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Central Nervous System Infections
Published in Miriam Orcutt, Clare Shortall, Sarah Walpole, Aula Abbara, Sylvia Garry, Rita Issa, Alimuddin Zumla, Ibrahim Abubakar, Handbook of Refugee Health, 2021
The ability to recognise central nervous system (CNS) infections, whilst less common than other infections, is crucial in the refugee setting. There are large refugee populations at risk of these infections. For example, in a number of refugee settlements within the African ‘meningitis belt’ there is a risk of epidemics of meningococcal disease. Conditions in refugee settlements can also increase risk of transmission, such as overcrowding and poor hygiene. Infections of the CNS can be rapidly fatal, so urgent treatment and appropriate referral is required.
Sulfonamides
Published in M. Lindsay Grayson, Sara E. Cosgrove, Suzanne M. Crowe, M. Lindsay Grayson, William Hope, James S. McCarthy, John Mills, Johan W. Mouton, David L. Paterson, Kucers’ The Use of Antibiotics, 2017
Natasha E. Holmes, M. Lindsay Grayson
Sulfonamide-resistant meningococci are common in many parts of the world. Sulfadiazine-resistant N. meningitidis is highly prevalent in the African meningitis belt (Hedberg et al., 2009). Although sulfonamide-resistant meningococci were once thought to release more endotoxin than susceptible strains, this has now been disproven, and there is no relationship between sulfonamide resistance and mortality from meningococcal disease during outbreaks (Andersen et al., 1987). Such resistance is generally plasmid mediated (Facinelli and Varaldo, 1987) but may also be chromosomally mediated (Kristiansen et al., 1990). Polymorphisms in the folP gene encoding DHPS confer sulfonamide resistance in meningococci (Triglia et al., 1997; Jorgensen et al., 2005), particularly insertions. Qvarström and Swedberg (2000) demonstrated two patterns of resistance: type 1 resistance has a low sequence divergence and is similar to wild-type genes; type 2 resistance has sequence divergence up to 10% at a large number of positions from the wild-type DHPS. A mutation at position 68 with an insertion of six base pairs leading to a Ser-Gly insertion is associated with higher levels of sulfonamide resistance than other mutations. Alterations in codon 228 also confer sulfonamide resistance in meningococci (Bennett and Cafferkey, 2003).
Understanding barriers to vaccination against invasive meningococcal disease: a survey of the knowledge gap and potential solutions
Published in Expert Review of Vaccines, 2023
Isabella Ballalai, Rob Dawson, Michael Horn, Vinny Smith, Rafik Bekkat-Berkani, Lamine Soumahoro, Nevena Vicic
While the use of meningococcal vaccines has led to substantial declines in both carriage and incidence of disease globally, IMD remains a global public health concern [15]. For example, by the end of 2020, the conjugate vaccine for N. meningitidis serogroup A (MenAfriVac) had been administered to almost 350 million people in 24 of the 26 countries in the African meningitis belt [20]. Prior to the introduction of this vaccine, serogroup A caused 80–85% of meningitis epidemics in the African meningitis belt [20]. Surveillance data showed that MenAfriVac introduction led to substantial reductions in the incidence of suspected meningitis (57%) and epidemic risk (59%) in vaccinated vs unvaccinated populations, as well as a > 99% reduction in confirmed serogroup A disease in fully vaccinated populations within nine countries between 2005 and 2015 [21]. For adolescents aged 13–17 years in the USA in 2020, the estimated meningitis A, C, W, and Y (MenACWY) vaccine coverage was 89% for ≥ 1 dose and 54% for ≥ 2 doses [22]. For adolescents aged 17 years in the USA in 2020, only 28% had received ≥ 1 dose of the MenB vaccine [22]. As such, much remains to be done in terms of improving IMD awareness and vaccine coverage globally.
A policy review of the introduction of the MenACWY vaccine in toddlers across multiple countries
Published in Expert Review of Vaccines, 2022
Charalampos Valmas, Emanuele Arcà, Marja Hensen, Habeeda Rashid
Invasive meningococcal disease (IMD) is a major cause of meningitis and septicemia, both serious and life-threatening illnesses. The number of global meningitis cases increased from 2.50 million (95% CI 2.19–2.91) in 1990 to 2.82 million (2.46–3.31) in 2016 [1]. Incidence rates vary greatly across regions, with the highest rates reported in Northern Africa across the so-called African meningitis belt, where individual countries have reported rates up to 1,000/100,000 inhabitants [2]. While any age group can be affected, infants (0–12 months) and toddlers (12–24 months) constitute the highest proportion of IMD cases, with the majority of cases caused by the A, B, C, W, and Y serogroups (the ratio of cases caused by the individual serogroups varies by geographical region and time) [3,4]. Beyond children, adolescents and young adults are also more affected than other age groups [3,4].
Equity in vaccination policies to overcome social deprivation as a risk factor for invasive meningococcal disease
Published in Expert Review of Vaccines, 2022
Muhamed-Kheir Taha, Federico Martinon-Torres, Ralph Köllges, Paolo Bonanni, Marco Aurelio Palazzi Safadi, Robert Booy, Vinny Smith, Stéphanie Garcia, Rafik Bekkat-Berkani, Véronique Abitbol
Recommendations for vaccination differ between countries [63] (Supplementary Table 1 and references therein). Most European countries recommend MenC vaccination in infants and MenACWY in adolescents. Far fewer countries recommend MenB vaccination. Only Andorra, Czech Republic, Ireland, Italy, Malta, San Marino, and the UK target all the most prevalent serogroups in the age groups that are most affected, by offering MenB and MenC vaccination in infants (MenACWY in Czech Republic and Malta) and MenACWY in adolescents (Czech Republic will also offer MenB vaccination to adolescents from 2022 [64]). Other European countries offering MenB vaccination are Lithuania, Portugal, and France. Australia offers MenACWY vaccination to all toddlers and adolescents and MenB vaccination to Aboriginal and Torres Strait Islander infants; in addition to MenACWY, South Australia offers MenB vaccination to all infants and adolescents. In Latin America, Brazil offers MenC vaccination to infants and MenACWY vaccination to adolescents, Chile offers MenACWY vaccination to toddlers, Argentina offers MenACWY vaccination to infants and adolescents, and Cuba offers a locally produced combined MenB OMV with MenC polysaccharide vaccine in infants. In the USA, MenACWY vaccination is offered to all adolescents and MenB vaccination to those aged 16 − 23 years on a ‘shared clinical decision-making’ basis. In some countries in the African meningitis belt, MenA vaccination is offered to infants.