It does not take long for news to travel through the expatriate
community on the jungle drums, especially when a serious health
issue is a concern. This week it seems that meningitis is
the hot topic for discussion, following what seemed to be
a nasty case of the disease here in the expatriate community
requiring emergency medical evacuation for intensive treatment
overseas.
What is the difference between “Meningococcal”
and “Meningitis”?
The term “meningitis” just means “inflammation
of the brain”. There are many different kinds of Meningitis,
with equally as many causes (bacterial, viral, fungal, trauma).
The Meningoccocal Meningitis is one of the most likely cause
of infectious meningitis, and is caused by a bacteria –
Neisseria Meningitidis. There are several different strains
of this bacteria, namely the types A, B, C, W135 & Y.
The Meningococcal can present it self as a brain infection
or a septicemia (general infection of the bloodstream). Once
the disease has progressed to septicemia, it may cause bleeding
into the tissues (purple / red spots under the skin) and eventually
cause death of the peripheral tissues (fingers, toes, feet).
This may result in amputation of the affected limbs and even
death of the victim.
In 2000, 388 cases of Meningococcal were reported in Australia,
and 25 of those were fatal. No accurate figures are available
for Indonesia, but I imagine that the figures are very similar.
In this part of the world types B (affecting mostly young
adults) and C (affecting mostly babies and young children)
are of concern, and certainly cause the most severe cases
of the disease.
What are the symptoms of Meningococcal?
Early Meningococcal disease symptoms can be very similar to
a flu or heavy cold. This can be confusing and may potentially
delay a definitive diagnosis. The onset of Meningococcal is
very sudden (within hours to a few days) and symptoms in adults
may include:
· Headache.
· Fever.
· Neck stiffness.
· Nausea and vomiting.
· Photophobia (light hurts the eyes).
· Altered mental status.
· A rash of purple red spots (not apparent in every
case).
·
In babies and younger children you may expect to see all of
the above as well as:
· Refusing feeds, loss of appetite.
· High pitched cry or moan.
· Difficult to rouse / drowsy.
Any one with the above symptoms should consult their doctor
immediately as delay in diagnosis and treatment can worsen
the outcome.
How is Meningococcal spread?
Meningococcal is spread by bacteria found in the nose and
throat of healthy children and adults. 10 - 20% of the population
carry the Niesseria bacteria and are unaffected by the disease.
The reason why some people develop or pass on the disease
is not clear. The bacteria are not able to survive for long
periods outside of the body, and dies very quickly in an unfavorable
environment. It is spread by close contact such as kissing,
sharing drinks or eating utensils. It IS NOT spread by swimming
pools, water supplies, animals, air-conditioning vents etc.
How is Meningococcal treated?
Once Meningococcal is diagnosed with examination of the spinal
fluid (lumbar puncture), it is treated with very specific
antibiotics. The patient is generally very ill and will be
kept in an intensive care unit until their condition is stable.
Close contacts of the patient must also be treated with prophylactic
(preventative) antibiotics that will stop them from the developing
the disease. The person affected by Meningoccocal will remain
infectious for as long as there are bacteria in the nose or
throat. This may be days or weeks after therapy has commenced.
What about a Vaccine?
A vaccine is available against Meningococcal Type C. In infants
3 doses of the vaccine are required to give life long immunity.
In Older children and adults, only one dose will give life
long protection. A combined vaccine against Types A,C,W135
&Y is available for adults and children over 2 years of
age. Only one dose of the vaccine is required initially, but
it does need to be boosted every 3 years. There is currently
no vaccine available against Meningococcal type B.
Vaccination with the Hib and pneumoccocal (Prevenar) vaccines
DO NOT protect against the Meningococcal meningitis. These
vaccines give immunity against the hemophillus Influenza Type
B and pneumococcal bacteria that can cause a different kind
of meningitis in children.
No vaccine is 100% effective, so please have your child assessed
by a medical practitioner if they demonstrate any disease
symptoms even after they have been vaccinated.
Post Exposure Prophylaxis (Safeguard Treatment)
If someone you know is suspected of having meningococcal,
you must take a prophylactic dose of antibiotic (usually Ciproflaxacin)
to avoid contracting the disease. Your local GP can advise
you on the correct dose and course for post exposure prohylaxis.
“Kim Patra is a qualified Registered Nurse and Midwife
that has been living and working in Bali for almost twenty
years. She now runs her own private practice and medical referral
service from her Kuta office. Kim is happy to discuss any
health concerns with you and she may be contacted via e-mail
at info@chcbali.com or Hp. 081 2366 0000”.
