• SAN LUIS POTOSI:

(1945 – 1949)

• 753 PEOPLE AFFECTED

• SAME TIME IN THE US

THE LAST

SEROGROUP A

OUTBREAK

Almeida-González L, et al. Sal Pub Mex 2004; 46(5): 438-50

MENINGOCOCCAL DISEASE (MED)

IN MEXICO

40’s OUTBREAK

MED IN MEXICO1990 - 2009

# O

F C

AS

ES

*JulySUIVE - INDRE

TWO KINDS OF SURVEILLANCE:ACTIVE AND PASSIVE

• Active:

Starts at the ER

Much more information

Less number of strains

Less number of Hospitals ($)

• Passive:

Starts in the Lab

Less information

More number of strains

More Hospitals

BACTERIAL MENINGITIS IN TIJUANA, MEXICO

ACTIVE SURVEILLANCE FROM OCT / 2005 - SEPT / 2014 (9 YEARS)

ONLY CULTURE-CONFIRMED BACTERIAL ISOLATES FROM BLOOD AND/OR CSF, AND CLINICALLY / CSF-CYTOCHEMICAL ANALYSIS CONSISTENT WITH MENINGITIS

DEMOGRAPHIC, CLINICAL, MICROBIOLOGICAL STUDY

ALL CHILDREN < 16 YEARS OLD ADMITTED AT THE ER OF THE GENERAL HOSPITAL OF TIJUANA

6 PEDIATRIC PATIENTS FROM THE 2013-OUTBREAK NOT INCLUDED

TOTAL CASES OF GRANULOCITIC MENINGITIS

• TOTAL = 71

• WITH ISOLATION = 60 (84.5%)

• NO ISOLATION = 11 (15.5%)

– 3 HAD PURPURA (27.27%)

CAUSES OF CONFIRMED BACTERIAL MENINGITIS (%)

(n = 60)

MENINGOCOCCAL MENINGITISBEFORE / AT ADMISSION (n=38)

• MEDIAN AGE: 2.5 yo (3 months - 15 yo)

47.3% < 2 yo

63% < 5 yo

• 57.8% MALE, 42.2% FEMALE

• PREDISPOSING FACTORS: 3 (7.9%): SEL, ALL, HIV

• PREVIOUS USE OF ANTIBIOTICS: 15 (39.5%)

• MEDIAN DAYS OF ANTIBIOTICS: 2 (1 - 7)

• MENINGOCOCCAL VACCINE: ONLY 1 PATIENT, WITH MCV4-D, 3 MONTHS BEFORE = "B" DISEASE

MENINGOCOCCAL MENINGITISAT ADMISSION (n=38)

• MEDIAN DURATION OF SYMPTOMS: 2 (1 - 14)

• MENINGITIS: 100%

• PURPURA: 16 (42%)

• OTHERS: URTI = 18 (47.3%), PLEURAL EFFUSION = 1 (2.6%), DIARRHEA = 1 (2.6%)

• CBC:

MEDIAN WBC: 16300 (500 - 52300), >10000 = 24 (68.6%), < 5000 = 5 (14.3%)

MEDIAN NEUTROPHILS (%): 77 (8 - 94)

MEDIAN PLATELETS: 180000 (2000 - 428000), < 150000 = 6 (42.8%)

MENINGOCOCCAL DISEASE CASESPER YEAR (9 YEARS, n = 38)

AVG / YEAR:

4.2

MENINGOCOCCAL MENINGITISAT ADMISSION AND OUTCOMES

(n=38)

• PROLONGED CLOTTING TIMES: 40%

• MEDIAN CSF-WBC: 115 (0 - 30400)

• MEDIAN CSF-PMN's (%): 89.5 (0 - 100)

• MEDIAN CSF-GLUCOSE (mgs/dL): 41.5 (3 - 110)

• MEDIAN CSF-PROTEINS (mgs): 85 (12 - 473)

• MEDIAN HOSPITALIZATION DAYS: 10 (1 - 21)

• OVERALL MORTALITY: 10 (26.3%)

• CAUSES OF DEATH: 100% SEPTIC SHOCK ± IDC (79%)

• NEUROLOGIC SEQUELAE AT DISCHARGE: 9 (32%)

MILD SEQUELAE: 8 (88.9%)

