Invasive Meningococcal Disease Flashcards

Question

Describe petechiae

Answer 1

Rash does not fade if you press the side of a clear glass firmly against the skin. The rash can be harder to see on brown or black skin: Check paler areas, such as the palms of the hands, soles of the feet, roof of the mouth, tummy, whites of the eyes or the inside of the eyelids.

Answer 2

Sepsis can cause Disseminated Intravascular Coagulation (DIC) – the activation of coagulation pathways that results in formation of intravascular thrombi (clots) and depletion of platelets and coagulation factors. These clots can cause arterial occlusions leading to gangrene of extremities & auto-amputations (spontaneous detachment of an appendage from the body).

Answer 3

- Acute onset - Fulminating infection (death can occur rapidly) 5% in meningitis, 22% in septicaemia. Prolonged and persistent coccaemia. Survivors may have long term sequelae (deafness, seizures, motor deficit, amputations).

Answer 4

Specimen should be collected ideally before initiating ABx treatments (but treatment should be started before Dx). - Blood culture and PCR - CSF for microscopy, culture and PCR - Aspirate from sterile sites - Throat swab for culture - Acute serum for enhanced surveillance.

Answer 5

Legal requirement to report it to regional UKHSA.

Answer 6

Contact tracing Chemoprohylaxis Vaccination Alerting and informing close contacts and the public.

Answer 7

Confirmed (by lab). Immediate action. Probable case (no lab confirmation, but meningococcal disease is most likely). Immediate action. Possible (no lab diagnosis and other diagnosis is equally likely). No immediate action.

Answer 8

Close contacts are identified as : * People living in the same household as the case * Anyone who slept overnight in the same household as the case in previous 7 days * Other household members if case stayed overnight elsewhere in previous 7 days * Intimate kissing contacts in last 7 days

Answer 9

ABx is given to eradicate throat carriage! Ciprofloxacin (all age groups, even in pregnancy). Single dose, does not interact with oral contraceptives, readily available. Rifampicin (alternative).

Answer 10

In cases caused by vaccine preventable strains, vaccination would be expected to reduce the long-term risk of disease in close contacts within a week.

Answer 11

Rare <5% cases occur in clusters. Most common in teenagers/youths. Outbreaks occur in schools/colleges. Action depends on: Attack rate Isolation of the same organism Establishing a link between cases Public anxiety

Answer 12

Two probable or confirmed cases of the same type within 4 weeks.

Answer 13

Occurs sporadically, and in small clusters worldwide Seasonal variation: October-May in Northern Hemisphere Groups B&C most common in Europe and Americas Group A most common in Africa and Asia.

Answer 14

New conjugate Men A vaccine -> delivered to 284 million people, affordable 40c per dose.

Answer 15

Dry season (Dec – Jun) dust laden winds. Upper Respiratory Tract Infection (URTI) due to cold nights. Decrease in “local immunity” in pharynx. Overcrowded housing. Large population displacements due to pilgrimages and traditional markets. Herd immunity leads to cyclical epidemics

Answer 16

Elimination of bacterial meningitis epidemics. Reduction of cases of vaccine-preventable bacterial meningitis by 50% and deaths by 70%. Reduction of disability and improvement of quality of life after meningitis due to any cause.

Answer 17

Men A&C polysaccharide (travel to Africa). Men C conjugate introduced into routine childhood schedule in 1999. Also used for close contacts of confirmed Group C disease. Quadrivalent Men ACWY – advised for the Hajj and close contacts of W135 or Y disease. New Men B vaccine. 4CMenB protein vaccine (Bexsero®, GSK) In 2013, a four-component protein-based meningococcal B (4CMenB) protein vaccine (Bexsero®) was licensed authorised for children and adults in Europe. The vaccine is estimated to protect against 66-88% of MenB strains in England and Wales (Parikh et al., 2017). 4CMenB has been very effective in preventing MenB disease in infants and toddlers since its implementation into the UK national infant immunisation programme in September 2015 (Ladhani et al, 2020). 4CMenB can also protect against infection by sero groups other than MenB (Ladhani et al, 2021).

Answer 18

Polysaccharide vaccines give only short term (3-5 years) protection. Polysaccharide vaccines will not evoke an immune response in children under 2 years.

Answer 19

Polysaccharide-conjugate vaccines are immunogenic across all ages. In infants and young children, conjugation increases the immunogenicity of the vaccines compared to polysaccharide only vaccines. Prevents acquisition of carriage so interrupt transmission of meningococci to others and induces population protection. Serogroup specific and do not provide any cross-protection against other meningococcal serogroups.

Answer 20

Biologically difficult to produce. Antigenically similar to brain protein. In UK, multiple strains of serogroup B, so not easy to produce a “one size fits all” vaccine. Group B vaccine developed, given routinely for infants, but issues with uncertain effectiveness and high costs. Not used in outbreaks.