Each year during the winter and early spring, there are reports of meningitis caused by the Meningococcus. In 1992, there were 124 cases of meningococcal meningitis reported in Ontario, down from 196 in 1989. Throughout Canada, approximately 20 people die of this disease each year, or 10% of all reported cases. This figure is down from 30% in the 1950s.
Meningococcal disease is primarily an early childhood infection, but also affects adolescents and adults. Outbreaks have been reported in military barracks and boarding schools, and were related to the shared sleeping accommodation. This disease is world-wide, with large outbreaks having been reported in Ethiopia and Brazil.
The bacteria, Neisseria meningiditis (Meningococcus) is normally found in the nasopharnyx (throat) in about 5% of healthy individuals and does not cause disease. Therefore throat cultures are not helpful to diagnose an illness.
Meningitis is the most common disease caused by the bacteria. There is a rapid onset of fever, headache, confusion, lethargy and stiff neck. If it is present in the blood, petechiae or purpura (red rash) will be seen over the body and shock may develop.
Penicillin is the usual antibiotic used to treat the patient, and he/she is placed in Respiratory (Stop) Isolation for 24 hours. At that time, the isolation may be discontinued as the person is no longer considered infectious. In rare cases, the bacteria may cause an acute arthritis, which is accompanied by a rash.
The bacteria is transmitted to others by the direct contamination of nose or mouth with oral or nasal secretions. Therefore kissing or sharing food, drinks or cigarettes with the patient could transmit the disease if it occurred within 7 days of symptoms developing.
The Laboratory Centre for Disease Control (L.C.D.C.) in Ottawa describes a close contact in the hospital setting as anyone performing mouth to mouth resuscitation, intubating or suctioning a patient with the disease, without the protection of a mask.
Community and hospital close contacts should receive prophylactic antibiotic treatment, usually Rifampin for two days. This drug will colour urine and tears a reddish orange, and will stain contact lenses. It may also interfere with the action of birth control pills. There is a vaccine available which might be used under certain outbreak situtations. However, it is effective against only four subtypes of the bacteria (ACWY). Therefore it would not be useful during an outbreak of type B, which is responsible for nearly half of all cases in Canada. The vaccine is not completely effective in children under the age of 2.
Unfortunately, the Meningococcus continues to be a leading cause of bacterial meningitis and septicemia. It is cyclic, occuring yearly, with occasional localized outbreaks. It is important to maintain a constant vigilance for Meningococcal disease in the community and to implement preventative and control measures as soon as possible.
REFERENCES:
Guidelines for the control of Meningococcal disease. CCDR 1994; Vol. 20-3.
Varughese P. Meningococcal disease in Canada 1987. CDWR 1989; 15:89-96.
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