The Travel Clinic Ltd

It’s a double first for the UK in advancing the fight against meningococcal disease: the new vaccine can protect travellers against four types of meningitis.

Previous meningococcal quadrivalent (protecting against four strains of meningitis disease) vaccines have always been polysaccharide vaccines, not conjugate vaccines.

The difference between polysaccharide and conjugate vaccines is the duration of protection obtained. Plain polysaccharide vaccines do not stimulate the immune system as broadly as conjugate vaccines, meaning protection is not long lasting and in children response can be poor.

The immune system response to a conjugate vaccine is broader, even in young children, and stimulates immunological memory, meaning protection is longer lasting.

Within days of the EMEA licence approval for the marketing of Menveo being received by Novartis Vaccines and Diagnostics, the first batch was making its way to the UK: "We are advancing the fight of prevention of meningococcal disease not just here in the UK but also worldwide as international travel gathers pace. We have been waiting for this moment for a long time. We now have a conjugated vaccine that can fight four of the five main groups of bacteria that cause meningitis and this is truly evolutionary."

Meningitis disease
The disease is transmitted by sneezing, coughing or direct contact with respiratory secretions. The bacteria are found in the nasal passages of healthy individuals. Around 25% of adolescents and 5-11% of adults carry the bacteria, meaning these persons are a continuing infectious risk to other individuals.

Meningococcal disease, a leading cause of bacterial meningitis, is a rare but contagious and potentially life-threatening infection. Infants and adolescents have the highest rates of disease, which can be fatal.

A meningitis epidemic has struck earlier than usual this year and is spreading across sub-Saharan Africa's "meningitis belt" from Senegal to Ethiopia. More reports of infections are being received from further south than usual, including Kenya, Uganda, and Democratic Republic of Congo, and Sudan is also reporting an increase in cases, with 184 suspected cases mainly in the north of the country.

The most common symptoms are:
• Sudden onset of fever
• Intense headache
• Nausea
• Vomiting
• Photophobia (intolerance of light)
• Stiff neck
• Petechial rash (blood spots under the skin)

If one or more of these symptoms occurs, medical attention should be sought immediately. Antibiotic treatment is usually commenced as soon as meningococcal disease is suspected. It may also be necessary to give antibiotic treatment to close contacts of patients confirmed as having meningitis.

Even when the disease is diagnosed early and adequate treatment is started, 5% to 10% of patients die. Bacterial meningitis may result in brain damage, hearing loss or a learning disability in 10% to 20% of survivors. A less common but even more severe (often fatal) form of meningococcal disease is meningococcal septicemia, which is characterized by a hemorrhagic rash and rapid circulatory collapse.

Recommendations for travellers
Respiratory infections are often difficult to prevent but by adhering to basic personal hygiene etiquette when coughing and sneezing can help. Always cough or sneeze into a tissue, bin the tissue and either wash your hands or apply a hand sanitizer gel.

Avoid overcrowded areas, busy markets and local transport: this will reduce your risk of exposure but may not always be practical.

Vaccines to protect against Meningococcal Meningitis for travellers are available, including the new conjugated Men A,C W-135 & Y, Menveo vaccine, now stocked and available at both the Cambridge branch and the Ipswich branch of the Travel Clinic Ltd. http://www.travelclinic.ltd.uk

Ideally the vaccine should be received 7-10 days before travel as it can take time for development of protective levels of anti-meningococcal antibodies.

This is a different vaccine to the one available in the UK childhood vaccination programme. Individuals should consider being vaccinated if they are travelling to a country where Meningococcal Meningitis is present and where their stay maybe prolonged or they are involved in activities which may increase the risk of exposure to the disease, for example, working and living closely with the local population.

For pilgrims travelling to Saudi Arabia for Haj, a valid certificate of vaccination against the disease is a requirement, and a visa for country entry will not be issued without proof of vaccination.