Meningococcal disease in the Eastern Townships
Two cases of invasive meningococcal infection found in the Eastern Townships recently have health officials very concerned. One of the victims worked at Gendreau Elementary School in Coaticook and passed away from the infection on Feb. 14. A release from the CIUSSS de l’Estrie-CHUS mentioned that although the victim worked in the school during his infectious period, the school’s staff and students did not come into close contact. Preventative antibiotics and vaccines were offered for those at risk. Dr. Alex Carignan, a microbiologistinfectiologist at the CIUSSS warned the public to take this seriously and to watch for any symptoms, as meningococcal infections can kill a patient in good health in a few hours.
Meningococcal disease is caused by a bacteria known as Neisseria meningitidis. About 10 per cent of people carry these bacteria in their throat or nose without getting sick. However, the bacteria can take over the body and cause serious sickness. The disease can also infect others. Meningococcal bacteria are transmitted by sharing respiratory and throat secretions (for instance through coughing or kissing). Usually, it takes close or prolonged contact to spread the bacteria. Fortunately, the bacteria are not transmitted through casual contact or by simply breathing air where an infected patient has been. Certain people are at a higher risk of catching the disease. Infants under one year old, teenagers and young adults between 16 and 23 years old, and the elderly over 65 years old have the highest incidences of meningococcal disease. Immunodeficient disorders can increase the patient’s risk of catching the disease. Patients taking certain medications, namely complement inhibitors are at a higher risk. Those travelling to certain areas such as subSaharan Africa may be at increased risk for meningococcal disease.
The two most prevalent types of meningococcal infections are meningitis and septicemia. Both types are extremely serious and can result in death in a matter of hours. Meningitis is caused by the bacteria infecting the lining of the brain and spinal cord, resulting in inflammation. Symptoms normally include fever, headache, stiff neck, nausea/vomiting, sensitivity to light and confusion. In newborns, these symptoms may not present in the same manner as a young adult. Therefore, doctors often look at the child’s reflexes or for any bulging of the soft spot of the skull to better diagnose the infection. Babies may also be slow or inactive, vomit or have a significantly reduced appetite. Meningococcal septicemia is a bloodstream infection caused by the bacteria. The bacteria enter the bloodstream and multiplies, causing destruction to the walls of blood vessels and bleeding into the skin and organs. Symptoms of septicemia generally overlap with those of meningitis, but can also include severe pain in muscles, joints, chest or abdomen, rapid breathing, diarrhea, and rashes.
Early diagnosis and treatment are the key to surviving meningococcal disease. Diagnosis can be tricky as the symptoms are often similar to many other illnesses. A blood or cerebrospinal fluid is collected to test for the presence of Neisseria meningitidis. Laboratory technicians will grow the bacteria to narrow down the specific type of bacteria causing the infection. There are six types of Neisseria meningitidis – A, B, C, W, X and Y. In Canada, meningococcal B is the most common, infecting roughly 200 patients per year. Once the type of bacteria is identified, specific antibiotics is prescribed to the infected patient, which helps to reduce the risk of death. However, depending on the progression of the disease, patients may need other treatments including breathing assistance, medications to treat low blood pressure, surgery to eliminate dead tissue and other wound care for damaged skin. It is estimated that even with antibiotic treatment, roughly 10% to 15% of people with meningococcal disease will die. Up to 20% of survivors will have long-term disabilities, such as loss of limb, nervous system problems, brain damage and deafness.
The best protection against meningococcal disease is to ensure you are up to date with recommended vaccines. People can catch the disease more than once, although this is rare. It is important to note that a previous infection does not offer permanent protection from future infections. The Quebec immunization program recommends administration of one dose of the meningococcal type C vaccine at 18 months of age, followed by one dose of types A, C, W and Y vaccine in secondary 3. However, depending on the person’s health, other vaccines against meningococcus may also be recommended. Since the introduction of the free meningococcal C vaccination in Canada, the incidences of severe infections have decreased by nearly 97 per cent.