Meningokoki

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Meningococci (or Meningococcal Meningitis) are the bacteria responsible for the so-called Invasive Menigococcal Disease (IChM). It can take the form of meningitis or sepsis (sepsis), when the bacteria in the blood are accompanied by a strong, generalized inflammatory reaction with symptoms involving several organs.

There are many types of meningococcus. In Poland, as in the rest of Europe, meningococci B and C are mainly responsible for the incidence of IChM. Meningococcal A is often responsible for epidemics in Africa and Asia. Meningococcus less frequently causes local infections. Incidence of IChM may occur sporadically (isolated cases), in the form of outbreaks or epidemics (mainly in Africa and Asia).

In recent years, more cases of IChM have been reported in Poland (about 400 per year). The share of C meningococci, which is currently responsible for approx. 50% of cases, including epidemic outbreaks, is growing.

Who are meningococcal at risk?

Everyone is exposed to IChM, regardless of age and body resistance. However, the most common diseases are children from 2 months to 4 years of age, and adolescents and young adults between 11 and 24 years of age. In children in the first year of life, the disease is more often caused by meningococcus B (70%), in children over 5 years of age and adults – by meningococcus C. Patients with no spleen and immunodeficiency are particularly susceptible to the disease.

How can you get infected?

The source of the infection can be a sick person or – more often – an asymptomatic carrier. Both B and C meningococci often colonize the nasopharynx without causing any symptoms. The phenomenon of carriage is particularly common among young children and adolescents (20-40%).

Transmission of meningococci is by airborne transmission when coughing, sneezing, speaking, and by direct (e.g. kissing) or indirect contact with respiratory secretions (e.g. using the same glass, smoking the same cigarette). The risk of infection is greater in closed environments (nursery, kindergarten, boarding house, dormitory, barracks) and large groups of people (discos, concerts). Infection is favored by passive and active smoking and a flu infection. A sick person or carrier in a kindergarten or school may become the source of a local epidemic.

What are the symptoms of Invasive Meningococcal Disease?

Initially, the symptoms are uncharacteristic: malaise, fever, weakness, pain in muscles and joints. Young children develop fever, unwillingness to play or eat, excessive sleepiness or irritability. Influenza or other viral infection is often diagnosed then, especially since the majority of IChM cases occur during the flu season (autumn and winter). On the other hand, haemorrhagic rash is characteristic of IChM. Dark red or bluish red bruises and papules appear in the skin, caused by bacterial embolisms in the small blood vessels of the skin. They do not disappear under pressure, which can be checked by pressing on them with the edge of a glass or other transparent object. If meningitis develops, headache, nausea, vomiting, neck stiffness, convulsions, and disturbed consciousness appear.

Such a patient should be taken to the nearest hospital as soon as possible. IChM is treated with intravenous antibiotics, which is always done in a hospital, often in an intensive care unit.

In some patients, the course of IChM is very rapid and electrifying. Sometimes, despite the quick initiation of the appropriate treatment, it is not possible to save the patient. Mortality in IChM is approx. 10%. In some patients (about 20%) who have recovered, permanent consequences are observed – hearing loss, neurological symptoms, sometimes limb amputation is necessary due to necrotic changes.

How can IChM be prevented?

You can reduce the risk of meningococcal infection by observing basic hygiene measures and avoiding certain behaviors (e.g. drinking from the same glass or smoking the same cigarette). If someone in the immediate vicinity (family, kindergarten, school) is suspected or diagnosed with IChM, you should contact a doctor who will decide on the use of chemoprophylaxis (administration of an appropriate bactericidal drug). It is recommended for people who had close contact with the sick person during the week preceding the illness. Some meningococcal infections can be successfully prevented by immunization. Among the vaccines available in Poland, due to the epidemiological situation, the use of meningococcal vaccines is justified. Since 2003, vaccination against meningococcus is among the vaccinations recommended in the Protective Vaccination Program. Vaccination is especially recommended for young children and adolescents, but can be done at any age.

There is currently no effective vaccine against meningococcus B available. However, before traveling to the regions where meningococcal A disease occurs, you can and should be vaccinated with the meningococcal A + C vaccine.

Is the meningococcal vaccination free?

Vaccination is reimbursed (free of charge) in the event of an epidemic, in which case people most at risk of infection are vaccinated. The decision about this is made by the sanitary and epidemiological authorities. In other cases, vaccination is paid.

Author: Ewa Talarek, MD, PhD

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