MEN-C HERE: HERE’S THE FACTS

This is the reply tabled by the Minister of Health and Medical Services Rosy Akbar in Parliament yesterday regarding Meningococcal Disease. The question on the issue was raised by Opposition Member of Parliament Parmod Chand.

MADAM SPEAKER,

I thank the Honourable Member for this question.

MADAM SPEAKER,

Meningococcal disease is found worldwide and results in sporadic cases and outbreaks. There are an estimated 1.2 million cases annually worldwide, with deaths of around 135,000 people. The highest incidence occurs in the ‘meningitis belt’ of sub-Saharan Africa, which includes 26 countries stretching from Ethiopia in the East to Senegal in the West.

These countries have frequent outbreaks in the dry season (December to June), with incidence that can be as high as 1000 cases per 100,000 population.

This is compared to the rest of the world where incidence is between 0.3 to 3 cases per 100,000 per year. The World Health Organisation reports that the meningitis belt reports up to 30,000 cases of meningococcal disease every year.

MADAM SPEAKER,

Closer to home, New Zealand had an outbreak of meningococcal disease over about a 10 year period in the 1990s and early 2000s. Case numbers went from 53 (incidence: 1.6 cases per 100,000 population) in 1990 to 650 (incidence: 17.4 per 100,000 population) in 2001.

The highest rates of illness were Pacific Islanders. A vaccine against the meningococcal B strain causing the outbreak was introduced in 2004, and the incidence decreased to 2.6 per 100,000 population in 2007.

Australia had an increase in meningococcal disease from 1997 to 2002, with notifications going from around 300 cases in 1996 to approximately 700 in 2002 (incidence of 3.5 cases per 100,000).

This increase was driven by meningococcal C, and in 2003 the Australian government introduced a vaccination program for meningococcal C. They used new conjugate vaccines for meningococcal C that had been developed by the late 1990s.

This vaccine stayed on the government funded immunisation schedule for all 12 month old babies until 2018.

MADAM SPEAKER,

Invasive meningococcal disease used to be very rare in Fiji. Prior to 2015, annual incidence was consistently below 1 per 100,000 population, with a mean of 0.5 per 100,000 population. This is between 0-10 cases annually.

From the 4th quarter of 2016 to date there has been a significant increase in reported cases of meningococcal disease with 29 cases by the end of the year, and then in 2017 there were 48 cases. In 2017 our national incidence of meningococcal disease was 5.9 per 100,000 population and there were a total of 7 deaths reported.

MADAM SPEAKER,

The 2017 cases included an institutional outbreak at St John’s College in Cawaci. Seven cases were reported from January to June 2017 with up to two students getting sick within a month and the outbreak was caused by serogroup C Neisseria Meningitidis.

Interventions by the Ministry of Health through visits to St John’s College by the subdivisional outbreak response team included inspection of dormitories, water, sanitation and hygiene facilities, information and education sessions and the provision of WASH facilities including hand gels, soaps and disinfectants.

Preventative antibiotics were also given to all students. And in July all students were vaccinated. There were no cases from the school after vaccination.

MADAM SPEAKER,

I would like to clarify that we don’t declare outbreaks overnight normally as we have to study the disease pattern and we had declared localised outbreak at the St John’s College, that was contained by the health team as soon as diagnosis, tests were done, results are confirmed the students were vaccinated and to date we have no cases from, St John’s College. And while we have been carrying out the necessary interventions, we have also been raising awareness and advising people that this disease is treatable and preventable and there are antibiotics which are available for free at the hospitals.

MADAM SPEAKER,

The term meningococcal disease refers to any illness caused by the bacteria Neisseria meningitidis. The illnesses caused by this bacterium causes the most devastating effects which are known as Invasive Meningococcal Disease – and they include: Meningitis: the infection and inflammation of the lining of the brain and spinal cord.

Septicaemia: infection of the blood or blood poisoning.

MADAM SPEAKER,

These are both severe diseases with high fatality rates. The World Health Organisation reports that meningococcal meningitis is fatal in up to 50% of people particularly if they don’t receive treatment, and the rate is higher for septicaemia.

And even with treatment the death rate is still 8 percent to 15 per cent. People who are more at risk of getting the disease include those who live in the same household and/or are intimate partners.

MADAM SPEAKER,

Anyone can get meningococcal disease. However, most cases are seen in babies, children under the age of 5, teenagers and young adults. While we do know the risk groups, it is also important to also understand how this disease is spread from person to person.

There are 13 serogroups of Neisseria meningitidis and 6 of these are associated with disease in humans. This bacteria only lives in humans, and are found from time to time in 5-20% of the general population, where their natural habitat is the back of the nose, and throat (know as the naso-pharynx).

The bacteria are passed from person to person through direct contact with respiratory secretions (saliva, spit).

This most often happens with deep kissing on the mouth between intimate partners, but there is also an elevated risk with social activities involving the sharing of cups/water bottles and coughing/sneezing directly on another person.

MADAM SPEAKER,

For the vast majority of people, having the bacteria at the back of their noses or mouths causes no problems, and you would not even know that they are there.

The disease occurs when the bacteria breaches the layers of the nasopharynx and moves into the blood stream, as well as passed the barrier that separates the brain from the blood of an infected person.

