An outbreak of meningitis, considered unusual, exploded in Great Britain, reaching 27 cases, including two deaths, in an area of Kent on Thursday. Is there a danger of spreading in Europe or not? What we need to know.
Cases of meningococcal disease emerged over the weekend in a student community, with the number of confirmed cases in the outbreak rising to 27 on Thursday, according to The Guardian. The European Center for Disease Prevention and Control (ECDC) said on Wednesday that the risk of invasive meningococcal disease spreading to the general population remains “very low” across the European Union and the European Economic Area.
Why did the disease spread so quickly in the Kent County outbreak
In Great Britain the outbreak is considered, instead, by the authorities to be “unprecedented” regarding the spread, this in the conditions where approximately 350 cases are registered in a year.
The explanation would be that there was a possible place of exposure – a nightclub in Canterbury, Kent -, the diagnosed cases being associated with the presence in this club, between March 5-7. And France has reported a case possibly linked to the UK outbreak, with the European Center for Disease Prevention and Control monitoring the situation closely and urging doctors who have patients with meningitis symptoms to ask them if they have recently traveled to Kent.
Authorities in the UK have begun action in the outbreak, distributing antibiotics and launching a vaccination program with meningococcal group B vaccine for thousands of students at the University of Ken, officials believe the strategy of preventive antibiotics and targeted vaccination is effective. What still remains unclear is why there were so many cases associated with a single event. Prof. Robinn May, chief scientific officer of the UK Health Security Agency, said there are two possible reasons: one is that there could be something to do with the type of behaviors that individuals have, and the second possibility is that the bacteria itself could have evolved to be more efficient at transmission.
How meningococcal disease spreads
In order to understand what the real risk is, I requested the opinion of Prof. Univ. Dr. Emilian Popovici, primary medical epidemiologist, vice-president of the Romanian Society of Epidemiology.
“First of all, I consider it useful to clarify some aspects related to both the condition itself and the causative pathogen and the event currently generated by it in Great Britain. Meningococcal disease, as it is, is caused by the bacterium Neisseria meningitidis. So, first of all, I emphasize that the causative pathogen in this case is a bacterium and not a virus!”, the doctor explained.
About 10% of the population can have the bacteria present in the nose or throat without causing serious health problems. Very rarely, it can invade the bloodstream or central nervous system and cause life-threatening illnesses, the doctor added. “Meningococcal meningitis is the disease that manifests clinically and results in an inflammation of the membranes around the brain and spinal cord. Meningococcal disease is spread by close contact with respiratory droplets. This can happen through kissing, sharing drinks, sharing objects, close contact, as well as coughing and sneezing. This is why the risk is greater in environments where people live, study and socialize together, such as would be university campuses”explained Dr. Popovici.
Outbreaks like the one in Kent, particularly in community settings such as universities or schools, are less common than individual sporadic cases, the doctor pointed out. Although there is generally low risk, the proportion of cases among young adults and students is higher than in older age groups simply given the social context on campuses and the living conditions typical of school and university life, the epidemiologist added. In the specific case in Great Britain, the parties attended by young people acted as a supertransmitter of meningococcal infection, pointed out Dr. Popovici.
Can the disease reach other countries?
The medical epidemiologist explained that the risk of this disease being transmitted beyond the borders of Great Britain is an insignificant one. “Given, as I said, that this is a bacteria and not a virus, that transmission requires close contact, and that casual transmission is less relevant, I don’t think there is even a general UK risk at present, much less any significant risk of European spread!”the doctor pointed out.
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An outbreak such as the one in Kent can generate secondary contact cases in other communities if infected persons enter these communities and the conditions for transmission are present and if adequate prophylaxis and control measures are not taken. It is the reason why the authorities in England have recommended those who monitor the outbreak to isolate the suspects without waiting for the appearance of the classic clinical signs of meningococcal disease, explained Dr. Popovici. There is no question of “cross-border transmission of epidemiologically relevant proportions”according to Dr. Emilian Popovici.
“I repeat the fact that at this moment, even in Great Britain, it is not considered that there is any general risk of infection, so that the concern at European level is justified only possibly at the level of university campuses that exchange students with the affected university in Great Britain”. the doctor also specified.
The signal for Romania
Meningococcal disease can be prevented by vaccination, and there are countries in the world that have this vaccine in the national immunization schedule. This is not the case in Romania, but also in our country the vaccine is available on the market and can be administered optionally.
I asked Dr. Emilian Popovici if the outbreak in Great Britain can be attributed to the lack of vaccination or if there are other factors.
“Meningococcal vaccination is the most effective targeted method of preventing the disease, so surely the absence of vaccination is an important cause, but other community factors intervened in the affected university community – among which I mentioned those student parties with the role of a super transmitter of the infection – and certainly the presence of meningococcal carriers. Other individual contributing factors may also intervene, such as certain immune deficiencies, etc.”, the doctor explained.
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As for the effectiveness of introducing meningococcal vaccination into the national scheme as a measure to prevent outbreaks such as the one in question, the epidemiologist was of the opinion that it could constitute the next priority for the vaccination program.
“Meningococcal vaccination it is intensely immunogenic and consequently protective against meningococcal infection, so it is highly recommended by both family doctors and paediatricians. It has not yet been introduced in the national child immunization program, but taking into account the large number of meningococcal carriers present in the general population as well as the fact that most meningococcal infections occur in childhood and the seriousness of the clinically manifest disease (meningococcal meningitis), we can think of this vaccination as the next priority for the national immunization program”. concluded Dr. Emilian Popovici.
