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IMD Cause and Symptoms

Meningitis Disease

Invasive Meningococcal Disease (IMD) is a Global Health Problem

1,200,000 Cases/Year1
135,000 Deaths/Year1

IMD is a disease of high incidence and fatality rate that needs a clear disease knowledge and optimal prevention path.

Invasive Meningococcal Disease (IMD) is Caused by Neisseria Meningitidis

Majority (90%) of IMD cases worldwide are caused by capsular groups A, B, C, W, and Y.2-3

References

  1. Rouphael NG, Stephens DS. Methods Mol Biol 2012; 799: 1–20; 
  2. Jafri RZ, et al. Popul Health Metr 2013; 11: 1–9; Image form https://phil.cdc.gov/Details.aspx?pid=22881. 
  3. Kieny, M., Excler, J. and Girard, M. (2004). Research and Development of New Vaccines Against Infectious Diseases. American Journal of Public Health, 94(11),pp.1931-1935.

Invasive Meningococcal Disease can occur if N. meningitidis enters the bloodstream.1-3

References

  1. Van Deuren, et al. Clin Microbiol 2000; 13: 144–66; 
  2. Rosenstein NE, et al. N Engl J Med 2001; 344: 1378–8; 
  3. NHS. Meningitis overview. 2019. https://www.nhs.uk/conditions/meningitis/ [Jan 2021]. Vessel image: Andrew Meyerson. http://creativecommons.org/licences/by-sa/3.0/deed.en Via Wikimedia. Respiratory track image : Patrick J. Lynch, medical illustrator, C. Carl Jaffe, MD, cardiologist. https://creativecommons.org/licences/by/2.5/ Via Wikimedia.

IMD is difficult to be Diagnosed Early, and Progresses Rapidly1-3

Average incubation period for IMD: 4 days (Range, 2 to 10 days)1

References

  1. WHO. Meningococcal meningitis fact sheet February 2018. http://www.who.int/news-room/fact-sheets/detail/meningococcal-meningitis [Jan 2021];
  2. NICE Clinical Guidelines. Bacterial Meningitis and Meningococcal Septicaemia in Children. https://www.ncbi.nlm.nih.gov/books/NBK83078/ pdf/Bookshelf_NBK83078.pdf [Jan 2021];
  3. Thompson MJ. Lancet 2006; 367: 397–403.

Symptoms

IMD Symptoms start with non-specific symptoms, but it will lead to serious sequelae

Newborns and babies may not have or it may be difficult to notice the classic symptoms as fever, headache, neck stiffness.1

Babies may be slow or inactive, irritable, feeding poorly, or have a bulging in the soft spot of the skull (anterior fontanelle).1,2

Symptoms

IMD Symptoms start with non-specific symptoms, but it will lead to serious sequelae

Newborns and babies may not have or it may be difficult to notice the classic symptoms as fever, headache, neck stiffness.1

Babies may be slow or inactive, irritable, feeding poorly, or have a bulging in the soft spot of the skull (anterior fontanelle).1,2

References

  1. Cdc.gov. 2020. Meningococcal | Signs And Symptoms | CDC. [online] Available at: https://www.cdc.gov/meningococcal/about/symptoms.html [Accessed 28 January 2021].
  2. Meningitisnow. (2019). Meningitis Symptoms in Babies & Toddlers. [online] Available at: https://www.meningitisnow.org/ meningitis-explained/signs-and-symptoms/signs-and-symptoms-babies-and-toddlers/ [Accessed 28 January 2021].
  3. Thompson MJ. Lancet 2006; 367: 397–403.

IMD Symptoms Start with Non-specific Symptoms, but it will lead to Serious Sequelae

References

  1. Thompson MJ, et al. Lancet. 2006;367:397
  2. Branco RG, et al. J Pediatr (Rio J). 2007;83(2 suppl):S46.

Severe Sequelae in Survivors1,2

Sequelae Occur in 10 to 20% of Survivors.

Permanent, devastating sequelae:

  • Hearing Loss
  • Neurological Damage
  • Loss of a Limb

References

  1. WHO. Meningococcal meningitis fact sheet February 2018. http://www.who.int/news-room/fact-sheets/detail/meningococcal-meningitis [Jan 2021];
  2. CDC. Pink Book. Chapter 14 Meningococcal Disease. https:www.cdc.gov/vaccines/pubs/pinkbook/downloads/mening.pdf [Jan 2021].

Up to 20% of Survivors will have Severe Sequelae1

Types of Complications Among IMD Survivors of All Ages

Reference

  1. Sadarangani M, et al. Clin Infect Dis 2015; 60: e27–35.

IMD Can lead to Death even when treated1,2

High Fatality Overall case fatality rate (CFR) is

10 TO 15% even after appropriate treatment.2

CFR of over 50% when untreated. 1

The CFR of meningococcemia is up to 40%2

References

  1. WHO. Meningococcal meningitis fact sheet February 2018. http://www.who.int/news-room/fact-sheets/detail/meningococcal-meningitis [Jan 2021]; 

  2. CDC. Pink Book. Chapter 14 Meningococcal Disease. https:www.cdc.gov/vaccines/pubs/pinkbook/downloads/mening.pdf [Jan 2021].

AT-risk population focus on IMD risk population according to age Infants Children and Adolescents

Infants & Children at risk

Most of Children Affected by IMD are Otherwise Healthy1 Only a Small Portion is Considered at Risk

Breakdown of health status of children affected by IMD

94% Healthy Children (n=150)

6% Risk Group (n=9)

  • Complement deficiency: 2
  • Sickle cell anemia: 2
  • Congenital hydrocephalus: 1
  • VSD: 1
  • Lung transplant for cystic fibrosis: 1
  • Autoimmune hepatitis: 1
  • Premature birth: 1

Reference

  1. Kaplan SL, Schutze GE, Leake JA, Barson WJ, Halasa NB, Byington CL, Woods CR, Tan TQ, Hoffman JA, Wald ER, Edwards KM, Mason EO Jr. Multicenter surveillance of invasive meningococcal infections in children. Pediatrics. 2006 Oct; 118(4): e979-84.

According to WHO, Infants and Children less than 4 years old are more at risk of contracting IMD1

Risk Factors

"Meningococcal disease can affect persons of all ages, but higher rates of invasive disease in developed countries are seen in infants and children less than 4 years of age, adolescents, military recruits, and groups where crowding and new exposures occur such as college students living in dormitories.”1

Reference

  1. Sage background Paper http://www.who.int/immunization/sage/1_mening_background_document_v5_3__apr_2011.pdf. [Accessed 28 January 2021]

Adolescents and young Adults are the most frequent carriers

References

  1. CDC. Pink Book. Chapter 14 Meningococcal Disease. https://www.cdc.gov/vaccines/pubs/pinkbook/downloads/mening.pdf [Jan 2021];
  2. Borrow R, et al. Expert Rev Vaccines 2017; 16: 313–28.
  3. MacLennan J, et al. Emerg Infect Dis 2006; 12: 950–7.
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