Call for more doctors to help defeat meningitis and promote vaccination
Invasive meningococcal disease (IMD) is caused by the Gram-negative bacterium Neisseria meningitidis, and can lead to serious manifestations, including meningitis and septic shock, if left untreated.1 It is for this reason that the Confederation of Meningitis Organisations advocates greater communication around signs and symptoms of meningitis, the importance of urgent treatment, and the fact that prevention is available through vaccination.2
Although uncommon, IMD in South Africa is a devastating illness largely affecting young children3 and can take a life in under 24 hours.2 In 2017, in-hospital case fatality in South Africa was 17%, with 21% of survivors suffering sequelae after discharge from hospital.3 Severe long-term consequences include neurological problems like deafness and brain damage leading to severe cognitive and functional problems, and can include limb amputations in the case of septic shock.1
Up to 10% of the South African population are asymptomatic carriers of N. meningitidis, which is a prerequisite for invasive disease.4 However, carriage is higher among children and adolescents.4 In industrialised countries, up to 25% of teenagers (aged 15–19 years) may unknowingly carry and transmit the disease.4
According to Dr Nasiha Soofie, Medical Head for Sanofi Pasteur Vaccines in South Africa: “When someone has IMD, it is important to act fast. Unfortunately, not many people know about the disease, and the symptoms can easily be confused with other diseases like the flu, malaria or COVID-19.”2
Although all ages may be affected, the highest incidence occurs among children younger than 10 years, and especially infants.5,6 “Younger children are at higher risk, but may not be able to articulate effectively that they are not feeling well and what their symptoms are. A delay in diagnosis and treatment claims lives, and leaves many others with serious lifelong after-effects.”2 says Dr Soofie. These facts are all the more tragic since meningitis can be prevented by immunisation.7
Meningococcal conjugate vaccines have been available in South Africa since 2014.4 Where possible, quadrivalent conjugate meningococcal vaccines are preferable to polysaccharide vaccines, given their ability to induce immune memory, allow for booster responses and eliminate carriage of the organism in the person vaccinated.4 They can be administered in conjunction with other childhood immunisations and can also be used during pregnancy after first having a risk assessment and consultation with a healthcare professional.4
Menactra is a quadrivalent meningococcal vaccine targeting serotypes A, C, W and Y, which were the most common N. meningitidis serotypes in South Africa between 2003 and 2015.4,8 Unlike polysaccharide vaccines, because it is a protein-conjugate polysaccharide vaccine, Menactra stimulates immune memory and induces mucosal immunity – meaning it not only provides protection against invasive disease but also decreases carriage of the organism.4 It is indicated for routine active immunisation for individuals aged 2 to 55 years.8 Children older than 2 years, adolescents and adults require a single primary dose.4,8 Local guidelines also recommend vaccination of infants aged 9 to 23 months, who require two primary doses separated by an interval of 12 weeks.4
Menactra vaccination is recommended especially for people at higher risk of acquiring meningitis.4 In addition to immunocompromised individuals, consideration should be given to healthy infants, young children attending creche and school children, university students, army recruits and others living in crowded conditions, people attending mass gatherings (e.g., sporting events) and those travelling to hyperendemic areas.4
“The impact of COVID-19 has led to some people missing their immunisations – and the number of meningitis cases may be expected to rise when groups are able to gather together again. Healthcare professionals play a vital role in creating awareness of IMD by empowering patients to make informed decisions in accordance with IMD guidelines. Saving a life is as easy as ensuring that patients and consumers are advised accordingly,” says Dr Soofie.
“It’s often said that vaccines save lives, but this is not strictly true – it is vaccination that saves lives.9 It is imperative that we all work together to ensure that a high level of coverage is achieved among those populations where vaccines are recommended.”9
“It is incumbent on all of us to stress the importance of vaccination to our patients and colleagues – both for the individual who is vaccinated as well as the communities they live in.9 Together we can defeat meningitis,” says Dr Soofie.
1 Brandwagt DAH, Van der Ende A, Ruijs WLM, De Melker HE, Knol MJ. Evaluation of the surveillance system for invasive meningococcal disease (IMD) in the Netherlands, 2004–2016. BMC Infect Dis.; 2019;19:860. Available from: https://bmcinfectdis.biomedcentral.com/articles/10.1186/s12879-019-4513-2#:~:text=Invasive%20meningococcal%20disease%20(IMD)%20is,including%20meningitis%20and%20septic%20shock.
2 Confederation of Meningitis Organisations. World Meningitis Day 2021. Available from: https://www.comomeningitis.org/world-meningitis-day-2021. Accessed 8 March 2021.
3 Meiring S, Cohen C, De Gouveia L, et al. GERMS-SA Annual Surveillance Report for Laboratory-Confirmed Invasive Meningococcal, Haemophilus Influenzae, Pneumococcal, Group A Streptococcal and Group B Streptococcal Infections, South Africa, 2019. Public Health Surveillance Bulletin. 2020;18(3):187.
4 Meiring S, Hussey G, Jeena P, et al. Recommendations for the use of meningococcal vaccines in South Africa. S Afr J Infect Dis. 2017;32(3):82-86.
5 National Institute for Communicable Diseases (NICD). Meningococcal disease update – January to September 2019. Communicable Diseases Communiqué. 2019;18(10). Available from: http://www.nicd.ac.za/wp-content/uploads/2019/10/NICD-Communicable-Diseases-Communique_Oct2019_final.pdf.
6 National Institute for Communicable Diseases (NICD). Invasive meningococcal disease surveillance update: January to June 2019. Communicable Diseases Communiqué. 2019;18(7). Available from: http://www.nicd.ac.za/wp-content/uploads/2019/07/Invasive-meningococcal-disease-surveillance-update_January-to-June-2019.pdf
7 World Health Organization. Preventing and controlling meningitis outbreaks. Available from: https://www.who.int/activities/preventing-and-controlling-meningitis-outbreaks. Accessed 8 March 2021.
8 Menactra Package Insert. Sanofi-Aventis, South Africa; March 2014.