The bacteria enters the bloodstream with the infection itself. The risk of this happening is higher in those with specific chronic illnesses that affect their immunity, smokers, and those with frequent upper respiratory tract infections.

MADAM SPEAKER,

On March 20th 2018, the Ministry of Health and Medical Services declared a national outbreak of meningococcal C. This was after a review of the evidence and recommendations by our group of experts on the National Meningococcal Taskforce.

There have been 46 cases from January 1st to April 12th 2018. Of these, 22 cases are laboratory confirmed, and 24 are either suspected or probable cases with similar symptoms but not diagnosed by laboratory.

The Central Division has reported 27 cases, followed by Western of 16 cases, Eastern 1 case and Northern 2 cases. There have been 4 confirmed meningococcal disease related deaths and 2 suspected from January 1st to April 12th 2018.

As of April 12th, all cases were in the age groups under 19 years. Of this, male account for 63.0% of cases while female accounts for 37.0%.

MADAM SPEAKER,

The Ministry, upon recommendations of the National Meningococcal Taskforce, has a four-component strategy to combating the outbreak:

Enhanced surveillance and early case detection

National surveillance coordinated by the Fiji Centre for Communicable Disease Control (FCCDC)

Risk communications plan and implementation to ensure the general public is aware of the outbreak, focusing on early recognition of symptoms and early presentation to a health facility; and

Awareness for clinicians through distribution and training on new guidelines for the public health management of the disease.

In terms of early treatment, the actions taken is the:

Revision and national training for clinicians and outbreak response teams on the Meningococcal Disease Guidelines; and

providing antibiotics specifically for the treatment of this disease to all health subdivisions.

In terms of contact tracing - the team conducts active case investigation and tracing of close contacts of cases by outbreak response teams in the respective division and subdivision.

In terms of prevention strategies, the ministry has been:

Communicating to the public the basic hygiene measures needed to prevent transmission of bacteria.

Strengthening infection prevention control measures among health care workers.

Planning and implementation for a targeted vaccination programme.

MADAM SPEAKER,

The response to this outbreak has been done with wide consultation with local and international experts, and follows international best practice in the control of meningococcal disease outbreaks.

MADAM SPEAKER,

The current case number for 2018 includes a cluster of cases reported from Navesau Adventist High School, a boarding school in Wainibuka, in the province of Tailevu.

The first case was reported on February 28th, and so far there have been 10 cases as of April 12th, with the latest case reported April 9thth.

Since report of the first case at Navesau Adventist High School the Nayavu Health Centre team, the Tailevu Subdivisional Team, and the Central Division Team made daily school visits where the following public health responses were undertaken:

Discussion with school management on strategies for early detection, control, and prevention of the disease in the school;

Conducted health awareness and education for students, parents, and teachers;

Administered preventative antibiotics to all students and teachers;

Inspected and assessed school facilities and infrastructure;

A vaccination campaign was conducted from April 5th to 6th for all Navesau Adventist students using vaccines procured by the Ministry;

Students were vaccinated with MENACTRA Conjugated Quadrivalent Vaccine that has the capacity to address 4 different strains (A, C, Y, W-135).

In terms of transparency of the vaccination programme the ministry always seeks the endorsement or approval of parents as consenting to vaccination program for their children. This consent is given when parents understand the benefits and the value of the vaccine against the risks and the cost of the burden of the disease.

The 4 different strains covered in the MENACTRA vaccine is a booster or extra protection against the other causative agents causing Meningococcal diseases. The predominant type is serotype C.

This MENACTRA vaccine ensures protection against Meningococcal diseases for 2 to 3 years and at the same time public health measures will continue to strengthen measures in place.

MADAM SPEAKER,

The Ministry is working closely with World Health Organisation and UNICEF to ensure effective implementation of the vaccination programme that would allow 333,876 children aged 1 to 19 years being vaccinated as a strategic form of preventative measure against Men-C.

MADAM SPEAKER,

Why 1- 19 years old?

According to the Meningococcal infection situation in Fiji, as of March 21st this year, all cases were in the less than 19 year age group. With 41% of cases less than 5 years old, 21% between 5 – 9 years, 24% between 10 – 14 years and 15% aged 15 – 19 years. These are the age group being heavily affected by this disease.

MADAM SPEAKER,

This is our TARGET population.

The vaccine is safe and effective and is recommended by WHO.

The vaccination for specific health staff is also being considered otherwise personal protective equipment and infection prevention control is used.

MADAM SPEAKER,

The Ministry is continues to work with WHO and UNICEF in the procurement of the mass vaccine. Supply on the world market is limited and usually reserved for mass vaccination in the next 3 to 6months as procurement of the vaccine was approved by Cabinet on the 27th March 2018.

We have a team within the Ministry of Health who are very experienced with the national routine immunisation programme for children and they will follow all established protocols for this mass vaccination rollout. This will include giving vaccines during normal Integrated Management of Childhood Illness (IMCI) and Maternal and Child Health (MCH) clinics as well in schools to obtain the optimum coverage.

MADAM SPEAKER,

We continue to urge the public to:

1. recognise the symptoms of the disease and seek early medical attention at their nearest health facility to be assessed by a clinician.

2. Practise basic hygiene measures to prevent spread of the bacteria.

MADAM SPEAKER,

We also urge the Members of Parliament to be an example to their communities in advocating for awareness for the early recognition and prevention of this disease.

Thank you Madam Speaker.