Health Matters by Dr.Paul: Meningococcal Infection and Prevention

The Meningococcus bacterium has been the source of most of the “meningitis” outbreaks across North America over the last 2 decades. This extremely dangerous infection is caused by the Neisseria meningitidis or meningococcal bacteria, of which there are several types including: A, B and C, Y and W. It spreads by direct person-to-person contact through respiratory secretions. This is why outbreaks of infection occur more frequently in crowded conditions such as in army, school or dormitory settings.

The symptoms of meningitis include headache, stiff neck, fever and possibly vomiting. However, meningococcal infections often begin only with little blue spots on the skin called "petechiae". These spots grow rapidly and spread all over the body eventually looking like large bruises. If a person ever develops such a rash, especially in the context of an outbreak of meningococcal infection, medical attention should be sought immediately. Note that not all petechiae are due to meningococcal infection, but this should be ruled out immediately, because if these bacteria is either suspected or confirmed, immediate treatment and monitoring are absolutely necessary. 

This infection is dangerous because in addition to causing meningitis, the bacteria can enter the blood stream (referred to as meningococcemia) and cause the body to go into shock, resulting in kidney failure and unfortunately, possibly death. Among survivors, the potential complications are also very serious and life-long; including loss of limbs, severe developmental delay and seizures. One of the difficulties with treating meningococcal infections is that they can spread so quickly and cause such an overwhelming infection, that even antibiotics and other supportive treatments can't always stop the infection. I have seen this in my practice where a child literally went into shock within a few minutes right in front of me. Fortunately we were able to save the child, but others are not so lucky. This is a very devastating disease, so prevention is our best bet. People with full-blown meningococcemia are very ill and therefore require intensive medical therapy, support and monitoring in addition to intravenous antibiotics. What happens to contacts of a person with meningococcal infection? The most important thing to do is to treat the close contacts with antibiotics taken by mouth. When given promptly, preventative antibiotics have been shown to prevent infection very effectively. 

Vaccination: An important part of prevention

Fortunately we now have vaccines that protect against this infection. In fact, effective and safe vaccines for types A, C, Y and W have been available for a few years. There are several vaccine preparations, with some protecting against C and others against all 4 types. In Ontario, vaccines against these 4 strains are publicly funded and are mandatory for all Grade 7 students. I strongly urge all parents to ensure that their children get this vaccine which is offered free of charge at Ontario schools by local public health units. On a final note, recently, (2013), a new vaccine against Type B meningococcus was approved in several countries including Canada and the UK. Your healthcare provider can give you more information.

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