1. Meningococcal Disease

2. What is Meningococcal Disease Meningococcal disease is a potentially life-threatening bacterial infection. Expressed as either – Meningococcal meningitis, or – Meningococcemia Meningococcal disease was first described in 1805 when an outbreak swept through Geneva, Switzerland. The causative agent, Neisseria meningitidis (meningococcus), was identified in 1887. WHO

3. Public Health Significance? Leading cause of bacterial meningitis in children and young adults in the U.S 2,400 to 3,000 cases each year in U.S. 5% to 10% of patients die, typically within 24-48 hours of onset of symptoms. 10 to 20% of survivors of bacterial meningitis may result in brain damage, permanent hearing loss, learning disability or other serious sequelae. Meningococcal septicemia - rapid circulatory collapse. sequelae: پيرو،تابع، نتيجه درطب ؛ بيماري ناشي از بيماري ديگر WHO

4. Etiologic Agent: Neisseria meningitidis (Gram-negative diplococcus bacterium) with multiple serogroups ( A, B, C, D, 29E, H, I, K, L, W-135, X, Y, and Z). Strains belonging to groups A, B, C, Y and W-135 are implicated most frequently in invasive disease. Implicate: دلالت كردن بر،گرفتار كردن،مستلزم بودن Meningococcal Disease

6. > 2 Years : High fever, headache, and stiff neck. Other symptoms include nausea, vomiting, discomfort looking into bright lights, confusion, and sleepiness. Newborns and small infants: Classic symptoms may be absent or difficult to detect. In babies under one year of age, the soft spot on the top of the head (fontanel) may bulge upward. Infant may only appear slow or inactive, or be irritable, have vomiting, or be feeding poorly. Bulge: بادكردگي،تحدب،برآمدگي،متورم شدن Upward: روببالا ، بطزف بالا Irritable: تحرك پذير ، كج خلق ، تند مزاج Clinical Presentation

9. Incubation Period: The incubation period is variable, 2-10 days, but usually 3-4 days Infectious Period: An infected person is infectious as long as meningococci are present in nasal and oral secretions or until 24 hours after initiation of effective antibiotic treatment. Meningococcal Disease

10. Case Definition Clinical Description: Meningococcal disease manifests most commonly as meningitis and/or meningococcemia that may progress rapidly to purpura fulminans, shock, and death. However, other manifestations might be observed. Laboratory criteria for diagnosis: Isolation of Neisseria meningitidis from a normally sterile site (e.g., blood or cerebrospinal fluid (CSF) or, less commonly, joint, pleural, or pericardial fluid) Manifest:آشكارساختن بارز و باز نمود كردن

11. Case Classification Probable: a case with a positive antigen test in cerebrospinal fluid or clinical purpura fulminans in the absence of a positive blood culture. Confirmed: a clinically compatible case that is laboratory confirmed. Case Definition

12. Epidemiology Reservoir: Humans are the only known reservoir of Neisseria Meningitidis. Mode of Transmission: Person to person through droplets of respiratory or throat secretions. Close and prolonged contact e.g., (kissing, sneezing and coughing on someone, living in close quarters or dormitories (military recruits, students), sharing eating or drinking utensils, etc.)

18. MMWR Morb Mortal Wkly Rep. 2000;49(RR-7):13-20

21. Public Health Actions Education: »Public »Providers »Laboratories

22. Public Health Actions Upon receiving a report of invasive meningococcal disease: 1.Determine if reported case is probable or confirmed. 2.Assure that isolates are forwarded to the Office of Laboratory Services for serogrouping. 3.Determine if contacts need prophylaxis. 4.Recommend prophylaxis if indicated. 5.Complete appropriate report form(s). 6.Send completed forms to IDEP

24. Comparison of incidence of meningococcal meningitis in Maryland college students to similar age group in the general population. The average annual incidence among students enrolled in four-year schools = 1.74 per 100,000 The average annual incidence in the general population of the same age = 1.44 per 100,000 Incidence in students who were on-campus residents = 3.24 per 100,000 Incidence in students in students living off-campus =.96 per 100,000 Harrison LH, Dwyer DM, Maples CT, Billmann L: Risk of Meningococcal Infection in College Students. JAMA. 1999;281(20) 1906-1910 JAMA. 1999 May 26;281(20):1906-10.

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