MENINGOCOCCAL MENINGITIS (MCM) AT NEW DELHI & INDIA Dr. A. K. AVASARALA MBBS, M.D. PROFESSOR & HEAD DEPT OF COMMUNITY MEDICINE & EPIDEMIOLOGY PRATHIMA INSTITUTE OF MEDICAL SCIENCES, KARIMNAGAR, A.P. INDIA: +91505417 avasarala@yahoo.com Author profile :-After medical graduation, worked for 17 years in the field as primary care physician in primary health centres, area hospitals, mobile medical units, cholera combat team, filarial control project, casualty department, divisional secondary care hospitals Then completed post graduation in public health medicine/preventive &social medicine &epidemiology and teaching medical graduates and post graduates, nursing students, physiotherapy students, primary care personnel for the last 15 years. At present ,working as Professor & Head of the department of Community medicine & Epidemiology contributing to the cause of epidemiological spread and growth in India as Indian super course epidemiology developer . Other TEN super course lectures of mine can be accessed at www. pitt.edu/~super1/faculty/lecturers/htm

PART- III DISCUSSION

DELHI PROBLEM-1 IS DELHI BECOMING HOMETOWN FOR MCM? DELHI IS PRESENTLY EXPERIENCING THE EIGTH OUTBREAK OF MCM COMMENCING FROM 1966 EPIDEMICS OCCURRED AT DELHI IN SIX CONSECUTIVE YEARS FROM 1983 TO 1988 .

DELHI PROBLEM - 2 WHY IS IT SO? PROBABLY , THE AGENT IS ABLE TO SURVIVE IN NASOPHARYNGEAL CARRIERS IN OVERCROWDED POPULATION OF DELHI. PROBABLY, HIGH OR OPTIMUM NASOPHARYNGEAL CARRIER STATE IS CONSTANTLY MAINTAINED PRESENT IN DELHI POPULATION. Majority of places often affected are overcrowded urban slums with people who are less immune Non vaccinated More children populated With less access or utilization of heath services Neglected by the health system

EPIDEMIOLOGICAL STUDY? HOW THE AGENT (MENINGOCOCCI ) IS THRIVING AT DELHI ? (AGENT FACTORS) WHAT ARE THE HOST FACTORS MAKING DELHI POPULATION MORE SUSCEPTIBLE TO MCM? HOW DELHI ENVIRONMENT IS FAVOURABLE (ENVIRONMENT FACTORS) TO MENINGOCOCCI?

DIFFICULT TO PREDICT BUT INDICATORS AVAILABLE MCM EPIDEMIC IS DIFFICULT TO PREDICT BUT INDICATORS AVAILABLE INCREASED LABORATORY CONFIRMED CASES - THIS WAS OBSERVED IN 1966 DELHI EPIDEMIC CHANGE IN SEROGROUPING OF CASES No change in serogroup. CHANGE IN AGE GROUP ( MORE IN HIGHER AGE GROUPS) Delhi epidemic 1966 predominantly affected infants, while the present epidemic affected mainly 15-29 years, young adults.

SPORADIC EPIDEMIC NATURE MOST OFTEN MCM EPIDEMIC COMMENCES WITH A FEW SPORADIC CASES EVERY YEAR AND THEN BLOWS UP INTO AN EPIDEMIC. This initial sporadic nature is the usual cause for ignorance by the people and delayed notification Delayed health action and complacency and heath care workers accumulation of cases This may be the reason for accumulation of 187 cases in first 42 days at Delhi in the first fortnight of May 2005 !

FULMINANT NATURE OF MCM HIGH MORTALITY: AS THE DISEASE IS OFTEN FATAL, PARTICULARLY IN CHILDREN AND YOUNG ADULTS, IT CREATES SCARE AMONG THE POPULATION

NASOPHRYNGEAL CARRIER STATE THIS FACTOR IS OF PARAMOUNT IMPORTANCE BECAUSE HIGH CARRIER RATE IS OFTEN RELATED TO THE EPIDEMICITY VACCINE CAN PREVENT NEITHER THE CARRIER STATE NOR THE EPIDEMIC Probably the nasopharyngeal carrier rate is maintained very high at Delhi in the overcrowded population during interepidemic periods also. The challenge for Delhi health authorities is to reduce this carrier state to a harmless level.

CHANGING TREND PRIMARILY A DISEASE OF INFANTS AND CHILDREN (1966) NOW AFFECTING YOUNG ADULTS CERTAIN POPULATIONS - ARE MORE SUCEPTIBLE. WHY?

SUMMARY INDIA AND MORE SO DELHI NEEDS MORE CONSTANT EFFECTIVE SURVILLANCE AND HEALTH ACTION FOR CONTROLLING MCM A VACCIVNE EFFECTIVE AGAINST NASOPHARYNGEAL CARRIERS COMMUNITY SENSITIZATION AND ACTIVE PARTICIPATION TO CONTROL MCM

REFERENCES UPDATES ON MENINGOCOCCAL MENINGITIS, COMMUNICABLE DISEASES DEPARTMENT, WHO, REGIONAL OFFICE FOR SOUTH EAST ASIA COMMUNICABLE DISEASE BULLETIN - REPORT BY DR. (MRS.) S. SEHGAL, DIRECTOR, NATIONAL INSTITUTE OF COMMUNICABLE DISEASES, NEW DELHI