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Chapter 8 : Patterns in the Emergence of Epidemic Meningococcal Disease

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Patterns in the Emergence of Epidemic Meningococcal Disease, Page 1 of 2

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Abstract:

This chapter reviews several recent surges in disease activity caused by the three main meningococcal serogroups (A, C and B) in the 1990s and discusses current and future strategies for prevention. The mortality rate of untreated meningococcal meningitis has not been recorded recently but was reported to be as high as 75% in the preantibiotic era. The precise reason for the distinct seasonality is unclear but may be related to the drying effect on mucous membranes, seasonal transmission of respiratory viruses, or other factors. More importantly, drying of the nasopharyngeal mucosa or intercurrent respiratory tract infections may contribute to invasiveness, transmission of carriage, or both. Complete immunization coverage with the polysaccharide vaccine is critical to halt epidemic disease. In the early 1990s, public health personnel in Oregon noticed increasing rates of meningococcal disease in the general population but surprisingly not in focal outbreaks. The epidemiologic pattern of disease was similar to endemic patterns in most respects, including seasonality, sex distribution, and mortality rates. A constant low level of disease is caused by a variety of serogroups and, within each serogroup, a variety of individual strains. The recent history of meningococcal disease outbreaks due to serogroups A, B, and C suggests that epidemic strains will continue to arise and cause major public health crises in both developing and developed countries.

Citation: Wenger J, Perkins B. 1998. Patterns in the Emergence of Epidemic Meningococcal Disease, p 125-136. In Scheld W, Armstrong D, Hughes J (ed), Emerging Infections 1. ASM Press, Washington, DC. doi: 10.1128/9781555816940.ch8
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Figure 1.

The sub-Saharan African meningitis belt.

Citation: Wenger J, Perkins B. 1998. Patterns in the Emergence of Epidemic Meningococcal Disease, p 125-136. In Scheld W, Armstrong D, Hughes J (ed), Emerging Infections 1. ASM Press, Washington, DC. doi: 10.1128/9781555816940.ch8
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Image of Figure 2.
Figure 2.

Epidemiology of meningitis in Niger, a country located in the African meningitis belt from 1919 through 1989. (Reprinted from reference with permission.)

Citation: Wenger J, Perkins B. 1998. Patterns in the Emergence of Epidemic Meningococcal Disease, p 125-136. In Scheld W, Armstrong D, Hughes J (ed), Emerging Infections 1. ASM Press, Washington, DC. doi: 10.1128/9781555816940.ch8
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Image of Figure 3.
Figure 3.

Epidemic curve from a group A meningococcal disease epidemic in Nairobi, Kenya, in 1989, The solid line shows the actual number of cases which occurred by week, including those that occurred after mass immunization campaigns. The dashed line shows modelled data with the estimated number of cases which would have occurred without any vaccination program. The space between these two lines represents the number of cases actually prevented, However, the dotted line shows modelled data of the number of cases which would have been prevented if immunization had been carried out according to the time line set forth in the Current World Health Organization guidelines, and it shows that a much larger number of cases were preventable by mass vaccination ( ).

Citation: Wenger J, Perkins B. 1998. Patterns in the Emergence of Epidemic Meningococcal Disease, p 125-136. In Scheld W, Armstrong D, Hughes J (ed), Emerging Infections 1. ASM Press, Washington, DC. doi: 10.1128/9781555816940.ch8
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Image of Figure 4.
Figure 4.

Incidence of reported meningococcal disease in the United Stales by year from 1920 through 1995.

Citation: Wenger J, Perkins B. 1998. Patterns in the Emergence of Epidemic Meningococcal Disease, p 125-136. In Scheld W, Armstrong D, Hughes J (ed), Emerging Infections 1. ASM Press, Washington, DC. doi: 10.1128/9781555816940.ch8
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Image of Figure 5.
Figure 5.

Multilocus enzyme electrophoresis dendrogram of serogroup B meningococci showing the location of the ET-5 complex. (From reference .)

Citation: Wenger J, Perkins B. 1998. Patterns in the Emergence of Epidemic Meningococcal Disease, p 125-136. In Scheld W, Armstrong D, Hughes J (ed), Emerging Infections 1. ASM Press, Washington, DC. doi: 10.1128/9781555816940.ch8
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