Meningococcal Meningitis in Australia and New Zealand Management

Question: You are currently working as a medical officer for the world health organization (WHO) and you have been asked to produce a report on the epidemiology of meningococcal meningitis in Australia and New Zealand? Answer: Abstracts Meningitis is an air borne disease which is caused by the Neisseria meningitides and it knwn to cause life threatening as prolonged inflammation to spinal cord and brain is coined as emergency. The infection is spread within the people through infected droplet of air which enters through respiratory tract. The infection of this disease can caused inflammation in membrane around spinal cord a brain known as meningitis, infection in blood termed as septicaemia, lung infection called pneumonia, arthritis and conjunctivitis. After infection some of the symptoms that appear are headache, fever, neck infection, vomiting and nausea. In Australia and New Zealand has started an extensive vaccination programing to combat the meningitis. Some of the common used vaccines are HibMenC and MenCCV. Meningococcal Meningitis in Australia and New Zealand Meningitis is clinically referred as inflammation in the covering membrane that laps over spinal cord and brain and collectively termed as meninges. The inflammation is often caused by different strain of bacteria Neisseria meningitidis and severity of inflammation could be life threatening as prolonged inflammation to spinal cord and brain is coined as emergency (Moniuszko et al., 2015. This disease has different serotype, in Australia the diseases is dominated by serotypeB while in New Zealand the disease progression is done by serotypeC. In New Zealand total number of notified cases of meningitis was 96 that constitute 1.9% of total 100000 populations which is lowest in past decade. Canterbury state has highest number of cases registered followed by Waite Mata state. Maximum incidence rate was found in Taranaki where it was 5.4 per 10000 populations. Total Six fatalities occurred constituting 7.1% of total case fatality rate. In Australia there was total 622 cases registered about meningitis in past two years that constitutes 1.5% of per 100000 populations. From total registered case 46% was meningococcal meningitis and 36% was septicaemia. The percentage of total hospitalised cases of total disease varied from 94% of cases upto 14 year age group to 82% of notified cases for those aged 60 years and 60% for those aged more than 60 years. In Australia the prevalence of the disease was in infant was 27% which has increased by 4.5% in aldolscent, then reduced in adult upto 8.2% in 50 year. In both the countries the popul ation upto age of 13 years is prone towards the meningococcal infection. In Australia the serogroups varies demographically as serogroup A occurs predominantly in low income households. Serogroup B is basically Men B is major cause of sporadic infection of menengiococcal and in Australia this is a major dominating serogroup. There were total 194 cases in year 2012 and 83% of total case have serogroup Men B, serogroup C was abot 6%, serogroupW was 4% and serogroup Y was 8% (NCIRS Fact sheet, 2014). In new Zealand out of total notified 85 cases about 68% was identified as serotypeB and 33% was denoted as serotypeC. Total fatality case was dominated by serotypeC registering about 17.4% and serotype B about 4.7%. In both the countries maximum incidence was reported in winter season (Client Report FW13021, 2012). Comprehensive vaccination program has been carried out in both the countries, in Newzealand meningococcal B immunisation programme was started in which MeNZB vaccine was administered and in Australia program called National Immunisation program was launched and combination HibMenC vaccine was given as per program. There is no vaccine alone which can counter all the serotypes hence there are different type of vaccine recommended to combat different serotypes. Meningococcal C conjugate vaccines has been prescribed for the infection serotypeC in which antigen for SerogroupC has been conjugated to a carrier protein and referred as MenCCV. Different type of companies have developed vaccines such as Menjugate Syringe developed by bioCSL/Novartis, Meningitec by Pfizer and NeisVac-C manufactured by Baxter. For serotypeB a vaccine has been developed Multicomponent meningococcal B vaccine commonly called as 4CMenB commercially sold as Bexsero by Novartis. a vaccine to encounter serotype A, C, W and Y Quadrivalent meningococcal conjugate vaccines have been developed and sold as Menveo by Novartis and nimerix by GlaxoSmithKline (NCIRS Fact sheet: June 2014). These vaccination has been done to induce immunogenicity against the disease correlated with the laboratory outcomes these vaccines have shownprotection again clinical meningococcal disease but the extend of protection is still unknown. References: Moniuszko, A., Zajkowska, A., Tumiel, E., Rutkowski, K., Czupryna, P., Pancewicz, S., Rutkowski, R., Zdrodowska, A., Zajkowska, J.2015. Meningitis, clinical presentation of tetanus. Case Report on Infectious Disease. doi: 10.1155/2015/372375 Dwilow, R., Fanella, S. 2014. Invasive meningococcal disease in the 21st centuryan update for the clinician. Current Neurology Neuroscience Report.15(3):2. Surveillance report. 2012. The epidemiology of meningococcal disease in New Zealand 2012. Client Report: FW13021. May 2013. Factsheet, Meningococcal vaccines for Australians, NCIRS Fact sheet: June 2014.