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Disease

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Meningococcal disease, also known as meningitis, is caused by the bacteria known as Neiserria meningitids, and is one of the leading causes of bacterial meningitis worldwide. Outbreaks of this disease are rare in the United States but are very common along an area of sub –Saharan African called the African Belt. The African Belt stretches from the Senegal in the west to Ethiopia in the east with 26 countries involved where it contains the highest rates of the disease. (Who, 2015). Neiserria meningitids is carried in the throat and is transmitted from person to person through droplets of respiratory or throat secretions from carriers. It is secreted from prolonged kissing, sneezing or coughing on someone or by living in close quarters. There is an incubation period of about 4 days before symptoms start to occur. Symptoms of meningitis include a stiff neck, high fever, confusion, headaches vomiting, and sensitivity to light. Meningococcal disease can be a potentially fatal disease if not treated right away. Patients must have a lumbar puncture performed so that spinal fluid can be examined and antibiotics, such as penicillin and ceftriaxone must be given as soon as possible. Sometimes the infection can be severe enough that death or serious long term problems can occur. About 11 to 19 out of every 100 survivors will have long term disabilities such as loss of limb, deafness nervous system problems or brain damage. (CDC, 2015). Meningococcal disease is influenced by a person’s age group, economic condition, and serogroup. Serogroups A, B, and C account for the largest amount of disease worldwide with Serogroup A as the predominant cause of the outbreaks reported in the African meningitis belt. Meningococcal disease can occur sporadically throughout the world in different seasons. The numbers increase during the winter and spring in the temperate regions such as Europe and the Americas. Some reported cases have been in Canada and the USA in 1992 to 1993 and in Spain in 1995 to 1997. Mongolia has reported to have a large epidemic in 1995 to 1995. There has been an increase in the meningococcal disease in New Zealand reporting an average of over 500 cases occurring yearly. Epidemics of meningococcal disease has been reported from the African continent since 1909 with largest and most frequently occurring outbreaks in sub-Saharan Africa. There are a total of 300 million people who live in this area known as the African meningitis belt. These epidemics occur in seasonal cycles between December to June and end when the rainy season occurs. These epidemic cycle last between 8 to 15 years. The most recent meningococcal meningitis pandemic began in the mid-1990s. In 1996, almost 190,000 cases were notified to WHO in Burkina Faso, Chad, Mali, Niger, Nigeria and other countries. (WHO, 2016). Another 6 countries in the meningitis belt experienced a large epidemic in 2001 which included: Benin, Burkina Faso, Central African Republic, Chad, Ethiopia, Niger. In the United States there has been a decline of meningococcal disease since the late 1990s. The total number of cases reported since 2013 were 550. The African countries in the meningitis belt face higher incidence of meningococcal disease due to their poor living conditions and overcrowding of areas and displacements due to pilgrimages. The climate that they live in poses a huge risk factor for the people of Africa due to drought and dust storms that run through their countries. Due to the dust winds and upper respiratory tract infections because of the colder nights, local immunity of the pharynx is diminished increasing their risk for meningitis. One of the largest risk factors for Africa is the medical conditions of their people and the immunological susceptibility of the population. Due to herd immunity the epidemic will occur in a cyclic mode (WHO, 2016). With a major African epidemic, the attack rates can range from 100 to 800 per 100,000 population with the highest attack rates in the endemic disease found in children and during an epidemic older children, teenagers and young adults were affected. An outbreak of meningococcal disease affects a community due to the fact that the disease mainly occurs in the student population because these students are all in close proximity of each other throughout the day. Many parents may not want to send students back to school due to fear that their son or daughter may acquire the disease, in turn which will cause low attendance rates at the schools. It would be important for the community health care workers to have a confirmed number of cases to establish the type of vaccination needed and how much. It will also be important on whether they can minimize the transmission to the area in which the outbreak is occurring, especially if the outbreak has occurred on a school campus. If a large outbreak were to occur hospital would need to have staff available to act quickly due to how fast the disease can cause mortality. Temporary clinics may need to be made to help with the demand for treatment and large amounts of antibiotics would need to be made available to the area. It would also be important for the doctors to provide prophylactic treatment to any student or family members that have been around the person with the disease to prevent further infection. The reporting protocol for a meningococcal disease outbreak would be to report all cases immediately to the state health departments. The CDC will then closely track the disease through the National Notifiable Disease Surveillance System and Active Bacterial Core Surveillance. Notifiable disease surveillance begins at the level of local, state, and territorial public health departments (also known as jurisdictions). Jurisdictional laws and regulations mandate reporting of cases of specified infectious and noninfectious conditions to health departments. The health departments work with healthcare providers, laboratories, hospitals, and other partners to obtain the information needed to monitor, control, and prevent the occurrence and spread of these health conditions. (CDC, 2015). Strategies to prevent an outbreak of the meningococcal disease would be to provide patient education to parents of young children or teens going off to college regarding the vaccination against the disease. Important information should include the age group that is most affected by the disease, how it is contacted and the signs and symptoms to look for and the availability of the vaccine. The American College Health Association has recommended that all colleges and university health services should take a proactive role in informing students and their parents about the risks and consequences of meningococcal disease, that college students consider meningococcal vaccination, and that college and university health services ensure that students have access to this vaccine (Pediatrics, 2000). A community education strategy would be to help school nurses provide information pamphlets or letters for families regarding risk factors and prevention strategies. There are several different websites, such as National Meningitis Association, website address is http://www.nmaus.org/educational-resources/for-healthcare-professionals-and-educators/ and Voices of Meningitis with their website address http://www.voicesofmeningitis.org that have brochures, letters and animated videos that can be passed out or presented to families for educational purposes. A second strategy for preventing an outbreak of meningococcal disease is to have people get vaccinated. Vaccination may be the most effective way to prevent the spread of meningococcal disease. The United States currently carries to vaccines that can protect individuals from most of types of the disease. The Centers for Disease Control and Prevention recommends children being vaccinated at ages 11 or 12 with a booster shot following around the ages of 16 to 18. (CDC, 2016).

References

Impact of the Problem: Geographic Distribution. WHO. World Health Organization 2016. Retrieved from http://www.who.int/csr/disease/meningococcal/impact/en/ Meningococcal Disease Prevention and Control Strategies for Practice-Based Physicians.

(December 2000). Pediatrics, 106(6). Retrieved from

http://pediatrics.aappublications.org/content/106/6/1500

Meningococcal: Who Needs to Be Vaccinated. CDC. Centers for Disease Control Prevention 2015. Retrieved from http://www.cdc.gov/vaccines/vpd-vac/mening/who-vaccinate.htm

National Notifiable Disease Surveillance System. CDC. Centers for Disease Control Prevention 2015. Retrieved from https://wwwn.cdc.gov/nndss/

Voices of Meningitis (May, 2014). A Meningococcal Disease Prevention Campaign from the

National Association of School Nurses. Retrieved from http://www.voicesofmeningitis.org

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