1. 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:
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

2. PART- III
DISCUSSION

3. 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 TO 1988 .

4. 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

5. 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?

6. 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 years, young adults.

7. 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 !

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

9. 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.

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

11. 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

12. 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