Global Alert and Response (GAR)

2001 - Meningococcal disease, serogroup W135 - Update 2

22 June 2001

Disease Outbreak Reported

During 2001 the following countries have reported cases of W135 meningococcal disease to WHO (see previous report) ; most cases are associated with international travel or contact with travellers to Saudi Arabia:

Burkina Faso: N. meningitidis serogroup W135 has been laboratory confirmed in 4 cases by the Centers for Disease Control and Prevention, Atlanta, United States. Travel/contact history of cases is not yet known.

Following a joint mission of Institut Pasteur, Paris and Association pour la Médecine Préventive (AMP) ) to investigate the epidemic meningitis situation, 10 additional cases of N. meningitidis W135 were laboratory confirmed.  The samples were taken from documented cases between 10-24 April 2001 and the proportion of N. meningitidis isolates belonging to the W135 serogroup was found to be 37% of the total N. meningitidis isolates identified by PCR on collected specimens.  None of the cases had any relationship with the 2001 Haj pilgrimage (travel or contact history).   Among 4 strains that were cultured from the same period, 3 were W135:2a:P1-2,5 and belong to the ET-37 complex.

Niger: A joint mission of Institut Pasteur, Paris and AMP investigated the epidemic meningitis situation and identified 10 laboratory confirmed cases of N. meningitidis W135. The samples were taken from documented cases between 10-16 April 2001 and the proportion of N. meningitidis isolates belonging to the W135 serogroup was found to be 40% of the total N. meningitidis isolates identified by PCR on collected specimens.   None of the cases had any relationship with the 2001 Haj pilgrimage (travel or contact history).

Central African Republic: 3 cases (Haj pilgrims) have been reported. N. meningitidis serogroup W135 have been laboratory confirmed.

Denmark: 2 cases (one case close contact with Haj pilgrims, the travel/contact history of the second case is not yet known)have been reported. N. meningitidis serogroup W135 has been laboratory confirmed.

France: 2 cases (close contacts with Haj pilgrims) have been reported. N. meningitidis serogroup W135 has been laboratory confirmed.

Norway: 4 cases (2 contacts with Haj pilgrims) have been reported. N. meningitidis serogroup W135 has been laboratory confirmed.

Saudi Arabia: 109 cases (predominantly Haj pilgrims from outside Saudi Arabia) including 35 deaths have been reported between 9 February and 22 March 2001. N. meningitidis serogroup W135 has been laboratory confirmed in more than half of the cases.

Singapore: 4 cases (3 close contacts with Haj pilgrims, 1 history of travel to Saudi Arabia), including 1 death have been reported. Two of the cases occurred in January 2001, before the main period of pilgrimage to Saudi Arabia. N. meningitidis serogroup W135 has been laboratory confirmed.

United Kingdom of Great Britain and Northern Ireland: 41 cases (8 pilgrims returning from the Haj, 19 cases of close contacts and data outstanding on the remaining cases) including 11 deaths of laboratory confirmed invasive N. meningitidis serogroup W135 have been reported.

Meningococcal disease. As with all types of meningococcal disease, early diagnosis and treatment are essential. The symptoms of group W135 meningococcal disease are the same as for other groups of the disease: sudden onset of intense headache, high fever, nausea, and vomiting, photophobia and stiff neck. The most severe clinical form of the disease, meningococcal septicaemia can be presented by abrupt onset, high fever, petechial rash or purpura.

WHO recommends that chemoprophylaxis be given to close contacts of the cases, such as persons sleeping in the same dwelling. In most countries rifampicin is recommended.

In preparation for the Umrah and the Haj seasons for next year, the Ministry of Health of the Government of Saudi Arabia has notified the Ministries of Health of all countries from which pilgrims arrive, that the vaccination against meningococcal meningitis with the quadrivalent vaccine (serogroups A,C, Y and W135) has been added to the health requirements for arrivals coming to the Umrah and Haj.

WHO encourages national reference laboratories to closely monitor meningococcal disease.

For further information, see the Control of Epidemic Meningococcal Disease. WHO Practical Guidelines. 2nd edition
(in English and in French, with annexes)

In order to fully identify and follow the epidemiological spread of the W135 strain, WHO encourages countries to send specimens to WHO Collaborating Centres for Meningococcal Infections. The Centres are:

Institut de Médecine Tropicale du Service de Santé des Armées
Parc du Pharo, B.P. 46
F-13998 Marseille-Armées
France
Dr. Pierre Nicolas
Tel: +33 4 91 15 01 15
Fax: +33 4 91 59 44 77
E-mail:imtssa.meningo@free.fr

WHO Collaborating Centre for Control of Epidemic Meningitis
Centers for Disease Control and Prevention
Atlanta, GA 30333
United States of America
Dr. Tanja Popovic
Tel: +1 404 639 17 30
Fax: +1 404 639 31 23
E-mail: txp1@cdc.gov

WHO Collaboration Centre for Reference and Research on Meningococci
Department of Bacteriology
National Institute of Public Health
PO Box 4404
Torshov
N-0403 Oslo
Norway
Dr. Dominique Caugant
Tel: + 47 22 04 23 11
Fax: + 47 22 04 25 18
E-mail:dominique.caugant@folkehelsa.no

For further information, please contact: outbreak@who.ch

Share