Meningitis in EmergenciesMeningitis in Emergencies

MeningitisMeningitis

Causative agents of epidemic Causative agents of epidemic meningitis-meningitis-• Most commonly Most commonly N. meningitidis-N. meningitidis-

serogroup A serogroup A B, C, W135 also possibleB, C, W135 also possible

Outbreaks occur throughout region Outbreaks occur throughout region • Not just in humantarian emergenciesNot just in humantarian emergencies

Examples of Meningitis Outbreaks in Examples of Meningitis Outbreaks in EmergenciesEmergencies

PlacePlace Attack Attack RateRate

CFR CFR DurationDuration VaccineVaccine

ThailandThailand 130130 2828 1818 NoneNone

EthiopiaEthiopia 187187 1111 55 Wk 2Wk 2

GuineaGuinea 9898 1515 1414 Wk 13Wk 13

GomaGoma 137137 33 77 Wk 5Wk 5

SurveillanceSurveillance

Meningitis surveillance part of greater Meningitis surveillance part of greater surveillance systemsurveillance system

Standard case definition for suspected, Standard case definition for suspected, probable, and confirmed casesprobable, and confirmed cases

Capacity for diagnosis must be assuredCapacity for diagnosis must be assured

Epidemic ThresholdsEpidemic Thresholds

Populations >30,000Populations >30,000• 15/100,000 per week15/100,000 per week• 10/100,000 per week- high risk zones10/100,000 per week- high risk zones

Populations <30,000Populations <30,000• 5/100,000 per week OR 5/100,000 per week OR • Doubling of cases from one week to the next Doubling of cases from one week to the next

for 3 consecutive weeksfor 3 consecutive weeks

Case ManagementCase Management Main Goal- to prevent mortalityMain Goal- to prevent mortality Presumptive treatmentPresumptive treatment

• Ceftriaxone / Chloramphenicol single dose IMCeftriaxone / Chloramphenicol single dose IM

• Both cost effective and efficientBoth cost effective and efficient

PreventionPrevention 3 approaches3 approaches

• Adequate vaccination in areas that are Adequate vaccination in areas that are high riskhigh risk

• Early detection and vaccines available in Early detection and vaccines available in the fieldthe field

• Surveillance with an emergency stock pile Surveillance with an emergency stock pile availableavailable

PreventionPrevention Vaccines currently available for Vaccines currently available for

serogroups A, B, C W135serogroups A, B, C W135 Routine vaccination is not cost Routine vaccination is not cost

effective (as it does not effect herd effective (as it does not effect herd immunity)immunity)• if there is an impending outbreak, if there is an impending outbreak,

vaccination should be undertakenvaccination should be undertaken

• vaccination recommended for age group vaccination recommended for age group 24 months and above to prevent epidemics24 months and above to prevent epidemics

Earthquake in Pakistan, October 8, 2005

Thursday, December 01 2005 @ 07:56 PM EST

Survivors Ask Aid for Flu, PneumoniaContributed by: Admin  |  Views:125                                                            MUZAFFARABAD, Pakistan - Hundreds of survivors of Pakistan's huge earthquake filled hospitals Thursday for treatment of pneumonia and flu as temperatures plunged below freezing with the arrival of the brutal Himalayan winter.

Survivors Ask Aid for Flu, PneumoniaContributed by: Admin  |  Views:125                                                            MUZAFFARABAD, Pakistan - Hundreds of survivors of Pakistan's huge earthquake filled hospitals Thursday for treatment of pneumonia and flu as temperatures plunged below freezing with the arrival of the brutal Himalayan winter.

Survivors Ask Aid for Flu, PneumoniaContributed by: Admin  |  Views:125                                                            MUZAFFARABAD, Pakistan - Hundreds of survivors of Pakistan's huge earthquake filled hospitals Thursday for treatment of pneumonia and flu as temperatures plunged below freezing with the arrival of the brutal Himalayan winter.

Survivors Ask Aid for Flu, Pneumonia

MUZAFFARABAD, Pakistan - Hundreds of survivors of Pakistan's huge earthquake filled hospitals Thursday for treatment of pneumonia and flu as temperatures plunged below freezing with the arrival of the brutal Himalayan winter.

Thursday, December 01 2005 @ 07:56 PM EST

Source: www.pakquake2005.com

Case study:Case study:You are an ARI expert at CDC. You are asked your opinion of whether You are an ARI expert at CDC. You are asked your opinion of whether Hib vaccination should be added to a measles vaccination campaign Hib vaccination should be added to a measles vaccination campaign for Pakistani children displaced by an earthquake. Pakistan does not for Pakistani children displaced by an earthquake. Pakistan does not

routinely immunize against Hib.routinely immunize against Hib.