meningococcal meningitis

1. MENINGOCOCCAL MENINGITIS
Dr. Sushrit A. Neelopant
Assistant Professor,
Department of Community Medicine
RIMS, Raichur

2. INTRODUCTION
• Acute comm.dis.  N. meningitidis
• Intense headache, vomiting, stiff neck-
• Within few hours  coma
• Fatality
– Without treatment – 80%
– With treatment - <10%

3. PROBLEM STATEMENT

4. PROBLEM STATEMENT- INDIA
• Endemic
• 2013 – 3380 cases, 176 deaths
• Majority- DL, AP, MP, OR

5. EPIDEMIOLOGY
• Agent: N. meningitidis
– G –ve diplococci - 12 serotypes A, B, C, 29E, H, I, K,
L, W135, X, Y, Z (polysaccharide capsule)
– Majority inf.- A, B, C, X, W135, Y- endemic & outbreak
– African meningitis belt- A
• Source: carriers- nasopharynx- 4-35%- 10 months
• Period of communicability-
• Age: children, highest attack rate- 3-12months
• Env.: Dec to June, overcrowding, low SES, tobacco
smoke, asplenia, HIV, travel
• MOT: droplet, IP: 3-4d, 2-10 days

6. CLINICAL COURSE
• Most if. – no clinical disease asymptomatic
carriers- reservoir and source of inf.
• Symptoms: sudden onset intense headache, fever,
nausea, vomiting, photophobia, stiff neck
• Fatal within 24-48hrs- 5-10% even with treatment
• Permanent neurological sequelae- 15-20%
• Septicaemia- circulatory collapse, skin rash, high
fatality rate

7. CONTROL
• CASES:
– Start treatment within first 2 days of illness- 95%-
survive
– Penicillin, ceftriaxone,chloramphenicol
• CARRIERS:
– Rifampicin
• CONTACTS:
– Rifampicin, ciprof, ceftriaxone, azithromycin
• MASS CHEMOPROPHYLAXIS:
– Immediate drop in incidence
– Cipro, mino, spira, ceftr

8. PREVENTION- VACCINES
• Polysachharide vaccines:
– Biv. (A, C), triv. (A, C, W135), quadriv. (A, C, W135, Y)
– Single dose, s/c, ≥2yrs, adv- pain, transient fever
• Conjugate vaccines:
– Monov. (A or C), quadriv. (A, C, W135, Y), Hib/MenC
– Monov. – 2-12mths- 2 doses & booster, 1-29yrs-1 dose
– Quadriv. - Single dose, ≥2yrs
• Conjugate > Polysachharide- herd imm., more imm.
• Both are safe in pregnancy