Good morning, SNOTI readers!
My last three posts were all about various outbreaks in humans, all in the midst of an ongoing COVID-19 pandemic. Well, unsurprisingly, this current post is about yet another outbreak, this one on meningococcal meningitis.
What exactly is an outbreak?
- An increase, often sudden, in the number of disease cases above what is normally seen and expected in a particular population in a particular area.
What does meningococcal refer to?
- It refers to a pretty sneaky bacterium called Neisseria meningitidis, which is also the most common cause for bacterial meningitis in the United States.
- These bacteria are also called meningococci.
Meningococci are transmitted by droplet aerosol or secretions from the nasopharynx (nose and throat) of colonized persons. Wait, what?! Does this mean meningococci can hang out in your nasopharynx without causing disease? Yes.
- About 5 to 25% of the population may carry these bacteria – the meningococci – in their nasopharynx and not be sick.
- These individuals are called carriers and although not sick themselves, they are certainly able to transmit these bacteria to others by lengthy or close contact such as kissing, coughing or sneezing.
- It is fortunate that people don’t get infected if they come in casual contact with carriers or patients, or by breathing the air where someone with meningococcal meningitis has been.
So, who is at increased risk of getting sick from carriers or patients?
- People living in the same household, college dorm, military unit (or similar confined spaces), roommates, and anyone with direct contact with the patient’s oral secretions, such as a kissing partner.
How do these bacteria cause disease?
- Meningococci can attach to and make more copies of themselves on the mucosal cells of the nasopharynx.
- In less than 1% of colonized persons, these bacteria will get inside the mucosal cells and enter the bloodstream.
- Once bacteria reach the bloodstream, they can now spread to multiple organs within the body.
- In about half of such individuals, meningococci will enter the brain, infect the meninges (membrane surrounding the brain and spinal cord) and also spill over into the cerebrospinal fluid.
Meningococcal diagnosis can be a bit tricky.
The above image from the CDC, highlights typical symptoms, which often appear late in the illness.
- By this time, it may either be too late to save the patient or too late to avoid severe neurologic defects in survivors.
- sudden onset of fever, nausea, vomiting, headache, decreased ability to focus and concentrate, and muscle aches in an otherwise healthy patient.
- All of these symptoms may also be seen in someone with flu, making it tricky to diagnose early.
- Early diagnosis is important because meningococcal meningitis can be treated with antibiotics.
- Once a potential diagnosis of meningococcal infection is considered, the patient should receive antibiotics within 30 minutes, before the bacteria have an opportunity to overwhelm the system and cause wide spread damage.
- Meningococcal meningitis can progress rapidly and cause death in just hours.
Can we intervene if someone has had close or lengthy contact with someone with meningococcal meningitis – the index patient?
- Antibiotics should be given as soon as possible after exposure, ideally less than 24 hours after identification of the index patient.
So, as you can imagine, it is crucial to trace close contacts and that is typically done by the health department.
- This type of meningitis is nationally reportable, which means, the clinic or doctor who identifies this disease in a patient, has to notify their health department, who will then notify the CDC.
At present, there is an ongoing outbreak of meningitis in Florida.
- While investigating outbreaks, we need to know the person, place, time, and clinical feature scenario of the particular outbreak.
- In the current scenario, person refers to primarily gay, bisexual, and other men who have sex with men, including those living with HIV who are living in Florida and some who have traveled to Florida; about half the cases are in Hispanic men;
- place refers to Florida;
- time refers to the period of June, 2022.
So far, there have been 26 cases and seven deaths.
- Lamentable? Yes.
- Preventable? Also, yes.
In severe cases, meningococcal meningitis can be life threatening.
- Seven individuals have already died in Florida.
- Unfortunately, depending on the severity of the disease, some individuals may also have long-term neurological consequences.
What is essential for prevention?
- Meningococcal vaccine
- We have vaccines for the five types of meningococci that are the major causes of meningitis.
- Hand hygiene
- Good cough and sneeze etiquette
The best protection for all of us, is recruiting our immune system to fight and that is ideally done with the help of the vaccine, together with basic infection prevention.
Stay healthy, my friends. Until next time.
SNOTI Inc. (Say No To Infections)
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