The Unexpected, Underrated Killer: Understanding Invasive Meningococcal Disease (IMD)

Recently, I was invited to attend Invasive Meningococcal Disease (IMD) talk at Setia City Convention Centre. Dr Yong Junina was there to discuss on IMD impact, spread etc

So here some sharing points from the event and also from my readings.

The disease is not under routine government surveillance and is given relatively scant attention in Asia. While there is a sizeable amount of research and data from America and Europe, not many studies are initiated in Asia.

What is meningococcal disease?

Meningitis occurs when the victim’s meninges (lining between the brain and the skull) suffers from swelling and inflammation after being attacked by bacteria, virus or occasionally, fungal parasites. Meningitis is commonly caused by meningococcal disease.

Meningococcal disease refers to infections caused by the bacterium, Neisseria meningitidis (abbreviated as N. meningitides, or sometimes termed as meningococcus).

Besides meningitis, N. meningitides can also cause sepsis or septicemia (widespread bloodinfection).

Meningococcal meningitis has a fatality rate of 10-14% whereas the death rate for meningococcal septicemia is a whopping 40%. Those who escape death may end up with permanent disability such as brain damage, deafness, blindness or physical disabilities arising from the amputation of limbs that have experienced serious blood poisoning.

Although invasive meningococcal disease (IMD) is not as common as pneumonia or diarrhea, it is still a very vicious and fast progressing disease that can be just as devastating, especially if not recognized and treated early enough.

Transmission

IMD can be transmitted through aerosolized droplets (when a carrier sneezes at a distance of 1 metre or less), and through secretions, e.g. saliva when sharing food or during direct physical contact. The incubation period of the disease is 2-10 days with an average of 3-4 days.Up to 10% of adolescents and adults are asymptomatic transient carriers.

The highest age-specific incidence is consistently observed in children below 5 years old. Carriage peaks (25%) in healthy 15-19 year-olds. An adolescent may appear to be free of sickness, but he/she is actually carrying the disease. That’s why adolescents are by far the most common source of transmission to the community.

When the carrier is exposed to a risk factor, the organisms that he/she carries in his/her respiratory system will emerge from their dormant state and start invading the carrier’s body tissues; hence, he/she becomes sick with what is called invasive meningococcal disease (IMD), putting those he/she comes in contact with at high risk.

What makes IMD especially dangerous is that infants not only lack the required antibodies, but there is also no meningococcus vaccine available for anyone below 9 months of age.

Secondly, it can be very hard for doctors to distinguish the symptoms of IMD from viral syndrome as the symptoms for both are rather similar at the beginning (e.g. high fever, rashes), and there is no conclusive test for the disease, so doctors merely carry out tests on a trial-and-elimination basis.

Increasing International Travel Presents Opportunities for Meningococcal Disease Exposure and Spread

International travelers have the potential both to acquire and to contribute to the global spread of meningococcal disease

For example:

•During the Hajj >3 million pilgrims from 140 countries visit Mecca

•Due to multiple meningococcal outbreaks over the past decade, the ACWY-PS vaccine is required in order to obtain Hajj/Umrah visas

•Risk of exposure to meningococcal disease for those traveling to the African meningitis belt

Meningococcal meningitis

•Fever and headache (flu-like symptoms)

•Stiff neck

•Nausea

•Photophobia

•Altered mental status

•Seizure

Meningococcal septicemia

•Fever

•Petechial or purpuric rash

•Hypotension

•Shock

•Multiorgan failure

•Death can occur within 24 hours

Recommended Precautions

The good news is that the vaccination is now available for babies from as young as 9 months old. Previously the vaccine was only available for older people.

Be suspicious if you come across any sudden onset of fever at 40oC and above, and especially if you also find a red rash that doesn’t disappear when you do the glass test – such a rash is called petichae or purpura (from the Latin word meaning “purple”), which refers to skin discolouration.

You think that this would not happen in your own country?

Well, Malaysia is no exception. In July 2002, three deaths occurred at Universiti Pertanian Malaysia, of which one was confirmed to be due to IMD, while 1,000 students had to be quarantined. In May 2009, there was an outbreak in the Road Transport Department Academy, which led to one death, 46 cases that were successfully isolated and treated, and 81 employees and students quarantined.

Did you know that the UK has one of the largest numbers of meningitis cases (both confirmed and probable)?

The two main reasons for this are first, their good reporting system and second, the interest they take in keeping tabs on the disease. By contrast in Malaysia, reporting of IMD cases is not mandatory, so there is under-reporting, Moreover, there could be many misdiagnosed cases that go unrecognized and unrecorded especially when death had overtaken the patient rather quickly and his/her symptoms were similar to those of other diseases.

Dr Yong Junina
(all the while selalu nampak Dr ni dlm magazines)

In addition, Dr Yong Junina also shared after effects of meningitis and septicaemia e.g. memory loss / difficulty retaining information / lack of concentration and so on. On the other hand her presentation also include challenges of IMD, rapid progression with death as little as 24 hours and primary prevention of IMD

Q & A session followed after the presentation. I asked one question (erm agak sebab puasa dan talk tu belah petang..cam lesu longlai je), sbb from my understanding pneumococcal boleh sebabkan meningitis..then since both my kids dh amik  pneumococcal perluke amik vaksin ni? From my understanding based on her answer, both vaccine cover for different type of meningitis. From reading

Pneumococcal infection refers to an infection caused by Streptococcus pneumonia. S. pneumoniae is responsible for 15–50% of all episodes of community acquired pneumonia, 30–50% of all cases of acute otitis media and a significant proportion of bacteremia and bacterial meningitis

Meningococcal disease refers to infections caused by the bacterium, Neisseria meningitidis (or sometimes termed as meningococcus). Besides meningitis, N. meningitides can also cause sepsis or septicemia (widespread bloodinfection).

Last not least group photo

Pic credit : Christine

You also can read Christine's post here on IMD.