Q—I am from Baliwag, Bulacan. In the last week of last October, somebody from our town died from meningococcemia. The news of his death caused widespread fear in many of the townspeople because they say the disease is very deadly and highly communicable. Does this fear have scientific bases? Is there danger of the disease becoming a nationwide epidemic?—

A—Fulminant meningococcemia—the illness your townmate evidently contracted—is one of the two severe forms of an infection referred to as meningococcal disease, the other one being meningococcal meningitis. Even with the best treatment, about half of those who get fulminant meningococcemia die. What’s more, death often occurs within hours of the onset of the symptoms. Hence, the disease is indeed highly fatal, but it is not highly communicable. Meningococcal disease is an infection caused by the bacteria Neisseria meningitides whose natural habitat is the throat. About 10 percent of the population act as carriers for N. meningitides, i.e., they harbor the bacteria without getting sick. A carrier can transmit the bacteria to a susceptible individual through the inhalation of infected droplets from the throat and by direct
(e.g., kissing) or indirect oral contact, e.g., sharing of eating utensils.

Clinical course of meningococcal disease
Meningococcal disease typically starts as an upper respiratory tract infection that presents as sore throat, cough, headache, and nasal discharge. In some patients, the disease follows a benign course and subsides spontaneously, but in most, the disease progresses into meningococcemia (i.e., invasion of the bloodstream by the bacteria). Meningococcemia usually manifest as high fever accompanied by chills, nausea and vomiting, muscle and joint pains, and the appearance of a skin rash.

About 10 to 20 percent of patients who contract meningococcemia develop fulminant meningococcemia, a form of the disease that is characterized by rapid development of shock, disseminated intravascular coagulation, and multiple organ failure. Death from fulminant meningococcemia can come within hours to two days of the onset of the illness.

In some patients with meningococcemia, the bacteria attack the brain resulting in meningococcal meningitis that manifest as headache, stiffness of the neck, vomiting, and various other nervous system signs and symptoms. In its later stages, meningitis leads to sensorium changes—disorientation, incoherence, etc.—before it progresses to coma and ultimately, death.

Meningococcemia in the Philippines
Meningococcemia is endemic in the Philippines. From January to Sept. 21, 2019, the DOH Epidemiology Bureau has recorded 169 cases of meningococcemia with 88 deaths, but most of the deaths (79) were not laboratory confirmed. According to DOH Assistant Secretary of the Public Health Services Team Maria Rosario Vergeire, “As of the moment, there is no meningococcemia outbreak in the country.” This is because the cases are “sporadic in nature and are not clustering.”

Why epidemics of meningococcemia are unlikely occurrences
There are several reasons why epidemics of meningococcemia are unlikely to happen. Firstly, the bacteria have a low transmission rate because they cannot survive outside the human host. Secondly, the only ones very susceptible to the infection are young children. Infants are protected from meningococcal infections during the first few months of life because of passive immunity they acquired from their mothers.

With the loss of passive immunity, children become susceptible to the infection (peak susceptibility is at six to 12 months). But as children grow older, most acquire active immunity from meningococcal infections because of antibodies they develop as a result of asymptomatic exposure to non-virulent strains of N. meninigitidis or other bacteria that have the same immunologic properties. Most adults (experts estimate that as many as 95 percent) are already immune from meningococcal infections.

Management of meningococcemia
There are antibiotics that are effective against N. meningitides. Still, because severe forms of meningococcal disease are rapidly fatal, treatment is often given late in the illness such that 50 to 60 percent of patients die while many of those who survive have permanent disabilities that include deafness, cranial nerve palsy, and mental deficiency.

Those who have been in close contact (e.g., household, day-care
center, nursery school) with people with meningococcemia are sometimes given prophylactic antibiotics as a preventive measure. Prophylactic treatment is, however, not recommended for the general public.


See more at: Manila Bulletin


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