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Meningococcal Disease – Mini course Education

Dr Krupali Rathod Tappoo is an Australian qualified general practitioner, a Fellow of the Royal Australian College of General Practitioners and the Medical co-ordinator for Fiji based NGO – Sai
23 Mar 2018 11:00
Meningococcal Disease – Mini course Education

Dr Krupali Rathod Tappoo is an Australian qualified general practitioner, a Fellow of the Royal Australian College of General Practitioners and the Medical co-ordinator for Fiji based NGO – Sai Prema Foundation. Dr Krupali is based at TappooCity Medical Centre in TappooCity Suva and has a special interest in Women and Children’s Health.


Over the last few days there has been a lot of attention in the media regarding meningococcal disease in Fiji after the health authorities have declared an outbreak. Cases of meningococcal disease in Fiji have consistently increased from 1-10 cases in total before 2016 to 29 cases in 2016, 48 in 2017 and as of February 21 there were already 18 cases reported in 2018. (Ministry of Health and Medical services)

Many people are concerned regarding this outbreak and are wondering what they can do to protect themselves. Some are wondering whether this is a new disease. In factmeningitis has been described in ancient texts. Hippocrates(the father of medicine) described meningitis in his work. Tuberculous meningitis was first described by Edinburgh physician Sir Robert Whytt in a posthumous report that appeared in 1768. However, the link with Tubercle bacilli that also causes tuberculosis took another 100 years to discover.

Meningitis outbreak was first recorded in Geneva in 1805. Gaspard Vieusseux (1746-1814) and Andre Matthey (1778-1842) in Geneva, and Elisa North (1771-1843) in Massachusetts, described epidemic (meningococcal) meningitis. Several other epidemics in Europe and the United States were described shortly afterward.

In Africa the first outbreak was described in 1840. African epidemics became much more common in the 20th century. The first major one was reported in Nigeria and Ghana in 1905–1908. In early reports large number of people died of the disease.

The first evidence that linked bacterial infection as a cause of meningitis was written by Austrian bacteriology Anton Vaykselbaum who described meningococcal bacteria in 1887.Heinrich Quincke (1842-1922) utilized his new technique of lumbar puncture (1891) to provide an early analysis of cerebrospinal fluid (CSF). William Mestrezat (1883-1929), and H. Houston Merritt (1902-1979) compiled large series of CSF profiles in meningitis.


Organisms causing meningitis were identified in the late 19th century including:

Streptococcus pneumonia (children are routinely immunized in childhood)

Neisseria meningitidis

Haemophilus influenza (children are routinely immunized in childhood)


What is Meningococcal Infection?

Meningococcal infection is caused by a bacteria (germ) called meningococcus, and can cause serious infections including:

  • Meningitis – an infection of the covering of the brain and spinal cord.
  • Septicaemia – a serious infection of the blood.
  • Infections in other parts of the body, such as in the joints.

These infections can come on and become extremely serious very quickly. Meningococcal infection may cause life long disabilities or death in about one in 10 people. Many people carry the bacteria in their noses and throats without getting sick. They are called healthy carriers. Healthy carriers can spread the bacteria to other people. The meningococcus a bacterium is spread by tiny drops of fluid from the nose and throat through coughing, sneezing, spluttering and sharing eating and drinking utensils. It is not easy to get infected because once out of the body, the bacteria do not live long.


Signs and Symptoms

Children and adults can have one or more symptoms if they have meningococcal Infection

  • High fever (temperature over 39oC)
  • Severe headache
  • Stiffness and pain in the neck, shoulders, back and other muscles
  • Skin rash of small bright red spots or purple spots or bruises which do not turn white (blanch) when you press on them
  • Dislike of bright lights (photophobia)
  • Lethargy, drowsiness or confusion
  • Nausea and vomiting.


Symptoms in Babies:

  • A fever (temperature above 38oC)
  • High pitched, moaning cry
  • Be irritable, agitated or just be unsettled
  • Refusing or not waking for feeds
  • Vomiting
  • Difficult to wake or be lethargic and floppy
  • Have pale or blotchy skin
  • Have a rash of small bright red spots or purple spots or bruises which do not turn white (blanch) when you press on them.

In newborns and babies, the typical symptoms may be hard to detect.Symptoms will show up within two to 10 days (but usually about three to four days) after your child has been in contact with meningococcus. Symptoms often begin suddenly.

  •  Anyone showing signs of meningococcal infection needs to see a doctor or be taken to the nearest hospital emergency department immediately.



  •  If your child has symptoms of meningococcus they will be treated in hospital with antibiotics.
  •  Early treatment with antibiotics is the key to saving their life.
  •  Diagnosis is not always easy to make in the beginning. If your child is sent home by the doctor or hospital and becomes worse or doesn’t improve, take them straight back to the nearest hospital emergency department.


Treatment for Contact People

If your child has been in contact with a person who has meningococcus, they may need antibiotic treatment (usually with rifampicin unless contraindicated). Contact people may include:

  • Somebody who lives in the same house and shares meals and living space.
  •  A person who has contact with your child’s mouth or nose secretions. This can happen by using the same eating and drinking utensils, through kissing (friends, boyfriends and girlfriends) or adolescents and adults sharing cigarettes.
  •  A person who has done medical treatments such as giving mouth-to-mouth resuscitation on your child.
  •  Children mouthing and sharing toys, such as in group day care centres, family day care, playgroup or kindergarten.

Doctors treating people with suspected meningococcal disease need to inform the department of public health so that they can trace contacts and provide treatment for contacts. Meningococcal disease is a Notifiable disease.


Prevention of Meningococcal Disease

Currently the Fiji immunization schedule does not have the meningococcal vaccine. Most children who were born overseas – in developed countries would have had the meningococcal vaccine. There is a vaccine available in the private pharmacies which covers for meningococcal C and another which covers for Meningococcal A, C, W, Y.  As per the Health authorities, most of the infections in the recent outbreak have been with the meningococcal C strain of bacteria. If you are concerned and would like to get your child vaccinated, please discuss this with your doctor. However, note that this vaccine is not free. Hopefully in the future, this vaccine will become part of the childhood immunization schedule in Fiji, hence saving the lives of many.Children of parents who smoke are at a much higher risk of meningococcal disease. It is a great time to quit smoking- ask your doctor for help if you need nicotine replacement therapy.

Wise words by Bill Gates who said:  “Treatment without prevention is simply unsustainable.”

Till we meet next week, stay safe, educate yourself, as knowledge is power and visit your doctor if you are concerned.


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