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Meningococcal Meningitis (Menveo and Menomune)
KEY POINTS
- The bacterial agent of this disease is carried in the respiratory passages and transmitted through casual contact in close quarters (shared air-space), such as in school dormitories and military barracks.
- Meningococcal meningitis is yearound and worldwide, but tends to occur in certain locations epidemically (such as during the annual Islamic Haj pilgrimage from Mecca to Medina).
- In the U.S., most children are increasingly required by colleges to receive this vaccine prior to entry.
Disease: Neisseria meningitidis, a bacterium, can cause systemic illness by bloodstream infection (meningococcemia) or central nervous system infection (meningitis).
Symptoms:
- Fever
- Headache
- Rash (hemorrhagic)
- Neurological findings/deficits
- Stiff neck
- Light aversion (photophobia)
Transmission:
- Airborne aerosols
- Kissing
- Contact with objects freshly contaminated with infectious nasal secretions (cigarettes, food, beverages, eating utensils, lip gloss)
Prevalence:
- Sub-Saharan “meningitis belt” from Senegal and Guinea to Ethiopia in the dry season (December – June); also the Middle East and parts of Asia
- Worldwide in overcrowded, impoverished areas; outbreaks also occur in childcare centers, schools, colleges, military barracks settings, etc.
- Risk to travelers is low, but increases with length of stay in high-risk areas and contact with the local populace. The highest rates of meningococcal disease are in 16 – 21 yrs. old. It is the leading cause of bacterial meningitis in children 2 – 18 yrs-old in the U.S.
Treatment: Antibiotics
Prevention
- The Vaccines (Menveo; Menomune)
- Menveo (2 – 55 yrs-old)
- Covers meningococcal bacterial serogroups A, C, Y, and W135
- Given intramuscularly, 0.5cc
- Certified by Islamic Services of America as suitable for Hajj (Mecca to Medina) pilgrimage.
- Dosing:
- Non-Immune Compromised
- Adults – 1 dose; booster every 5 yrs.
- Adolescents
- If 1st dose at 11 – 12 yrs, booster at 16 yr
- If 1st dose at 13 – 15 yrs, booster at 16 – 18yrs (or up to 21yrs)
- Children – booster after 3 yrs; if 1st dose at 16 yrs-old, no routine booster needed; unless high risk exposure, as under “Targets”.
- Immune compromised: Initially, 2 doses, 8 weeks apart
- The vaccine should be received 1 – 2 weeks pre-travel for protection.
- Non-Immune Compromised
- Menomune (Over 55 yrs-old)
- Covers bacterial serogroups A, C, Y, and W135
- Given subcutaneously, 0.5cc
- Certified by Islamic Services of America as suitable for Hajj (Mecca to Medina) pilgrimage.
- Dosing
- Single dose for adult
- Booster: 2 – 3 yrs after 1st dose
- Side-Effects
- Menveo: Common adverse effects are injection site pain, headache, muscle aches, malaise, and nausea.
- Menomune: very infrequent adverse reactions; mainly local redness 1 – 2 days after injection
- Guillaine-Barre’ syndrome (polyneuritis) risk unknown with meningococcal vaccines
- Precautions/Contraindications
- Postpone vaccination with moderate illness.
- Menomune may be a risk with latex allergy.
- In immune compromised, response to the vaccine may be suboptimal (discuss with a physician).
- Use with pregnancy only if clearly indicated (definitive disease risk).
- Caution use with breastfeeding.
- Targets
- Required for travelers to Saudi Arabia for Hajj pilgrimage or Umra.
- Exposure to active meningococcal disease case
- Freshman college students entering dormitory
- HIV, persistent complement deficiency, diminished spleen function
- Travelers to Africa’s sub-Saharan “meningitis belt” during December – June (dry season)
- Travelers entering a country endemic for N. meningitidis when disease activity is increased
- Military recruits
- Occupations with exposure to N. meningitidis
- All 11yrs-old
- Menveo (2 – 55 yrs-old)
- Special Considerations
- Travelers arriving in the African meningitis belt, in addition to being required to show proof of vaccination, will also be given a preventive antibiotic (by mouth) at the point of entry.
- Anyone participation in the Hajj pilgrimage will be required to show proof of meningococcal vaccination within the prior 3 yrs.
- Meningococcal vaccine can be given concurrently with other vaccines except in those with sickle cell disease or without a spleen.
- Other Preventive Measures
- In areas where N. meningitidis is endemic (naturally present),
- Avoid crowded places (to minimize direct human contact).
- Avoid being near those sneezing and coughing.
- Do not share drink containers, cigarettes, lip gloss/balm.
- Wash hands frequently.
- In areas where N. meningitidis is endemic (naturally present),
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