Meningococcus and Meningitis – how to protect ourselves from these deadly infections

Meningococcus and Meningitis

by Dr. Zach, 2019

An 18 year old Montreal woman died from a meningococcus infection on March 23, 2019.  Here we discuss this dangerous infection and how to prevent it.

Neisseria meningitidis, often referred to as meningococcus, is a Gram-negative bacterium that can cause meningitis and other forms of meningococcal disease such as meningococcemia, a life-threatening sepsis.

Vaccination

QC gives meningococcus C vaccine at 12 months and at secondary 3 (grade 9 — 14 years old)

There is also a multivalent vaccine available that covers ACWY serotypes

BEXSERO is an FDA-approved vaccine to prevent invasive disease caused by Neisseria meningitidis serogroup B. BEXSERO is approved for use in individuals 10 through 25 years of age.   It is given as a two-dose series to people 16 through 23 years old who are not at increased risk of meningococcal disease. It is also given as a two-dose series to people 10 years or older at increased risk of meningococcal disease.

The meningitis vaccine takes 2-4 weeks to fully kick in, and should protect you for three to five years.  80-90% effectiveness

Signs that things are going wrong?

Fever, headache, stiff neck, vomiting, rash, seizure, altered mental status

Certain bacteria, particularly N. meningitidis, can cause characteristic skin manifestations, such as petechiae and palpable purpura.

Which adults should receive the meningococcal vaccine?

The CDC recommends you get the vaccine if you are an adult and:

• Are living in a dorm as a first-year college student

• Work with meningococcal bacteria in a lab

• Are in the military

• Are traveling to or living in a country where meningococcal disease is common, such as in certain parts of Africa

• Have a damaged spleen, or it’s been removed

• Have an immune system disorder called terminal complement deficiency

• Are taking eculizumab (Soliris)

• May have been exposed to meningitis during an outbreak

• Have HIV

Are there any adults who should not get the meningococcal vaccine?

You shouldn’t get either type of meningococcal vaccine if you:

• Are moderately or seriously ill; wait until you recover.

• Have had a serious allergic reaction (called anaphylaxis) to a previous dose

• Had a severe reaction to any part of the vaccine

If you are pregnant or have other concerns, ask your doctor which meningitis vaccine is right for you.

How and when should you receive the meningococcal vaccine?

In most cases, adults only need one dose. But if you remain at risk, you may need a booster.

Some adults may need another type of meningitis vaccine, the serogroup B meningococcal vaccine, if they are exposed to this virus through work or travel or if they have a damaged or missing spleen, or certain immune system disorders.

Which adults need meningococcal vaccine? Adults need to be vaccinated if they are at increased risk of meningococcal disease. This includes college students, military personnel, international travelers to areas where meningococcal disease is endemic, scientists who may be exposed to meningococcal bacteria, and those without a functioning spleen. Adults who got the vaccine as adolescents may not need to be vaccinated again.

There are two types of meningococcal vaccines currently approved for use in the US. The quadrivalent vaccine protects against four meningococcal serogroups (A, C, W, and Y) and is recommended for routine use in adolescents. The other vaccine protects against serogroup B disease. Adolescents and young adults age 16-23 years are encouraged to talk with their healthcare professional about serogroup B vaccination.

What is treatment you’d receive?

Antibiotics by vein, fluids, steroids

(ceftri vanco ampi >50 acyclovir if hsv considered)

How is it transmitted?

People spread meningococcal bacteria to other people by sharing respiratory and throat secretions (saliva or spit). Generally, it takes close (for example, coughing or kissing) or lengthy contact to spread these bacteria. Fortunately, they are not as contagious as germs that cause the common cold or the flu. People do not catch them through casual contact or by breathing air where someone with meningococcal disease has been.

Sometimes the bacteria spread to people who have had close or lengthy contact with a patient with meningococcal disease. Those at increased risk of getting sick include:

• People who live with the patient

• Anyone with direct contact with the patient’s oral secretions, such as a boyfriend or girlfriend

Close contacts of someone with meningococcal disease should receive antibiotics to help prevent them from getting the disease. This is known as prophylaxis. Health departments investigate each case of meningococcal disease to identify all close contacts and make sure they receive prophylaxis. This does not mean that the contacts have the disease; it is to prevent it. People who are not a close contact of a patient with meningococcal disease do not need prophylaxis.

https://santemontreal.qc.ca/population/actualites/nouvelle/cas-dinfection-a-meningocoque-a-montreal/

                                2019.03.26 – Population, Professionnel, Direction de santé publique, CIUSSS du Centre-Sud-de-l’Île-de-Montréal

Cas d’infection à méningocoque à Montréal

Mise à jour en date du 26 mars 2019

Cas d’infection à méningocoque à Montréal – Sérogroupe identifié

Une jeune femme étant décédée des suites d’une infection à méningocoque le 23 mars dernier, la Direction régionale de santé publique de Montréal a procédé à une enquête épidémiologique et à l’identification des contacts étroits.

La DRSP de Montréal a rejoint et évalué plus de 100 personnes afin d’identifier celles qui répondaient à la définition de contact étroit et donc, qui nécessitaient un traitement préventif. Toutes ces personnes ont déjà reçu un antibiotique. De plus, les analyses de laboratoire ont confirmé aujourd’hui que la bactérie en cause était du sérogroupe B. Le vaccin Bexsero qui protège contre ce sérogroupe sera donc offert aux personnes identifiées comme contacts étroits, pour compléter le traitement préventif.

