An Update on Meningococcal Disease Dr Suzanne Cotter World Meningitis Day April 24th 2018 Dr Suzanne Cotter Health Protection Surveillance Centre www.hpsc.ie

Topic for today Invasive Meningococcal Disease (IMD) What is it and who gets it ? How is it transmitted? Clinical presentation and urgent actions Overall IMD trends in Ireland Focus serogroup B and C disease (MenC and MenB) Impact of meningococcal vaccines on IMD incidence Concerns Re-emergence of IMD serogroup C Missed vaccination (MenC and MenB vaccines)

Invasive Meningococcal Disease (IMD) Caused by N. meningitidis (meningococcus) Gram negative diplocci A, B, C, W, X ,Y most common serogroups All age groups affected Most common in young children and adults Suspicion of IMD is a medical emergency Immediate referral to hospital required Diagnosis and serogroup identification by Local hospital and national reference laboratory National vaccination programme MenC implemented since 2000 MenB implemented since 2016

Transmission of meningococcus Person- person transmission droplet spread (respiratory or throat secretions from carriers) close and prolonged contact normally required Household, child care, sexual, child house parties > 4 hours Average incubation period 4 days (range 2 and 10 days) Carriage Asymptomatic carriage common ~10% to 20% of population carry organism in throat Carriage rate may be higher in epidemic situations ,

Clinical presentation Meningocccal septicaemia Meningitis Meningocccal septicaemia Stiff neck High fever Photophobia Confusion Headache Vomiting As for meningitis +/- Fatigue Cold hands and feet, cold chills Aches/pain in muscles, joints, chest or abdomen Rapid breathing Diarrhoea (more common with MenW) Haemorrhagic rash Adverse outcomes Case fatality ~ 5-10% Other sequelae (~10%-20%); brain damage, hearing loss, learning disability, amputation ,

Surveillance IMD is a notifiable disease by laboratories and clinicians Director of Public Health (DPH)/Medical Officer of Health (MoH)* Objectives of surveillance Identify, control and protect case contacts chemoprophylaxis +/-vaccination Detect and confirm outbreaks Monitor incidence trends, incl. serogroup distribution antibiotic resistance impact of meningitis control strategies, particularly vaccination programmes *in local Departments of Public Health

Invasive Meningococcal Disease Serogroup distribution, 2018 – B, C, Y, Map Production: WHO Health Emergencies Data Source: World Health Organization SEROGROUP boundaries. Dotted and dashed lines on maps represent approximate border lines for which there may of any opinion whatsoever on the part of the World Health Organization concerning the legal status of not yet be full agreement. The boundaries and names shown and the designations used on this map do not imply the expression SEROGROUP Most frequent Programme W B, C, W Y B, C, W, B, W, C, W W B, C, Y B, C, W A, C , A A © WHO 2018. All rights reserved. Less frequent Invasive Meningococcal Disease Serogroup distribution, 2018 – B, C, W, X, Map date: 16/02/2018 any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or

Rates of invasive meningococcal disease reported cases, EU/EEA, 2015 Source: https://ecdc.europa.eu/en/publications-data/invasive-meningococcal-disease-annual-epidemiological-report-2015

Bacterial meningitis notifications by organism, Ireland, 1999-2017* Source: CIDR; *2017 data provisional

IMD by serogroup, year of vaccine introduction, 1999-2017* Source: CIDR; *2017 data provisional

MenC as % all IMD, by age and year, 1999-2017* Source: CIDR; *2017 data provisional

MenC cases by MenC vaccination status, age group, Ireland. 2016 & 2017 MenC cases by MenC vaccination status, age group, Ireland. 2016 & 2017* (n=51) Source: CIDR; *2017 data provisional

MenB notifications (number and CIR**) by age groups and year, 1999-2017* Source: CIDR; *2017 data provisional **CIR; Crude incidence rate (per 100,000 pop.)

Summary Overall significant decrease in all IMD since 2000 MenB and MenC most common IMD serogroups in Ireland MenC disease Rapid decline following introduction of MenC vaccine Recent emergence of concern Occurring among age groups targeted for vaccine Indication of increased carriage in community MenB disease Introduction of MenB vaccine will prevent cases in children Full impact to be monitored

Resources HSE HPSC Guidelines for the Early Clinical and Public Approval Date Document Purpose Revised Responsibility for Review and Audit Document Developed by Revision Number Document Approved by Target Audience Contact Person Title Chapter 9. Chemoprophylaxis. Recommendations regarding chemoprophylaxis use of ciprofloxacin. Note: The November 2016 revised edition includes updates to the following sections: Chapter 4. Invasive pneumococcal Disease case definition-updated Chapter 7. Public health management of sporadic cases of meningococcal disease. Updates to vaccines available and recommended in Ireland, including Meningococcal B vaccine. Health Management of Bacterial Meningitis Guidelines for the Early Clinical and Public (including Meningococcal Disease) Web: Health Protection Surveillance Centre Dr Suzanne Cotter Health Protection Surveillance Centre 3 Scientific Advisory Committee, Committee, HPSC January 2012 Email: Hospitals, Departments of Public Health, HPSC November 2016 Bacterial Meningitis Sub-Committee of the Scientific Advisory Health care staff dealing with patients where a diagnosis of (and meningococcal disease) in primary care and at hospital level To promote best practice management of bacterial meningitis of bacterial meningitis (including meningococcal disease) bacterial meningitis or septicaemia is suspected To standardise practice Guidelines for the early clinical and public health management To ensure that GPs, hospital and public health clinicians are To act as an educational tool To act as a basis for audit and evaluation clear on roles and responsibilities Report of the Scientific Advisory Committee of HPSC www.hpsc.ie suzanne.cotter@hse.ie Resources HSE HPSC Guidelines for the Early Clinical and Public Health Management of Bacterial Meningitis (including Meningococcal Disease) FAQs on bacterial meningitis and IMD Quarterly reports on bacterial meningitis European Centre for Disease Prevention and Control (ECDC) Meningococcal disease WHO – Meningococcal disease Guidelines for the Early Clinical and Public Health Management of Bacterial Meningitis (including Meningococcal Disease) Guidelines for the Early Clinical and Public Health Management of Bacterial Meningitis (including Meningococcal Disease) Published: January 2012 Document c ontrol Revised: November 2016 -2-

Acknowledgements Clinicians, nurses and hospital laboratories Irish Meningitis and Sepsis Reference Laboratory (IMSRL) Departments of Public Health Dr Piaras O’Lorcain, Surveillance Scientist, HPSC