Date: 16 Dec 2015
Source: MIR24.TV [in Russian, trans. Mod.NP, abbreviated, edited]
In Kyrgyzstan, there is an increasing number of patients with meningitis. Doctors fear outbreaks of disease. More than 20 people have died from the infection within a few months. More than 300 cases of infection have been recorded in the country since the beginning of the year  in total.
The main cause of meningitis is meningococcal disease. Without preventive measures, outbreaks occur once every 10 years. The last time it was recorded in Kyrgyzstan was 2006. There were deaths. Forecasts of doctors are unfavorable.
"Starting in 2014, the increase in the incidence of meningococcal meningitis was recorded. If you take our hospital data, you will see that in 2014, 283 patients were hospitalized due to meningitis; for 11 months of the current year , we have 301 sick persons," said Asel Balabanova, the head of the admissions department of the Republican Clinical Infectious Diseases Hospital.
MoH [Ministry of Health] last year  and this year officially addressed to the Kyrgyz government the specific calculation of needs for the purchase of vaccines against this infection," said Abdykadyr Joroev, the head of the Department of Prevention of Diseases of the Sanitary-Epidemiological Service of the Ministry of Health of the Kyrgyz Republic.
The plans are to vaccinate children from 2 to 17 years of age. It will take more than half a million dollars. Such money doesn't exist in the budget. Therefore, the MoH sent several requests to donors and to the embassies of various countries to help with the purchase of vaccine. These letters are under review. Vaccination in the country costs up to USD 5.00. Such a sum for vaccination is not payable by everyone in Kyrgyzstan.
Meningococcal disease may affect people of all ages but is commoner in children of preschool age.
[_Neisseria meningitidis_ infects only humans; there is no animal reservoir, and the organism dies quickly outside the human host. _N. meningitidis_ colonizes the mucosal membranes of the nose and throat; up to 5-10 per cent of a population may be asymptomatic nasopharyngeal carriers, but the carrier rate may be higher in epidemic situations. Droplets of nasopharyngeal secretions from these carriers, as well as people ill with invasive meningococcal disease, are responsible for the spread of the disease. The risk for acquiring meningococcal disease in close contacts of ill people is 500-800 times greater than among the general population (<http://www.cdc.gov/mmwr/preview/mmwrhtml/00046237.htm
>). The average incubation period is 4 days but can range between 2 and 10 days.
Antibiotics are recommended to prevent secondary infection in close contacts of patients with invasive meningococcal disease. Those at-risk contacts include household members, roommates, attendees at the same child care center, or anyone directly exposed to the patient's oral secretions through close social contact during the 7 days before onset of disease in the index case, such as through kissing, mouth-to-mouth resuscitation, or endotracheal intubation. Because the risk for illness in contacts is highest during the 1st few days after infection, chemoprophylaxis should be administered as soon as possible (ideally within 24 hours) after contact with an index case-patient. Chemoprophylaxis administered after 14 days is probably of limited or no value (<http://www.cdc.gov/mmwr/pdf/rr/rr4605.pdf
>). Antibiotics that effectively eliminate nasopharyngeal carriage of _N. meningitidis_ include rifampin, ciprofloxacin, ceftriaxone, and azithromycin, and these drugs are appropriate for chemoprophylaxis. In areas where ciprofloxacin-resistant strains of _N. meningitidis_ have been detected, ciprofloxacin should not be used for chemoprophylaxis (<http://www.cdc.gov/MMWR/preview/mmwrhtml/mm5707a2.htm
Mass meningococcal vaccination campaigns have been used to control outbreaks of invasive meningococcal disease with vaccines that contain meningococcal serogroups appropriate for the outbreak (<http://www.cdc.gov/mmwr/preview/mmwrhtml/00046237.htm
>). However, we are not told in the news report above what serogroups are causing the outbreak or what types of meningococcal vaccines are planned to be used. More information in this regard would be appreciated from knowledgeable sources.
Several meningococcal vaccines are available. Immunity following use of a meningococcal polysaccharide vaccine is specific for the type of capsular polysaccharide that the vaccine contains, with no cross-protection against infection due to other meningococcal polysaccharide groups. Although there are at least 13 _N. meningitidis_ serogroups, based on the antigenic specificity of their capsular polysaccharides, disease due to serogroups A, B, C, Y, and W135 are most common.
There are vaccines that contain capsular polysaccharide (A, C, Y, W135), either alone or conjugated to protein. Conjugate vaccines are preferable, because, unlike the polysaccharide vaccines, conjugate vaccines immunize infants, reduce the carriage of meningococci in the throat and thus its transmission, as well as confer a more sustained immune response, and, therefore, longer-term protection than the polysaccharide vaccines. Serogroup B vaccines are based upon meningococcal B protein antigens, because group B polysaccharide is poorly immunogenic in humans and is a potential auto-antigen. - ProMed Mod.ML]
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