Published Date: 2009-01-17 18:00:43
Subject: PRO/EDR> Meningitis, meningococcal - India: (ML)
Archive Number: 20090117.0206

MENINGITIS, MENINGOCOCCAL - INDIA: (MEGHALAYA)
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Date: Tue 13 Jan 2009
Source: The Assam Tribune [edited]
<http://www.assamtribune.com/scripts/details.asp?id=jan1409/ne4>


After meningococcal meningitis claimed 132 lives in Meghalaya, the Centre
has rushed in a team from the National Institute of Communicable Diseases
(NICD) to assist the health officials. The NICD team is being led by joint
director[s? - Mod.SH] Jagdir Singh and S Gupta to help the Meghalaya Health
department to combat the disease.

"NICD with its expertise would help the State Health department to tackle
the disease," director of health services (DHS) Dr A Kynjing said.

Cases of meningococcal meningitis have been reported from all parts of the
state but mostly from areas like Jhalupara, Mawlai, Lumparing and
Nongmynsong in East Khasi Hills here and in areas in Garo Hills from last
year [2008]. The death toll has reached 132 according to the health
department. However, unconfirmed reports put the death toll much higher.

Meningitis affects the membrane around the brain called the meninges.
Infected fluid from meninges run into the spinal cord causing stiff neck,
fever and rash. If left untreated the disease can be fatal.

The health department has been accused of not keeping enough stock of the
anti-meningococcal meningitis vaccines for the affected people. The vaccine
costs about Rs 360 [USD 7.38] in private hospitals.

Dr Kynjing refuted the allegation, saying there were "enough stock of the
vaccines" in the health department. "We get the vaccines from the Centre
and as of now we have enough stock and people should not panic," he
assured. The health official added that a massive public awareness campaign
has been launched to emphasise the importance of cleanliness to prevent
spread of this airborne disease. Dr Kynjing further urged the public to
join in and help the Health department to help prevent further spread of
the disease.

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communicated by:
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[An outbreak of meningococcal meningitis was previously reported in
Meghalaya in April 2008 that involved 300 cases with 30 deaths
(<http://www.theshillongtimes.com/a-29-April.htm>). In an undated article
from the same website (<http://www.theshillongtimes.com/shillong.html>),
the state Health Department was said to be "considering the option of mass
vaccination to control this disease but added that it would involve huge
financial implications and manpower. In view of limited supply of vaccines
in the market, the government may provide vaccines only to the age group
that has been worst affected by meningococcal meningitis. 'So far,
preventive medicines [chemoprophylaxis] have been provided only to those
families having one of its members infected with the virus. To a certain
extent, preventive medicines have also been provided in a number of
schools,' sources said."

Chemoprophylaxis is used to prevent secondary cases of _Neisseria
meningitidis_ infection, which usually occur within 10 days of the primary
cases among certain high-risk groups. These groups include household
contacts, closed populations living with cases in college dormitories,
long-term care institutions, nursery schools, or military barracks, and
close social contacts who are directly exposed to a case's oral secretions,
for example by kissing, sharing eating utensils, or toothbrushes, in the
week prior to onset of illness in the primary case. Appropriate
chemoprophylactic drugs include rifampin, ciprofloxacin, or ceftriaxone.

To control an outbreak, WHO recommends mass vaccination with the
appropriate serogroup-specific meningococcal vaccine, depending on
availability, in every involved district in an attempt to induce herd
immunity (whereby transmission is blocked when a critical percentage of the
population have been vaccinated
(<http://www.who.int/mediacentre/factsheets/fs141/en/>). However, the
serogroup(s) of _N. meningitidis_ involved in the current or past outbreaks
in Meghalaya is not specified in the above news releases.

Outbreaks of serogroup A meningococcal meningitis in and around Delhi,
India, have been documented in 1966, 1985, and 2005
(<http://www.who.int/csr/don/2005_05_09/en/index.html>). To the north,
there was an epidemic of serogroup A meningococcal meningitis in the
Kathmandu valley of Nepal from 1982-84
(<http://www.who.int/csr/don/2005_05_09/en/index.html>). In 1984, a
widespread vaccination program prevented a 2nd epidemic
(<http://ije.oxfordjournals.org/cgi/content/abstract/16/1/91>). Cases of
meningococcal meningitis occurred in foreigners in Nepal at the time,
mostly in trekkers that led to the CDC to issue a travel advisory notice
recommending the meningococcal meningitis vaccine for all travelers to
Nepal that was later lifted
(<http://wonder.cdc.gov/wonder/prevguid/p0000259/p0000259.asp>).
Meningococcal meningitis was also noted in Bhutan from 1985-1986
(<http://web.gideononline.com/abstract.php?module=epidemiology&disease=11480&view=Distribution&country=G122>).
Meghalaya, a mountainous Indian state, is located between the north eastern
border of Bangladesh and the Indian state of Assam. Meghalaya consists of
the 7 districts: East Garo Hills, East Khasi Hills, Jaintia Hills, Ri-Bhoi,
South Garo Hills, West Garo Hills and the West Khasi Hills
(<http://en.wikipedia.org/wiki/Meghalaya>). Its capital and largest city is
Shillong. A map of India can be found at
<http://healthmap.org/promed/en?v=22.9,79.6,5>. - Mod.ML]

See Also

2005
---
Meningococcal disease - India (New Delhi) (06): spread 20050512.1299
Meningococcal disease - India (New Delhi) (05): spread 20050511.1295
Meningococcal disease - India (New Delhi) (04) 20050510.1287
Meningococcal disease - India (New Delhi) (03) 20050509.1273
Meningococcal disease - India (New Delhi) (02) 20050508.1269
Meningococcal disease - India (New Delhi) 20050506.1256

....................ml/ejp/sh


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