Meningococcal Disease in Travellers

Transcription

1 Meningococcal Disease in Travellers Please find product Prescribing Information at the end of this presentation

2 Meningococcal disease A rare but potentially serious illness in travellers1 Caused by the bacterium Neisseria meningitidis / 100,000 Estimated incidence of infection in high-risk travellers (per month of stay)2 0.4 / 100,000 Estimated incidence in general travellers (per month of stay)2 1. Travel Health Pro Factsheet. Available at Accessed February Goodman AL et al. Awareness of Meningococcal Disease among Travelers from the United Kingdom to the Meningitis Belt in Africa. Am J Trop Med Hyg Aug 6;91(2): HPA. Meningococcal Infection Factsheet Last updated 30 June Available at Accessed February 2016.

3 5 of SEROGROUPS Neisseria meningitidis cause the majority of disease 1,2 Serogroups vary around the world Travellers to high-risk areas should vaccinate against A, C, W-135 and Y serogroups 2,3 C B W-135 A Vaccination against serogroup B meningococcal bacteria is not usually recommended for travel to high-risk regions because serogroup B is not highly prevalent in these regions 4 Y 1. WHO. Meningococcal vaccines: WHO position paper, November Wkly Epidemiol Rec. 2011;86: Halperin SA et al. The changing and dynamic epidemiology of meningococcal disease. Vaccine (2011), doi: /j.vaccine NHS Choices, Meningitis Vaccination, Available at Accessed February CDC. Yellow book, chapter 3. Meningococcal Disease. Novartis Vaccines. Available at Accessed February 2016.

4 PERSON-TO-PERSON spread Neisseria meningitidis in the back of their nose or throat without ill effects 1 The carriage rate may be higher in epidemic situations 1 The bacteria invade the body causing serious disease % are carriers Meningitis infection of the protective lining of the brain Septicaemia blood poisoning UK general population 1. WHO. Fact sheet no Meningococcal meningitis, February Available at Accessed February 2016.

5 SYMPTOMS of meningococcal disease Septicaemia 1 Fever Neck stiffness Meningococcal meningitis 1 Sudden onset of fever & intense headache Vomiting Non-blanching petechial rash Nausea 1. Centers for Disease Prevention and Control. Yellow Book: Meningococcal disease Available at Accessed February 2016.

6 SYMPTOMS of meningococcal disease Meningococcal disease is rapidly progressive and can be fatal within hours 1 R.I.P 1. WHO. Meningococcal vaccines: WHO position paper, November Wkly Epidemiol Rec. 2011;86:

7 Tumbler Test A quick diagnostic test for travellers 1 Press the glass firmly against the suspected rash Seek help immediately if the rash doesn t fade under pressure, as shown 1. Meningitis UK. The rash. Available at Accessed February 2016.

8 How can travellers get the disease? PERSON-TO-PERSON through infected saliva or respiratory secretions 1 Coughs & sneezes Kissing Close prolonged contact Sharing kitchen utensils 1. WHO. Fact sheet no Meningococcal meningitis, February Available at Accessed February 2016.

9 High-risk traveller populations The disease is primarily a risk for those travelling to the meningitis belt, Mecca or an area where a known outbreak is occurring 1,2 Those living/ working with local people Healthcare workers Hajj or Umrah pilgrims (Mecca) / 100,000 Incidence of meningococcal disease in high-risk travellers (per month of stay) 3 Individuals with no spleen or a poorly functioning spleen Backpackers Individuals with immune deficiencies 1. Department of Health. The Green Book - Chapter 22: Meningococcal, Available at Green_Book_Chapter_22_v2_5.pdf. Accessed February Travel Health Pro Factsheet. Available at Accessed February Goodman AL et al. Awareness of Meningococcal Disease among Travelers from the United Kingdom to the Meningitis Belt in Africa. Am J Trop Med Hyg Aug 6;91(2):

10 Meningitis belt: a high-risk area for travellers Disease outbreaks can occur anywhere worldwide, but there are differences in disease incidence 1 Countries at high epidemic risk Travellers are also at risk in an area where a known outbreak is occurring 2 Meningitis belt Sub-Saharan Africa poses the greatest risk to travellers 2-6 highest meningococcal disease rates globally frequent epidemics, every 5-10 years This map represents all 26 countries of the extended African meningitis belt. 1. Halperin SA et al. The changing and dynamic epidemiology of meningococcal disease. Vaccine (2011), doi: /j.vaccine Travel Health Pro Factsheet. Available at Accessed February Wilder-Smith A. Meningococcal disease: risk for international travellers and vaccine strategies. Travel Med Infect Dis 2008;6: Stephens DS et al. Epidemic meningitis, meningococcaemia, and Neisseria meningitidis. Lancet 2007;369: Centers for Disease Prevention and Control. Yellow Book: Meningococcal disease Available at meningococcal-disease. Accessed February National Travel Health Network and Centre (NaTHNac). Meningococcal meningitis, June Available at Accessed February 2016.

