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Baguio health officials clarify meningo issues

BAGUIO CITY (Jan. 8) — The recent incidence of deaths in the city due to meningococcemia has sent residents lining up for masks and preventive antibiotics in drugstores and in the market. It has also prompted the city government to access P12 million from the local calamity funds to purchase a carbon dioxide incubator for the early detection of the disease and for the acquisition of more medicines. The city government will also use part of the budget to subsidize hospital bills of the reported cases.

Mayor Braulio Yaranon declared this week that “we are in a situation similar to that of a state of calamity”. The mayor’s statement prompted the immediate release of the calamity fund.

Meanwhile, the Department of Health (DOH) will set up a Meningococcemia Command Outpost in the city. It will be composed of the City Emergency Health Response Team, which was formed last year, members of the World Health Organization (WHO) and the Research Institute for Tropical Medicine (RITM), among others.

Last March-December 2004, 17 fatalities were documented in Baguio City. From January 1 to 8, 2005, three fatalities out of 22 cases were reported.

In a recent public forum, Dr. Marie Apolinar, a consultant of the Sacred Heart Hospital here, said that, “what we have now is a ‘cluster outbreak’”. A cluster outbreak is defined in epidemiology as an unusual rise in the number of cases of a disease in a specific geographic area.

Facts on meningococcemia

Meningococcemia is an acute disease caused by the bacteria called Neisseria meningitidis. Transmission is by direct contact with droplets from the nose and throat of infected persons. These large droplets are only able to travel up to 0.5-1.0 meter from the infected patient. The bacteria are extremely fragile or delicate, existing for 30 minutes outside the body.

Since the bacteria are so delicate, transmission during casual contact (e.g. passing by an infected person at Session Road, talking to a salesperson or bank teller, riding a jeepney) is highly improbable. Even the health personnel directly treating a meningococcemia patient are at little risk of getting the disease, unless they perform mouth-to-mouth resuscitation or intubation.

Those at highest risk of acquiring the bacteria are the persons living in the same household as the patient since they have prolonged close contact with the patient. Dr. Sally Gatchalian of the Research Institute for Tropical Medicine (RITM) gave other concrete examples of close contact: recent visitors who stayed overnight at the patient’s house within the seven days before onset of illness, bus/ airplane passengers who have sat next to a patient for 8 hours or more, and children and school staff staying in the classroom of a patient for at least four hours straight.

Gatchalian also corrected the notion that the disease is spread through salivary contact. She clarified that the organism lives in the nose and throat, and may actually be killed by other bacteria living in the saliva. Therefore, prolonged exposure to a coughing/ sneezing patient is more contagious than exposure to saliva through the sharing of food, drinks or utensils.

How does meningococcemia cause disease?

These bacteria are normally found in the nose and throat of 1-2% of infants and 15-25% of adolescents. In the general community, usually less than 5% carry the bacteria. Most of these so-called carriers remain asymptomatic.

Meningococccal infection occurs when a disease-causing strain of the bacteria lodging in the nose and throat of a person is able to overcome the body’s natural defenses. The bacteria then proceed to invade the lining of the nose and throat and/or the bloodstream. It can then cause meningitis (inflammation of the covering of the brain). It can also lead to kidney and heart failure.

What are the signs and symptoms of meningococcemia?

The incubation period (the period when the bacteria lodges in a person up to the time he/she first develops symptoms) lasts for 2-10 days, with an average of 3-4 days. The DOH has advised that any patient with the following signs and symptoms should be admitted as a possible case of meningococcemia: sudden onset of high-grade fever, rash and rapid deterioration within 24 hours, with or without signs of meningitis (such as very stiff neck, headache, vomiting, drowsiness, etc.).

In general these symptoms are found in combination. Meaning when one just has a headache, it does not necessarily mean you have meningococcemia already.

Do all patients with meningococcemia die?

With prompt treatment, only 7-19% of patients with meningococcemia die. Other sources say that one in 10 persons may die. In addition, another one in 10 will experience permanent disabilities such as deafness or brain damage.

Treatment is with antibiotics such as penicillin and chloramphenicol for 4-5 days. These antibiotics are readily available and relatively cheap.

Government response

To address the increasing number of cases in the city, the City Health Emergency Response Team launched a massive education campaign, cleanliness drive and distribution of preventive antibiotics. The team also cited the strict implementation of city laws and ordinances like anti-spitting, anti-littering and anti-vagrancy. Illegal stalls along Blocks 3 and 4 of the City Public Market have been the targets of series of demolitions being implemented by the City Engineer’s Office.

Mass immunization or vaccination, though seen by some sectors here as the most effective solution to control the disease, is not being advocated by the Baguio Health Department (BHD) and the DOH. In communities where the vaccine has actually been used, it has been documented to be 79-88% effective.

Gatchalian emphasized that mass immunization is not being recommended at this time. Even if mass vaccination were to be done, she said, only those at highest risk of exposure (for example, household contacts, those living in the same geographic area) or at highest risk of dying (for example, those below 2 years old) would be targeted. The vaccine only gives 3-5 years protection. Re-vaccination may have to be done after this period should another outbreak occur. Aside from this, they also cited that mass immunization is too expensive and that the vaccines are not readily available.

When asked by concerned residents on their opinion regarding vaccination for protection, Gatchalian and Dr. Florence Reyes were quick to say that anyone who can afford the vaccine should avail of it by all means. According to Reyes, the bivalent vaccine (for the a and c strains) costs P920 while the quadrivalent (for the a, c, w and y strains) vaccine costs P1,600. Since the start of the year, there has been an increase in the vaccines’ price rates. Supply has also become scarce. The bivalent vaccine in private clinics is at P1, 500, while the quadrivalent vaccine is at P2,300.

People’s response

There has been a range of responses from the public regarding the issue. Debates over the management of public health vis-à-vis tourism and economic issues have become more heated especially with the confusion over the “state of calamity” declaration in the city. Some sectors blamed the mass media for “irresponsible reporting.”

As fear continues to grip a considerable number of the Baguio City population, concerned residents have expressed in different occasions that the city government must be more decisive in addressing the problem. They also hope for this “health crisis” to end. # Ana Marie Leung, MD and Audrey Mary Beltran for NORDIS

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