• Meningococcal meningitis activity in Africa: revised vaccine recommendations

• Increase in cases of human H5N1 avian influenza reported from Egypt
  

 

 

 

Meningococcal meningitis activity in Africa: revised vaccine recommendations

The National Travel Health Network and Centre (NaTHNaC) has revised its recommendations for meningococcal vaccine for travellers to Africa based on surveillance data from outbreaks and cases reported by the World Health Organization over the last five years [1].

Countries that are now considered to be risk destinations* include those considered to be 'meningitis belt' countries (from Senegal in the west to Ethiopia in the east) [2] as well as some which are not typically included in the belt: Angola, Benin, Burkina Faso, Burundi, Cameroon, Central African Republic, Chad, Côte d'Ivoire, Democratic Republic of the Congo, Eritrea, Ethiopia, The Gambia, Ghana, Guinea, Kenya, Mali, Niger, Nigeria, Rwanda, Senegal, Somalia, Sudan, Tanzania, Togo, Uganda, and Zambia.

Quadrivalent meningitis ACW135Y vaccine should be considered for those travelling to the above listed countries and whose planned activities may put them at a higher risk of infection. Higher risk activities may include working closely with local populations for extended periods either through medical or relief work for example, or visiting friends and relations. Travellers to these countries should also try where possible to avoid crowded conditions.

Although meningococcal disease occurs worldwide, the highest burden occurs in Africa. Epidemics in the meningitis belt countries usually occur in the dry season between November and May/June. The serogroups most commonly associated with the African meningitis belt are A and C, although, serogroup W135 emerged in Burkina Faso in 2002 [3].

Further information about meningococcal disease can be found in the NaTHNaC information sheet at http://www.nathnac.org/pro/factsheets/meningococcal.htm or on the HPA website at http://www.hpa.org.uk/infections/topics_az/meningo/menu.htm.

*Risk destinations may be subject to change over time.

References

1. The National Travel Health Network and Centre (NaTHNaC). Meningococcal meningitis activity and revised vaccine recommendations. Clinical update [online] 30 March 2007 [cited 4 April 2007]. Available at <http://www.nathnac.org/pro/clinical_updates/meningitis300307.htm>.

2. World Health Organization. Meningococcal meningitis fact sheet 141 [online]. Revised May 2003 [cited 4 April 2007]. Available at <http://www.who.int/mediacentre/factsheets/fs141/en/>.

3. World Health Organization. 2002 - Meningococcal disease in the African meningitis belt - update 2 [online] 6 May 2002 [cited 4 April 2007]. Available at <http://www.who.int/csr/don/2002_05_06/en/index.html>.

 

 

 

 

 

Increase in cases of human H5N1 avian influenza reported from Egypt

On 2 April 2007 the World Health Organization (WHO) reported three additional human cases of avian influenza A(H5N1) virus infection in Egypt [1]. All three cases are in children (two boys and one girl, aged between 4 and 7 years) who are receiving treatment and remain in a stable condition in hospital. Five cases in children aged between two and ten years were also reported in the previous two weeks. All have survived to date [1,2]. So far this year worldwide, the highest number of human cases of avian influenza A(H5N1) virus infection have been reported from Egypt – 14 cases (including three fatal cases that occurred in January and February). Eleven of these were in children aged 10 years or under. The youngest case occurred in a 2 year old boy.

The case fatality rate in Egypt (21.4%, 3/14) is low compared with the overall case fatality rate of 59.0% (170/288) globally. The reason for this is unclear but the following factors might all play a part: better awareness, early detection, and timely treatment. According to the World Organization for Animal Health (OIE), Egypt has carried out a poultry vaccination programme with H5N1 and H5N2 inactivated vaccines [3] but the completeness and quality of this programme is unknown.

According to WHO, the 14 Egyptian cases that have occurred this year were reported from the following Governorates, Beni Sweif, Fayyoum (two cases), Sharkia, Dakahlea, Ad Daqahliyah, Aswan (three), Qena (two cases in a brother and sister), Menia, Sohag ,and Qalubiea. None of the children live in areas frequented by tourists and according to OIE, all these Governorates have reported avian influenza H5N1 outbreaks in poultry [3].

Human cases of avian influenza A(H5N1) virus infection started to appear in Egypt in 2006 after poultry H5N1 outbreaks occurred in the same year. Poultry outbreaks were reported firstly in February 2006 and were followed by the reporting of the first human case in March 2006. In total, 18 human cases, ten of whom died, were reported in 2006. Egypt has the highest number of confirmed human cases outside Asia .

Indonesia has the second highest number of reported cases so far this year. Six have been reported, five of whom died [4]. Other country reports have come from Lao DPR (two fatal cases), China (two cases, one fatal) and Nigeria (one fatal case) [4].

References

1. Avian influenza - situation in Egypt - update 13. [online] [cited 5 April 2007] Geneva: World Health Organisation, 2007. Available at < http://www.who.int/csr/don/2007_04_02/en/index.html>.

2. Disease Outbreak News. Epidemic and Pandemic Alert and Response (EPR). [online] [cited 5 April 2007] Geneva: World Health Organisation, 2007. Available at <http://www.who.int/csr/don/en/index.html>.

3. Update on avian influenza in animals (Type H5). [online] [cited 5 April 2007] Paris: World Organisation for Animal Health (OIE, 2007. Available at <)http://www.oie.int/downld/AVIAN%20INFLUENZA/A_AI-Asia.htm>

4. Cumulative number of confirmed human cases of avian influenza A/(H5N1) reported to WHO [online] [cited 5 April 2007] Geneva: World Health Organisation, 2007. Available at http://www.who.int/csr/disease/avian_influenza/country/cases_table_2007_04_02/en/index.html