11 Mecca: Hajj and Umrah travellers N. meningitidis quadrivalent (A,C,W and Y) vaccination is a mandatory entry requirement for the Hajj or Umrah pilgrimages 1,2 Severely crowded conditions favour increased carriage and transmission of Neisseria meningitidis 4 2 m Hajj & Umrah pilgrims 3 A W Wilder-Smith A. Meningococcal disease: risk for international travellers and vaccine strategies. Travel Med Infect Dis. 2008;6: Health requirements and recommendations for Hajj and Umrah performers and those working in Hajj areas Pages/HealthRegulations1436.aspx. Accessed February Memish ZA, Venkatesh S, Ahmed QA. Travel epidemiology: the Saudi perspective. Int J Antimicrob Agents. 2003;21: Al-Gahtani, YM, Al-Bushra, Al-Qarawi, SM et al, Epidemiological investigation of an outbreak of meningococcal meningitis in Makkah, Saudi Arabia, Epidemiol Infect. 1995;115: Lingappa JR, et al. Serogroup W-135 Meningococcal Disease during the Hajj, Emerg Infect Dis. 2003;9: Memish ZA, et al. Travel epidemiology: the Saudi perspective. Int J Antimicrob Agents. 2003;21:

12 How can travellers prevent meningococcal disease? The majority receiving the vaccination will be travellers to the African meningitis belt and Hajj or Umrah pilgrims 1,2 MenACWY vaccines MenACWY vaccines available in the UK as conjugate vaccines 1. Department of Health. The Green Book - Chapter 22: Meningococcal, Available at Green_Book_Chapter_22_v2_5.pdf. Accessed February Travel Health Pro Factsheet. Available at Accessed February 2016.

13 MenACWY conjugate vaccines available for travellers Menveo (meningococcal conjugate vaccine) 1 Nimenrix (meningococcal A,C,W-135 & Y vaccine) 2 Y W-135 C A A C W-135 Y All conjugated to Corynebacterium diphtheriae CRM 197 protein All conjugated to tetanus toxoid carrier protein Powder + solution for injection in 2 vials for reconstitution Powder in vial + solvent for solution for injection in pre-filled syringe 1. Menveo Summary of Product Characteristics. Available at Accessed February Nimenrix Summary of Product Characteristics.

14 Menveo conjugate MenACWY vaccine for travellers 1,2 A conjugate MenACWY vaccine WHAT? WHY? Helps protect against disease caused by Neisseria meningitidis serogroups A, C, W-135 and Y Children (from 2 years of age) Adolescents Adults WHO? HOW? A single dose vaccine (0.5ml) administered intramuscularly Can be given concomitantly with routine vaccinations 1. Menveo Summary of Product Characteristics. Available at Accessed February Menveo product overview. Available at Accessed February 2016.

15 Menveo adverse events & special warnings 1,2 Common adverse events Injection site reactions Headache Nausea Rash Malaise Pregnancy or breast-feeding women may receive Menveo if the benefit outweighs the risk given the lack of data in these populations 1. Menveo Summary of Product Characteristics. Available at Accessed February Menveo product overview. Available at Accessed February 2016.

16 Case scenario Name Age Gender Occupation Saleem 26 year old Male Medical Student He has up-to-date MMR, hepatitis A + B, diphtheria, tetanus and typhoid Which vaccines and other general travel advice would you recommend for this patient?

17 Menveo Prescribing Information MENVEO. Powder and solution, for injection. Meningococcal group A, C, W135 and Y conjugate vaccine. Indications: Active immunisation against Neisseria meningitides serogroups A, C, W135 and Y for children (from 2 years of age), adolescents and adults. Dosage: A single dose of 0.5 ml into the deltoid muscle. Booster vaccination: Refer to SPC and national recommendation. Contraindications: Hypersensitivity to the active substance or to any of the excipients, including diphtheria toxoid (CRM197). Postpone use in persons with acute, severe febrile conditions. Precautions: Separate injection sites should be used if administering more than one vaccine. See SPC for advice on use in immunocompromised individuals. Dizziness has rarely been reported after vaccination which may temporarily affect the ability to drive or use machines. Interactions: See SPC. Pregnancy and lactation: Insufficient clinical data on exposed pregnancies are available. Adverse reactions: See SPC for full details. Common: irritability, malaise, injection site pain or erythema, injection site induration, sleepiness, headache, chills, fever (38oC), eating disorder, nausea, vomiting, diarrhoea, rash, myalgia, arthralgia. Serious: hypersensitivity, convulsions, anaphylaxis, cellulitis. Legal category: POM. Presentation and basic NHS cost: Pack of two vials. MENVEO must be prepared for administration by reconstituting powder (in vial) with solution (in vial), per dose. MA holder: GSK Vaccines, Via Fiorentina 1, Siena, Italy. MA number: EU/1/10/614/002, EU/1/10/614/003. Further information is available from: Customer Contact Centre, GlaxoSmithKline, Stockley Park West, Uxbridge, Middlesex UB11 1BT; customercontactuk@gsk.com; Freephone: Date of preparation: November 2015 UK/MEN/ Adverse events should be reported. Reporting forms and information can be found at Adverse events should also be reported to GlaxoSmithKline on Please refer to the full Summary Product Characteristics before prescribing.