SEVERE SEQUELAE: 1 (11.1%)

• ALL PATIENTS WITH PURPURA WHO SURVIVED HAD SCARS AS SEQUELAE, ONE DIED DURING AMPUTATION

CLINICAL / LABORATORY VARIABLES ASSOCIATED WITH LETHALITY

• VARIABLE p:

PURPURA <0.05

WBC < 5000 <0.05

PLTS < 150000 <0.05

PROLONGED <0.05

CLOTT - TIMES

WITH PRED <0.05

CONDITIONS

(SEL, ALL, HIV)

MENINGOCOCCAL SEROGROUPS DISTRIBUTION IN % (n=38)

BINATIONAL STUDY, SAN DIEGO - HGTCASES BY SEROGOUP

(TOTAL OF 16 IN HG-TIJUANA AND 13 IN SD)

p < 0.004

POSTER IB-009Mexico- United States – Surveillance of Meningococcal Disease in ChildrenE. CHACON-CRUZ1, D. SUGERMAN2, M. GINSBERG3, J. HOPKINS3, JL. LOPEZ-VIERA1, CA. LARA-MUÑOZ1, RM. RIVAS-LANDEROS1, ML. VOLKER1, JA. HURTADO-MONTALVO1, J. LEAKE4

1 General Hospital of Tijuana, Mexico 2 CDC Epidemic Intelligence Officer3 Health and Human Services Agency, San Diego, CA. 4 San Diego Childrens Hospital

MENINGOCOCCAL DISEASE:RATES PER AGE GROUP

RA

TE

/ 100,0

00

NATIONAL ACTIVE

SURVEILLANCE, MED AND

MENINGITIS IN MEXICO

FEB/2010 – JAN/2013

MonterreyH. UniversitarioDr César Martínez

GuadalajaraH. CivilDr Antonio Luevanos

DFINPDr José L Castañeda

H Médica SurDr Fernando Aguilar

H PEMEXDra Ana Limón

MoreliaH. Infantil de MoreliaDr Jorge Vázquez

Tuxtla GtzH Gral de ChiapasDra Sandra Beltrán

CuliacánH. Pediátrico de SinaloaDr Eduardo Llausas

TijuanaH. Gral de TijuanaDr Enrique Chacón

TOTAL REPORTS

201 MENINGITIS

GRANULOCITIC

129 (64.2%)

VIRALS

72 (35.8%)

NO ISOLATION

56 (43.4%)

WITH ISOLATION

73 (56.5%)

MENINGOCOCCAL24 (32.8%)

PNEUMOCOCCAL

17 (23.3%) S. agalactiae

6 (8.2%)

OTHERS

17 (23.3%)

FINAL REPORT (3 YEARS)

18 (75%) - IN TIJUANAChacon-Cruz E, et al. ESPID-2015, abstract # 808

MED OUTBREAKTIJUANA, MEXICO

• 19 CASES

• 30 - JAN - 30 - MAR - 2013

• MEDIAN AGE= 16 yo (2 - 47)

• 74% > 13 yo - “TYPICAL FROM AN OUTBREAK“

• 11 FROM HG-TIJUANA (58%), 5 FROM IMSS (26%)

• ALL DIAGNOSED BY CULTURE AT HG-TIJUANA

• NO SPECIFIC CLUSTER

• SOME INTRAFAMILIAR (7)

• ALL BY SEROGROUP "C"

MED OUTBREAK, TIJUANATIMELINE

DEATHS

CASES AFTER THE OUTBREAK

• APR-AUG/2013

• FIVE CASES

• 3 BY SEROGROUP B

• 2 BY SEROGROUP C

• ONE FATALITY

• OCT 3rd – DEC 10th/2013

• SEVEN CASES (“SMALL OUTBREAK”?)

• SIX BY SEROGROUP C, ONE BY SEROGROUP Y

• FIVE FATALITIES!!!! (INCLUDING A MEDICINE STUDENT)

• SPEAKER – PFIZER VACCINES

• SPEAKER – MSD VACCINES

• FORMER SPEAKER AND INDEPENDENT RESEARCHER – NOVARTIS VACCINES

• FORMER SPEAKER – GSK VACCINES

• FORMER SPEAKER – SANOFI VACCINES