The event that happened in Baguio City over a decade ago serves as a chilling reminder of what public overreaction and panic can create. From October 2004 to January 2005, Baguio General Hospital and Medical Center in Baguio City reported an almost-daily admittance of patients afflicted with meningococcemia-like symptoms.
Meningococcemia, caused by the Neisseria meningitidis bacteria, is an acute and potentially life-threatening infection of the bloodstream. According to Dr. Lulu Bravo, professor emeritus at the University of the Philippines-Manila’s College of Medicine, meningococcemia can be so severe as to cause death within 24 hours after initial onset of fever and purpuric rashes (purplish spots caused by bleeding tiny blood vessels located beneath the skin’s surface).
Between those dates, the hospital recorded 98 cases of which 32 have died. The ensuing panic caused people to stay away from the Summer Capital, dampening local tourism and economy for many months.
“It was also the moment when the role of doctors and health officials became even more apparent to allay the fears and, at the same time, educate patients, their families and the public. Eventually, it has been established that meningococcal disease is transmitted only through droplets of respiratory or throat secretions from carriers [such as kissing, sneezing or coughing on someone] or living in close quarters,” recalled Dr. Ferdinand de Guzman, medical specialist IV at the San Lazaro Hospital, the national referral center for infectious diseases, including meningococcemia.
De Guzman added the event also reminded the public about the importance of getting immunized, considering that there is a vaccine that protects against four groups of N meningitidis: group A, group C, group Y and group W-135.
Getting protected via vaccine is crucial because meningococcal disease generally infects infants, children and adolescents in the 15 to 19 age group.
“While some forms of the disease could be less severe with the patient recovering completely, others may develop severe meningitis (swelling of the protective membranes covering the brain and spinal cord), resulting in mental retardation, as well as physical disabilities,” Bravo warned.
The United States’s Centers for Disease Control and Prevention established that one-fifth of survivors of meningococcal disease could suffer debilitating conditions, including hearing or visual loss, learning disabilities or mental retardation, seizures and amputation of limbs as result to vascular collapse.
According to De Guzman, the staff at the emergency room of San Lazaro are especially watchful for patients coming in with high fever, stiff neck, and presence of petechial or purpuric rashes that usually progress in a matter of hours to the development of abnormally low blood pressure (hypotension), shock, acute adrenal hemorrhage and multi organ failure.
Aggressive antibiotic treatment is usually given considering the case-fatality ratio of meningococcal disease is estimated to be between 10 percent and 15 percent, and even higher in the Philippines (case-fatality ratio of meningococcemia is more than 50 percent).
“We should realize that it is important for health-care workers to maintain a high index of suspicion and initiate rapid interventions if suspected,” de Guzman said, while adding that health-care workers are not at increased risk unless they have been directly exposed to a patient’s nasopharyngeal secretions, for example, if they performed mouth-to-mouth resuscitation or intubated the patient without using a face mask.
The doctor added that while maintaining healthy habits, like getting plenty of rest and not having close contact with people who are sick may help, keeping up to date with recommended immunizations is the best defense against meningococcal disease. “We may be able to prevent all these if we immunize ourselves with a meningococcal conjugate vaccine that protects against four of the most common types of meningococcal bacteria”.
April 24 marks the World Meningitis Day, a day set to appreciate patient stories, raise awareness of the signs and symptoms of the disease and encourage vaccination to prevent further cases.