The Public Health Agency of Canada (PHAC) is monitoring reports of meningococcal activity in the city of Delhi, India. The World Health Organization reports that between March 29, 2005 and May 26, 2005, India has recorded 303 cases, including 37 deaths of meningococcal meningitis. The majority of the cases and deaths have occurred mainly in young adults. To date, Neisseria meningitides serogroup (type) A has been confirmed in 35 cases. Cases are being reported predominantly in the following regions in the city of Delhi (also known as Old Delhi), located in the Union Territory of Delhi: Shahdara North, Shahdara South, Sadar Paharganj, Civil Lines, and Central. (Map) Meningococcal disease is endemic (commonly occurring) in Delhi and sporadic cases of meningococcal meningitis have occurred in previous years. Large outbreaks of meningococcal meningitis in and around Delhi, India, during 1966 and 1985 have been documented. The outbreak in 1985 resulted in 6133 reported cases, including 799 deaths (case fatality ratio = 13%). All samples of Neisseria meningitides in this outbreak were serogroup A. During 1966, 616 cases were reported, including 129 deaths (case-fatality ratio = 20.9%), however, analysis of the serogroup was not conducted. Source: World Health Organization Meningococcal meningitis, a form of meningococcal disease, is a contagious disease that causes inflammation of the lining of the brain and spinal cord and can lead to rapid death or permanent brain damage, particularly in young children. Transmission of meningitis occurs by direct contact with respiratory droplets from the nose and throat of infected persons. Fifty per cent of cases occur in infants, children and adolescents under 19 years of age, with the highest risk in children under 5 years of age. Symptoms include the sudden onset of intense headache, fever, nausea, vomiting, photophobia (aversion to light) and stiff neck. Neurological signs include lethargy, delirium, coma and/or convulsions. Infants may have illness without sudden onset and stiff neck. Many infected people do not develop symptoms but can become carriers. Meningococcal meningitis outbreaks sporadically occur throughout the world. The largest and most frequently recurring outbreaks have been in the semi-arid area of sub-Saharan Africa, designated as the “African Meningitis Belt”; this area extends from Guinea, Senegal and southern Mauritania in the west to Ethiopia, northern Kenya and western Eritrea in the east. Worldwide, most endemic meningococcal disease is caused by serogroups A, B or C. Serogroups Y and W-135 are relatively uncommon causes of meningococcal infection in most parts of the world. Meningococcal disease is endemic in Canada with periods of increased activity occurring roughly every 10 to 15 years, with no consistent pattern. The incidence rate of meningococcal disease has varied considerably with different serogroups, age groups, geographic locations and time. There have been sporadic localized outbreaks and periods of increased occurence of serogroup C disease during 1989-1993 and 1999-2001. From 1985 to 2001 there was an average of 305 cases of meningococcal disease reported annually. Recommendations Meningococcal disease is a medical emergency, requiring early diagnosis, hospitalization, and effective treatment. When the infection is diagnosed and treated early, antibiotics can be effective in arresting the illness and reducing fatalities. Vaccination against serotype A, C, Y and W135 is available. Some international travellers may be at risk of acquiring meningitis abroad due to the nature and location of their travel. As meningitis can be spread person-to-person and is airborne, the risk of exposure is likely related to the duration of stay or travel in high meningitis-prevalent areas. The nature and circumstances of contact with local people is also important in determining a traveller's risk of exposure. Those who will be in close contact with the local population through accommodation, public transport or work are considered to be at higher risk. Medical personnel are at greater risk if they have close, unprotected contact with infected persons. It is important to note that while serogroups B and C are responsible for most outbreaks in Canada, outbreaks caused by the other serogroups occur at the international level. The conjugate monovalent serogroup C vaccine, which is administered as part of Canada ’s routine immunization program, is not appropriate for protection of travellers, as it does not protect against serogroups A, Y or W-135. Therefore, vaccination with the quadrivalent vaccine, which protects against serotypes A, C, Y and W135 is recommended for Canadian’s travelling to international destinations with meningitis activity. The Public Health Agency of Canada recommends that Canadians travelling to geographic areas experiencing increased meningitis activity seek an individual risk assessment consultation with their personal physician or a travel medicine clinic before departure, to determine their risk for meningitis infection and their need for vaccination. Canadians working in countries with increased meningitis activity should ensure that their meningitis vaccination status is current. As a reminder... The Public Health Agency of Canada routinely recommends that Canadian international travellers seek the advice of their personal physician or travel clinic prior to international travel, regardless of destination, for an individual risk assessment to determine their individual health risks and their need for vaccination, preventative medication and personal protective measures. The Public Health Agency of Canada recommends as well, that travelers, who become sick or feel unwell on their return to Canada, should seek a medical assessment with their personal physician. Travellers should inform their physician, without being asked, that they have been travelling or living outside of Canada, and where they have been. For additional information, visit: The Public Health Agency of Canada's Disease Information Backgrounder on Meningitis The Committee to Advise on Tropical Medicine and Travel (CATMAT) - Travel Medicine Statement on Meningococcal Vaccination for Travellers Updated: June 9, 2005 [Information for Travellers] [Information for Travel Medicine Professionals]
