Meningococcemia historical perspective

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] ; Associate Editor(s)-in-Chief: Ammu Susheela, M.D. [2]

Historical Perspective

• Records indicate that the first case of meningococcal meningitis was described in Geneva in 1805.
• Another case was reported in New England , New Bedford , Massachusetts in 1806.
• The causative agent was described as intracellular oval cocci in a cerebrospinal fluid sample by Marchiafava and Celli in 1884.
• The organism was isolated by Anton Weischselbaum in 1887 and he gave the term Diplococcus intracellularis meningitidis.
• From then on for more than 2 hundred years, meningococcus has caused high rates of morbidity and mortality all around the world.
• No reports of outbreaks have been reported prior to 1806.
• The first meningococcal epidemics occured in early 1900s in sub saharan Africa.

Outbreaks

• Usually the menigococcal meningitis cases appear sporadic. Very rarely they can occur as an outbreaks and the outbreaks are usually found in communities like schools, colleges, prisons and such close populations.
• In temperate regions the number of cases increases in winter and spring. Serogroups B and C together account for a large majority of cases in Europe and the Americas.
• Several local outbreaks due to Neisseria meningitidis serogroup C have been reported in Canada and the United States (1992-93) and in Spain (1995-97).
• Major African epidemics are associated with Neisseria meningitidis serogroup A, which is usually the cause of meningococcal disease in Asia.
• In 2000 and 2001 several hundred pilgrims attending the Hajj in Saudi Arabia were infected with Neisseria meningitidis W.
• In 2002, Neisseria meningitidis W emerged in Burkina Faso, striking 13,000 people and killing 1,500.

Epidemics in Africa

• Epidemics have been happening in Africa for more than 100 years.
• The disease is usually found in SUb Saharan meningitis belt.
• Epidemics there occur in the dry season (December to June), ending during the intervening rainy season.
• Epidemics usually take place in irregular cycles every 5-12 years.
• 80-85% of all reported case is by Serogroup A meningococci.
• In 2002 there was a major outbreak of meningococcal disease in Burkina Faso with about 80% of cases due to serogroup W.
• Between 1988 and 1997, 704,000 cases and more than 100,000 deaths were reported in Africa, some 20,000 occurring in 1996, the largest epidemic year ever recorded.
• Between 1998 and 2002, African countries within the meningitis belt reported more than 224,000 new cases of meningococcal disease.