ABOUT MENINGITIS

The term invasive meningococcal disease includes different clinical manifestations caused by Neisseria meningitidis. There are 13 different serogroups/types of Neisseria meningitides: A, B, C, D, 29E, H, I, K, L, W-135, X, Y, Z.

Meningococcal diseases are caused by a germ (a kind of bacteria) called meningococcus. This germ can cause two serious diseases:

  • Meningitis – an infection of the fluid and lining that covers the brain and spinal cord.
  • Septicemia – a serious blood infection.

The common serogroups/types that cause invasive meningococcal disease (IMD) worldwide, and particularly in B.C. are: A, B, C, W-135 & Y. 


How Is The Disease Spread
– The organism is spread person to person through close contact with respiratory (saliva) secretions or droplets from the nose and mouth of infected or colonized individuals. Bacteria transmitted through respiratory droplets can be propelled short distances (< one metre) during coughing and sneezing. Other examples of how the organism is spread through close contact include: kissing, sharing food, drinks, water bottles, utensils, lipstick, lip balm, straws, cigarettes, etc., and airline travel sitting on either side of infected individual (but not across the aisle).
 

Signs & Symptoms – Meningitis mimics the flu, but progresses so rapidly that it can kill or debilitate previously healthy children, adolescents, and adults within 24- 48 hours from the onset of symptoms. Even with early appropriate medical treatment, the patient can be dead or beyond saving.

First signs of meningococcal infection are sudden and include headache, nausea, vomiting, fever, and feeling unwell. These symptoms progress quickly to a severe muscle pains, severe headache, stiff neck, photophobia, confusion, seizures and a bruise-like rash. The bruise-like rash is the most specific and noticeable symptom of invasive meningococcal disease, but it occurs in only about 2/3 of cases. Anyone who has these symptoms should seek medical attention right away.


Who Is At Risk?  
Disease occurs commonly in normally healthy children, adolescents, and young adults. As with most infections males are affected more often than females. The risk of disease is increased among those living under crowded living conditions. The highest incidence is observed in infants <1 year of age, followed by children 1-4 years of age. The rates decrease until adolescence and peak again in 15-19-year-olds and 20-24-year-olds.

Lifestyle factors common among teenagers and college students are believed to put them at increased risk of contracting meningococcal disease.

Smoking increases the risk of becoming a carrier and the risk of developing invasive disease.

The epidemiology of IMD changes over time and varies depending on geographic location, season and age. Serogroup B and C can occur as sporadic cases or as part of community outbreaks, whereas serogroups Y and W-135 tend to occur sporadically. Serogroup A is mainly a risk for travelers to endemic areas. Winter and early spring is typically a time of increased incidence. Various ages are affected differently in terms of incidence, as well as with respect to circulating serogroups that cause disease. IMD is endemic in Canada with periods of increased activity that occur about every 10 to 15 years, with no consistent pattern.


How Common Is Meningococcal Disease
- Approximately 15-20% of adolescents and young adults are carriers of meningococci at any point in time, which is between 200,000 and 400,000 people in Canada. The majority of people that spread this bacterium are healthy carriers, who have the germs living in their nose and throat but do not get sick from them. The carriage rate will vary with age and closeness in population. The carrier state in which a person has a strain of meningococcus in their nose or throat without any symptoms, can persist for many months.


How Severe Is Invasive Meningococcal Disease (IMD)
Without treatment, anyone who contracts meningitis will die from this devastating disease, many in the first 24 to 48 hours. Even in cases where treatment has been given, the fatality rate is high around 10%. Another 25% are left with lifelong disabilities that include the loss of limbs, neurological damage, blindness or hearing loss. A life lifetime of care that includes surgeries, frequent ER visits, doctors’ appointments, prescription drugs, rehabilitation, special education and prosthetic limbs is nearly guaranteed.

The immense financial responsibility of care falls not only on families of survivors, but on the entire health-care system. A recent British study found that the lifelong-care costs for a Meningitis survivor is in the millions.


Where to obtain MCV4 and 4CMenB vaccines 
- Currently in B.C., you must request and purchase the MCV4 (Meningococcal conjugate vaccine 4 –groups A,C,W-135 & Y) and the 4CMenB (Multicomponent Meningococcal B) – Bexsero® vaccines from your family physician or a Travel Clinic at the cost of approximately $130.00. The two MCV4 vaccines approved in Canada are “Menveo™” and “Menactra®”. In late December 2013 Health Canada approved the first MenB vaccine to be administered to age groups 2 months to 17 years, to be available for purchase in December 2014.  Due to this vaccine not being included in our public immunization program, there is no education or awareness to the general public.


Out-Break Areas Of IMD
For many years the incidence of serogroup A has been high in the sub-Saharan region of Africa with epidemics occurring every year somewhere in the “meningitis belt”. Cyclic epidemics caused by serogroup A have occurred in China every 10 years for much of the past century. Serogroup A epidemics have occurred in Nepal, India, Ethiopia, Sudan and other African countries. There has not been a group A epidemic in North America since the end of World War 2. During the 1990’s, serogroup B was the most common cause of disease in the Americas. Epidemics associated with serogroup B have been reported in Cuba, Brazil, Chile, Argentina, Columbia, and New Zealand. Serogroups A and W-135 have affected pilgrims to Mecca in three separate outbreaks from 1986 to 2001. Secondary cases have been associated with pilgrims returning to their homes.

The Y-strain disease is prevalent in the U.S. The Y strain caused only about 27 cases of disease in Canada a year, but is causing about 30 percent of the estimated 1,400 to 2,800 cases that occur in the United States each year.

Invasive meningococcal disease has been nationally reportable since 1924. It is endemic in Canada with periods of increased activity that occur about every 10 to 15 years, with no consistent pattern. The last major outbreak of serogroup A in Canada was in 1940 to 1943. The peak incidence was approximately 13/100,000 annually. Since that time, the incidence of disease caused by serogroup A has remained < 2/100,000 per year.

From 1971 to 1974, serogroups A and C were most frequently identified. From 1975 to 1989, serogroup B was most prominent. In 1986, a new clone of serogroup C was identified in Canada. Between 1995 – 2006, serogroups B (38%) and C (32%) have been responsible for most of the cases of endemic disease.

From 1985 to 2001, there was an average of 303 cases of IMD reported per year in Canada with the incidence ranging from 1.6/100,000 to 0.7/100,000. In 2000 and 2001, there was a period of elevated activity across the country caused by serogroup C. Localized outbreaks, predominantly affecting adolescents and young adults, were reported by five provinces: Alberta, British Columbia, Manitoba, Quebec and Ontario. There were 101 confirmed cases of IMD caused by serogroup C in 2000 (241 total cases) and in 2001, 182 cases were reported (350 total cases). The rate of all cases in 2000 was 0.77/100,000 and in 2001 the rate was 1.18/100,000. From 2002 to 2008 the rate of IMD in Canada has remained fairly steady at an average of 0.6/1000,000 population.

 

Vaccine Schedule for Canadian Provinces and Territories – MeningitisBC.org  (Click to view PDF / Right click to download)

Health Canada Approves Bexsero*

Consumer Iinformation BEXSERO® Multicomponent Meningococcal B Vaccine

HealthLinkBC Meninggococcal Quadrivalent Vaccines

HealthLinkBC Meningococcal B (Men-B) Vaccine

Protect your child and help others by signing our petition demanding the 4-strain Meningitis Vaccine in British Columbia.