above
expcted by time and place
Europe---- incidence 0.2 - 14 cases per 100,000 pop per
year
Serotype B strains
America--- incidence 0.3 -4 cases per 100,000 pop per
year
Serogroup B,C Y
Asia------- Serogroup A or C

India------ sporadic
2013--- 3380 cases
176 deaths
Africa---- serogp A
EPIDEMIOLOGICAL FEATURES
Agent-

N.meningitidis

DELICATE ORGANISM

dies rapidly on exposure to heat and cold

12 serotypes based on polysaccharide capsule-- gps


A,B,C, 29E, H, I,K,L,W135,X,Y,Z

serotypes A,B,C,X,W135,Y- invasive


Source of infection-

Nasopharynx of cases and carriers

4-35% of nomal population may harbour this organism in


their nasopharynx

carriers are the most imp source of infection

infection causes mild symp of pharyngitis

mean duration of temperory carriers is 10 months


Period of communicability-

Until meningococci are no longer found in the discharges of


case and carriers

cases rapidly loses their infectivity within 24 hrs of specific


treatment

Age-

Children of age 3-12 months mostly affected

both sexes
Immunity

all ages susceptible

younger gps more susceptible as antibody level low

immunity acquired by subclinical infection/ infection/


vaccination

infants---- passive immunity from mother


Environmental factors

Seasonal variation

dry nd cold months-- dec to june

predisposing factors
1. overcrowding
2. poor housing condition
3. low socio economic gp
4. tobacco
5. aspleenia
6. HIV infection
7. travel to endemic countries
Mode of transmission-

droplets

portal of entry--- nasopharynx

Incubation period-

2 to 10 days
CLINICAL COURSE
Mostly doesnt cause clinical disease

Infectd people become asymptomatic carriers


Fatal in 24-48 hrs in 5-10%

sudden onset of headache, fever, nausea, vomitting,


photophobia, stiff neck

individuals who survive 15-20% permananent


neurological damage

Meningococcal septicemia- haemorrhagic rash and


circulatory collapse
PREVENTION AND CONTROL
Cases-
treatment with antibiotics saves 95% if started within
first 2 days of illness
DOC-- Pencillin
if allergic ceftriaxone or third generation
cephalosporins
epidemic-- single dose of lonf lasting
chloramphenicol or ceftriaxone
treatment -- no effect on epidemiological pattern as it
reduces only fatality rate
isolation of cases--- no use in controlling epidemic
Carriers

treatment with penciilin doesnt eradicate carrier state

rifampicin -- puowerful abtibiotic required for eradicting

carrier state
Contacts-

antibiotics--- prevent additional cases through eradicating


carrier of invasive strain
secondary cases occur within 72 hrs after presentation of
index case
risk decreases by 10-14 days
close contacts include household, child care, preschool
contacts
treatment started within 24 hours of identification of index
case with rifampicin, ciprofloxacin, ceftriaxone,
azithromycin
treatment strted within 24 hrs of identificatin of index case
Mass prophylaxis-

mass medication of total poulation some of whom are not


infected

recommended---resticted to closed and medically supervised


communities

immediate drop in incidence of diseadse and proportion of


carriers

efficacy depends on the extent of population coverage .

DOC- cipro, spiramycin, ceftriaxone, minocycline


vaccines-
polysaccharide, protein polysaccharide conjugate vaccines
against serogroup A,C,W135,Y
conjugate vaccines--- more immunogenic
induce immunogenic memory
VACCINES
Polysaccharide Conjugate
bivalent (A,C) with Hib
trivalent(A,C,W135) intramuscular
quardivalent(A,C,W135 monovalent(A) single
,Y) dose 1-29 yrs. < 1 yr 2
50 microgm of doses with 2 mnths
individual interval, booster aftr 1yr
polysaccharide mono Men C single i.m
Single dose dose > 12 months of age
sub cut quadrivalent single
> 2 years of age dose, > 2 years
pain and redness
vaccines stored at 2-8 C

Conjugate vaccines preferred over polysaccharide vaccines


coz of

1. potential for herd protection


2. increased immunogenicity

both are safe in pregnancy


THANK YOU