MENINGOCOCCAL INFECTION Transmission and Disease Brian Greenwood London School of Hygiene & Tropical Medicine.

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Presentation transcript:

MENINGOCOCCAL INFECTION Transmission and Disease Brian Greenwood London School of Hygiene & Tropical Medicine

THE PATHWAY OF INFECTION Pharyngeal carrier Respiratory droplets (meningococci) Susceptible host Pharyngeal carrier CASE

Carrier Droplets CASE THE CYCLE OF INFECTION

THE PATHWAY OF INFECTION Pharyngeal carrier Respiratory droplets (meningococci) Susceptible host Pharyngeal carrier CASE

THE PATHWAY OF INFECTION Pharyngeal carrier Respiratory droplets (meningococci) Susceptible host Pharyngeal carrier CASE 1

INFECTIOUSNESS OF A CARRIER Density of carriage Duration of carriage Respiratory infection Durationof carriage % ? importance

THE PATHWAY OF INFECTION Pharyngeal carrier Respiratory droplets (meningococci) Susceptible host Pharyngeal carrier CASE 2

SURVIVAL OF MENINGOCOCCI IN RESPIRATORY DROPLETS Droplet size Environmental temperature Environmental humidity

HUMIDITY AND BACTERIAL SURVIVAL Towns Villages Relative humidity (%) Concentration of airborne bacteria (Ghipponi et al. Bull WHO 1971; 45:95)

THE PATHWAY OF INFECTION Pharyngeal carrier Respiratory droplets (meningococci) Susceptible host Pharyngeal carrier CASE 3

COLONISATION OF THE MUCOSA Cilia Epithelial cells Numbers of meningococci Integrity of the mucosa Physical damage Microbiological damage LOCAL IMMUNE DEFENSES

THE PATHWAY OF INFECTION Pharyngeal carrier Respiratory droplets (meningococci) Susceptible host Pharyngeal carrier CASE 4

Integrity of the mucosa Local immune defenses INVASION Mucosa Capillary

Carrier Droplets CASE CHANGING THE CARRIER TO CASE RATION

SURVIVAL IN THE HOST HOST IMMUNITY Natural exposure Passive protection Vaccination Host genetics Environmental factors

Pharyngeal carrier Respiratory droplets (meningococci) Susceptible host Pharyngeal carrier Case IMPACT OF THE ENVIRONMENT Survival of meningococci in droplets Damage to mucosa facilitating colonisation Damage to mucosa facilitating invasion Influence on the immune response

TOPICS FOR FUTURE RESEARCH The impact of environmental factors on meningococcal survival in droplets. The impact of environmental factors on mucosal immune defences. The influence of the environment on the Immune response to vaccination.