The preventable infection we should all be fighting against

Every year more than a quarter million will die of meningococcal infection around the world. What is even more unfortunate is that most of these deaths will involve infants, children and adolescents in the 15-19 age group.

And of the estimated 1.2 million individuals who get infected every year, 20 percent will be left with severe and often permanent disabilities ranging from becoming intellectually disabled, having recurring seizures, liver and kidney failure, sight and hearing problems, loss of fingers, toes and limbs, according to the Meningitis Research Foundation.

Indeed, meningococcal infection—caused by a type of bacteria called Neisseria meningitidis—is very serious as it can lead to potentially deadly blood infection (sepsis) as well as inflammation of the layers of tissue that cover the brain and spinal cord (meningitis).

“Meningococcemia—N. meningitidis invading the bloodstream—is a contagious disease that can be so severe as to cause death within 24 hours after initial onset of fever and purpuric rashes (purplish spots caused by bleeding tiny blood vessels located beneath the skin’s surface). While some patients would recover completely, others may develop severe meningitis that results in mental retardation as well as physical disabilities,” explained Dr. Lulu Bravo, professor emeritus at the University of the Philippines-Manila’s College of Medicine.

Highly preventable

The good news, though, is that meningococcal infection is highly preventable.

“We should realize that the infection, like meninogococcemia, can only be spread by direct contact with saliva or respiratory secretions (kissing as well as being in close proximity to a sneezing or coughing carrier). This is why the highest-risk groups for acquiring this disease include infants and young children, household in close contacts with the carrier as well as students living in dormitories. Interestingly, healthcare workers are not at increased risk unless they have been directly exposed to the carrier’s nasopharyngeal secretions, for example, if they perform mouth-to-mouth resuscitation or intubate the patient without using a face mask,” said Dr. Ferdinand de Guzman, Medical Specialist IV at the San Lazaro Hospital, the national referral center for infectious diseases including meningococcemia.

De Guzman believed the little knowledge or public information that people have about meningococcal infection could make the situation much worse.

The Philippines had this experience over a decade ago when from October 2004 to January 2005, Baguio General Hospital and Medical Center in Baguio City reported an almost daily admittance of patients afflicted with meningococcemia-like symptoms. Between these dates, 98 cases were recorded, of which 32 have died. The ensuing public panic also caused tourists to stay away from Baguio City, dampening local tourism and economy for many months.

“This is why public awareness campaign is crucial to prevent unnecessary fear and as well as further spread of meningococcal infection. Yes, meningococcal infection is a frightening diagnosis even for healthcare providers. As if being sick weren’t bad enough, this type of infection come with a social stigma that can make sufferers hide their illness. The misconceptions and stigma create unnecessary barriers to progress such as improving care and support services that could be life saver,” lamented De Guzman.

Maintain high index of suspicion

Because initial symptoms of the infection like meningococcemia is nonspecific and flu-like, healthcare providers are advised to maintain a high index of suspicion in symptomatic patients.

This is why according to Bravo, those in close contact with possible infected persons, may use drugs such as rifampicin and ciprofloxacin as protection. “The other way of prevention is through vaccination following certain indications with regards to age groups and type of vaccine to use.”

Indeed, while early diagnosis and treatment are very important, Dr. Cecilia Montalban, president of the Philippine Foundation for Vaccination, stressed the importance of getting a vaccine that offers broad protection against four of the vaccine-preventable strains of invasive meningococcal disease (like meningococcal conjugate vaccine that protects against A,C, Y and W135 strains).

“While better hygiene helps protect people from infections, many infections can still spread regardless of how clean we are. However, if more people are vaccinated, for example against meningococcal disease, we could be assured that the surge of cases that happened in some parts of the Philippines several years ago will never be repeated. Keeping up to date with recommended immunization is the best defense against meningococcal disease,” stressed Montalban who added that getting the recommended vaccines can give one the peace of mind that he or she has the best possible protection available against a number of serious infections, including meningococcal disease.