Transmission d’une infection à méningocoque

Les personnes considérées comme contacts étroits sont :

• Les personnes qui habitent sous le même toit;

• les personnes qui auraient eu un contact sexuel avec la personne concernée;

• les personnes qui auraient été en contact direct avec les sécrétions respiratoires de la personne concernée (baiser prolongé)

L’infection à méningocoque peut être transmise par les sécrétions respiratoires ou la salive, mais la bactérie n’est pas aussi contagieuse que les microbes qui causent les rhumes, la grippe, ou encore, des maladies comme la rougeole. Elle ne se transmet pas simplement en respirant l’air dans un espace où une personne malade se trouve, ni en ayant un contact superficiel, par exemple en faisant une accolade ou en embrassant sur les joues une personne infectée.

Protection et prévention Dans la présente situation, la DRSP de Montréal ne recommande pas de traitement préventif spécifique aux autres personnes qui ne répondent pas à la définition de contact étroit. Toutefois, elle rappelle l’importance de recevoir tous les vaccins de base prévus au Programme québécois d’immunisation. Les personnes dont la vaccination est incomplète peuvent la mettre à jour en prenant rendez-vous dans leur CIUSSS ou dans une clinique médicale qui offre ce service.

Rappel

Si vous avez des inquiétudes au sujet de votre santé ou celle d’un proche, communiquez avec Info-Santé au 8-1-1.

Source

Direction régionale de santé publique de Montréal

Dans les médias

Isabelle Maréchal – 98.5FM – Entrevue avec Mylène Drouin, directrice régionale de santé publique de Montréal

About meningococcus vaccines:

https://www.cdc.gov/vaccines/vpd/mening/public/index.html

QC immunization schedule:

https://www.quebec.ca/en/health/advice-and-prevention/vaccination/quebec-immunisation-program/

Meningitis info for patients:

What is meningitis?Meningitis is a condition that can cause a fever, headache, and stiff neck. It happens when the lining that covers the brain and spinal cord (called the “meninges”) gets inflamed or infected.

There are 2 main types of meningitis, depending on which germs are causing the infection. Bacteria cause bacterial meningitis. Viruses cause viral meningitis, which is also called aseptic meningitis. Both types of meningitis can cause similar symptoms.

It is very important that doctors figure out what kind of meningitis a person has. That’s because bacterial meningitis is a medical emergency. If it is not treated quickly, it can lead to brain problems such as hearing loss or learning problems. It can also lead to death.

This article discusses bacterial meningitis.

What are the symptoms of bacterial meningitis?Symptoms of bacterial meningitis usually come on suddenly, so people can get very sick over a short period of time. Common symptoms include:

●Fever – But some people have a temperature that is lower than normal instead of a fever.

●Headache

●Stiff neck – This happens most often in adults and children. Babies might not get a stiff neck.

●Nausea or vomiting

●Acting confused, or being hard to wake up

●Having light bother a person’s eyes

●A rash that looks like red or purple spots on the skin that do not go away when touched

●Seizures – Seizures are waves of abnormal electrical activity in the brain. They can make people pass out, or move or behave strangely.

Babies can also have other symptoms, including:

●Being more sleepy or fussy than usual

●Not feeding well

●A bulging soft spot on the skull

Should I see the doctor or nurse?Yes. If you have a fever, headache, and stiff neck, go to the emergency room right away. If you think your child has meningitis, bring him or her to the emergency room right away.

Will I have tests?Yes. Your doctor will learn about your symptoms and do an exam. He or she will do tests to see if you have meningitis and find out what type of bacteria is causing the infection. The tests can include:

●Blood tests

●A lumbar puncture (sometimes called a “spinal tap”) – During this procedure, a doctor puts a thin needle into your lower back and removes a small amount of spinal fluid. Spinal fluid is the fluid that surrounds the brain and spinal cord. He or she will do lab tests on the spinal fluid.

●A CT scan of the brain – This is an imaging test that creates pictures of the brain.

How is bacterial meningitis treated?People are treated in the hospital with:

●Antibiotic medicines that go into a vein through a tube called an “IV” – The antibiotics used depend on the type of bacteria causing the infection.

●Fluids and other medicines that go into a vein – These medicines sometimes include “”steroids.” The steroids help protect your brain from the effects of the bacterial meningitis. These are not the same as the steroids some athletes take illegally.

Can bacterial meningitis be spread from 1 person to another?Sometimes. It depends on the type of bacteria that’s causing the infection. Some types of bacteria can be spread from 1 person to another.

Can bacterial meningitis be prevented?Sometimes. Certain vaccines can help prevent bacterial meningitis. Vaccines can prevent certain serious or deadly infections.

To help prevent bacterial meningitis, make sure that you and your children have had all of the vaccines you need to prevent the following infections. Your doctor will decide which of these you and your children need:

●Meningococcus

●Pneumococcus

●Haemophilus influenzae type b, called “Hib” (for babies and young children)

If someone in your home has bacterial meningitis, ask your doctor or nurse if you should take antibiotics. Sometimes, other people at home need to take antibiotics to keep from getting the infection.    Plus, you can help avoid getting sick by washing your hands well before eating, and not sharing cups or silverware.