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• 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