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Maintaining our rationality at a time of Meningo panic

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 Department of Health 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 I need to wear a mask constantly?

Dr. Gatchalian expressed the opinion that wearing of masks is unnecessary since the bacteria is not that easily spread.

When should I take medicines for prophylaxis?

Prophylactic medicines (rifampicin or ciprofloxacin) should be taken by the household contacts of a suspected case within 24 hours after diagnosis of the case.

Since patients with TB (tuberculosis) or primary complex (TB in children) are already taking rifampicin, then it is like they are already taking prophylaxis against meningo.

Prophylaxis serves two purposes: (1) to prevent those exposed from developing the disease and (2) to prevent the further transmission of the disease.

Dr. Gatchalian emphasized that the greatest risk for spread of meningococcemia is when the household contacts do not take their prophylaxis. She surmised that this may have been the reason why meningococcemia resurfaced this December-January after it was initially controlled.

Should I get immunized?

The bacterial strains that cause disease are A, C, B, Y and W135. In the present setting, it is A that has been isolated. Therefore, the bivalent vaccine which produces resistance to strains A and C will give adequate protection at this time. (‘Bivalent’ means that the vaccine works against 2 strains as opposed to the more expensive quadrivalent vaccine which works against 4 strains.)

Dr. Gatchalian made clear that mass immunization is NOT being recommended at this time. Even if mass vaccination were to be done, only those at highest risk for 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.

Any one who can afford the vaccine may also get it.

However, the vaccine only gives 3-5 years protection. Re-vaccination may need to be done after this period should another outbreak occur.

The vaccine is administered intramuscularly (deep in the muscle of the upper arm) or subcutaneously (just under the skin). Usual side effects are pain and reddening around the injection site for 2 days. Rare side effects include the development of a severe allergic reaction.

The vaccine is safe for use among pregnant women after the 1st trimester. If the pregnant woman is exposed during the 1st trimester, she and her physician must weigh the costs/ benefits of getting the immunization anyway.
In communities where the vaccine has actually been used, it has been documented to be 79-88% effective.

What else can I do to avoid getting meningococcemia?

Maintain your natural resistance through good nutrition and a healthy lifestyle. Viral infections may make one more susceptible to meningococcemia.
Stop smoking and avoid cigarette smoke. Cigarette smoke destroys the natural defense mechanisms of the nose and throat and has been associated with an increased risk of developing the disease.
Avoid crowded places.# Dr. Ana Leung, Executive Director, Community Health Education Services and Training in the Cordillera (CHESTCORE) and Chairperson of St. Louis University’s Department of Preventive and Community Medicine.

*A lecture on meningococcemia by Dr. Sally Gatchalian, held last 6 January at the Cancer Building, DOH Compound, shed some rationality on the present meningococcemia scare. Dr. Gatchalian is a renowned pediatrician and Assistant Director at the Research Institute for Tropical Medicine (Alabang, Manila). The jam-packed auditorium was filled with physicians and other health personnel, members of media and concerned citizens of Baguio.

Dr. Gatchalian’s lecture as well as other references were used in writing this article.

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