The Gazette spoke to two pediatric infectious diseases specialists to find out more about the bacteria and how to protect children and teens.
Last Saturday, the day after celebrating her 18th birthday with friends, Julia Cianci died of an invasive meningococcal blood infection. Laboratory results determined that the infection was caused by meningococcus bacteria, serogroup B.
The Gazette spoke to two pediatric infectious diseases specialists — Dr. Earl Rubin and Dr. Marie-Astrid Lefebvre, both at the Montreal Children’s Hospital — to find out more about the bacteria and how to protect children and teens.
What is meningococcus?
Meningococcus is a bacteria that causes diseases such as meningitis and meningococcal blood infections. These bacteria are present in the nose and throat of five to 10 per cent of adults. If they stay in the nose or throat, they cause no harm. But if they invade the bloodstream, they can cause inappropriate clotting of the blood, tissue damage and obstruction of blood flow to organs. If the bacteria crosses the blood-brain barrier, they can cause meningitis, which is inflammation and irritation of the membranes surrounding the brain and spinal cord. Meningococcal diseases can result in serious illness, permanent disability, organ failure and amputations. About 20 per cent of cases are fatal.
How are the meningococcus bacteria transmitted from one person to another?
It is transmitted through direct exposure to oral secretions of someone who is infected. Montreal’s public health department says it is unlikely to be transmitted through casual contact such as hand holding, cheek kissing or sharing a glass, and recommends antibiotic treatment only to those who had prolonged close contact with an infected person, such as living with them, or prolonged kissing or sexual contact. The American Academy of Pediatrics gives other examples of contact that could result in transmission: sharing toothbrushes or eating utensils at any time during the seven days before the disease onset.
Aren’t children in Quebec routinely vaccinated against meningitis-related illnesses?
There are five strains, or serogroups, of meningococcus that predominantly cause illness: A, B, C, Y and W-135. Currently, children in Quebec are routinely vaccinated only against Serogroup C (at 12 months, and then a booster at around 14 years of age). Patients can request vaccinations against the other strains, but will pay a fee. Two vaccines exist for B: Bexsero, which is currently on backorder and difficult to obtain in Montreal, and a newer vaccine only for adolescents (not infants) called Trumenba. A combination vaccine that covers four serogroups (A, C, Y and W-135) is also available for a fee.
What age groups are most vulnerable to meningococcal diseases?
There are two age peaks for invasive meningococcal disease: infants up to two years and adolescents aged 15 to 19. Adolescents are vulnerable mainly because they tend to have more intimate contact with more people, Rubin said. “It’s predominantly related to behaviour,” he said. “Kids go to university and live in a dorm, so it’s crowded living. They will share joints, cigarettes, beer bottles, tongues and other activities. It’s a high risk age group of exposure to multiple people’s oral secretions.”
How does the bacteria get into the bloodstream?
The two main factors that increase the likelihood of the bacteria getting into the bloodstream are changes to the mucous membranes due to a recent cold, and never having been exposed to the particular strain before, so that the body has never mounted an antibody response, Rubin said.
What are the symptoms of meningococcal disease?
The symptoms of a meningococcal infection include: high fever, severe headache, nausea and vomiting, general feeling of illness and a rash, that develops into tiny pin-size red dots, and then bruises on the skin. “In adolescents, it presents with neck stiffness, neck pain, headache, nausea, vomiting, and light sensitivity,” Lefebvre said.
How worried should we be?
“Overall this is not a common infection,” said Lefebvre, adding in Quebec there are about 0.5 cases per 100,000 people each year. “People hear about one case and it can induce panic, but we have to keep in mind that overall it is still quite a rare disease, thankfully. We are not in an outbreak situation in Montreal, and this is something that public health monitors quite closely.”
The most common serogroup that is circulating is no longer C, but B. And the vaccine against serogroup B is not part of the regular vaccine schedule unless you have particular risk factors, like immune defects or if you are in an outbreak. “With vaccines, it’s always an analysis of cost and benefits. Public health (authorities) do extensive analysis of incidence of disease based on age groups, and cost of the vaccine etc, to determine whether it’s cost effective to include it in the regular calendar and so far it’s not in there,” Lefebvre said.