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MENINGOCOCCAL

MENINGITIS
Shivangi Singh
Batch 2016
Roll No. 115
MENINGOCOCCAL
MENINGITIS
• It is an acute communicable disease caused by
Neisseria meningitidis.

• Meningococcal meningitis is also called as cerebrospinal


fever.
• Meningitis usually begins with
Intense headache,
vomiting
stiff neck
and progress to coma within a few hours.

• Thefatalityoftypicaluntreatedcasesisabout50%.

• With early diagnosis and treatment, case fatality


rates havedeclined to less than 8-15%.
EPIDEMIOLOGY
•Occurs worldwide in both endemic and
epidemic forms.

•It is estimated to be responsible for:


over 500,000 cases and
about 135,000 deaths annually.

In some regions endemic situation may


alternate with unpredictable epidemics.This
is the case in African meningitis belt.
•During epidemics this region has a disease
incidence rate of >100 cases per 1,00000
population per year.

•Epidemics occur at irregular interval often


every 7-10 yr in “meningitis belt” of sub
Saharan Africa.

• In United States- serogroups B,C and Y.


•In Europe-serogroup B strains
•In Asia –serogroups A and C
Epidemiology in India
• In endemic countries
>10 cases/lakh population/year : High
2-10 cases/lakh population/year :Moderate
<2 cases/lakh population/year :Low

• India is low endemic zone as per WHO.


•Cases occur sporadically or in small clusters.
2017
State Cases Deaths
Andhra Pradesh 553 61
Madhya Pradesh 160 3
Uttar Pradesh 118 6
Rajasthan 210 6
West Bengal 734 95
Uttarakhand 24 1
Karnataka 276 1
Maharashtra 151 0
Bihar 378 0
Delhi 61 5
Jharkhand 65 0
Andaman and 17 2
Nicobar
Odisha 287 0
India 3257 205
EPIDEMIOLOGICAL
FEATURES
AGENT
• The causative agent,
Neisseria meningitidis
is gram negative
diplococci.

• It dies rapidly on
exposure to heat and
cold.
• 12 serotypes have been identified.

• A,B,C,29E,H,I,K,L,W135,X,Y,Z based on the


structure of the polysaccharidecapsule.

• The majority of invasive meningococcal


infections are caused by organisms of serogroups
A,B,C,X,W135and Y.

• These serogroups have the potential to cause


both endemic disease and outbreaks..
SOURCE OF INFECTION
• The organism is found in the nasopharynx of cases
and carriers.

• Cases-negligible source
• Carriers-important source of infection

• 4-35% of normal population may harbour the


organisms.

• Carrier rate during epidemics:70-80%.


• Temporary carriers-10 months
PERIOD OF
COMMUNICABILITY
• Until meningoccociare no longer present in
discharges from nose and throat.

• Casesrapidly lose their infectiousness within


24 hours of specific treatment.
AGE & SEX
• The disease is predominately the disease of
children and young adults.

• Highest attack rate in infants of 3-12


months.

• Younger groups are more susceptible than


older groups.

• Both gender are equally affected.


IMMUNITY
• Mostly immunity is acquired through
subclinical infection.

• Clinical disease and immunization also provide


immunity.

• Infants receive passive immunity from their


mother.
Environmental
factors
•Seasonal variation - outbreaks occur more frequently in
the dry and cold months (December to June).

•Overcrowding (schools, refugee and other camps)

•Poor socioeconomic status living under poor housing


conditions
•Tobacco smoke
•Asplenia
Mode Of transmission
• The disease spreads mainly by droplet infection.

• The portal of entry is through the (nasopharynx)


respiratory tract.

Incubation period
• Usually 3-4 days(2-10 days)
Clinical course
• Most infections do not cause clinicaldisease.

• Many infected people become asymptomatic


carriers of the bacteria and serve asreservoir
and source of infection.

• The disease is fatal within 24- 48 hours in 5-10% of


cases.
• Permanent neurological sequealae(15%)
• In meningococcal septicaemia, there is a
rapid dissemination of bacteria in the
blood stream, the lesscommon meningococcal
disease, is characterized by :

• circulatory collapse
• hemorrhagic skin rash
• high fatality rate.
PREVENTION
and
Control
CASES
• Treatment with antibiotics can save lives of 95%
provided that the treatment is started within
the first two days of illness.

• Penicillin is the drug of choice.


• In penicillin allergic patients,-ceftriaxone and other
third generation cephalosphorins
• Isolation is of limited use.

• Treatment of cases have practically no effect on


the epidemiological pattern of disease.
CARRIERS
• Treatment with penicillin does not eradicate
the carrier state

• More powerful antibiotics such as rifampicin


are needed to eradicate the carrier state.
CONTACTS
• Closecontacts are at risk of developing the
disease.

• Antibiotics which are effective:


Rifampicin
Ciprofloxacin
Ceftriaxone
Azithromycin
MASS
CHEMOPROPHYLAXIS
• Mass chemoprophylaxis is restricted to closed
and medically supervised communities.

• The drugs of choice are


CIPROFLOXACIN,
MINOCYCLINE
SPIRAMYCIN
CEFTRIAXONE.
VACCINE
• Currently available meningococcal vaccines
include :

• POLYSACCHARIDE VACCINES

• POLYSACCHARIDE-PROTEIN
CONJUGATE VACCINES.
• Both vaccines are safe when used during
pregnancy.
POLYSACCHARIDE VACCINE
• Polysaccharide vaccines are available in
Bivalent (A,C)
Trivalent (A,C,W 135)
Quadrivalent(A,C,W135, Y)

• administered as a single dose to


persons > 2 years old through s.c
route.
CONJUGATE VACCINES
• Licensed meningococcal conjugate vaccines are
• Monovalent (A or C)
• Quadrivalent (A,C,W135,Y)

• Combination vaccine (HibMenC)


H.influenza type b and
N.meningiditis serogroupCvaccines.

Intramuscular injection, preferably in the deltoid


muscle (or in the anterolateral aspect of the
upper thigh in children < 12 months of age).