Know before you go!
Infectious diseases not necessarily common in Canada can occur and may even be widespread in other countries. Standards of hygiene and medical care may differ from those at home. Before departure, you should learn about the health conditions in the country or countries you plan to visit, your own risk of disease and the steps you can take to prevent illness.
The risk is yours
Your risk of acquiring a disease depends on several factors. They include: your age, gender, immunization status and current state of health; your itinerary, duration and style of travel (e.g., first class, adventure) and anticipated travel activities (e.g., animal contact, exposure to fresh water, sexual contact); as well as the local disease situation.
Risk assessment consultation
Health Canada strongly recommends that your travel plans include contacting a travel medicine clinic or physician six to eight weeks before departure. Based on your individual risk assessment, a health care professional can determine your need for immunizations and/or preventive medication (prophylaxis) and advise you on precautions to avoid disease. We can help you locate a travel medicine clinic closest to your home.
Some facts from the experts
The information below has been developed and is updated in consultation with Health Canada's Committee to Advise on Tropical Medicine and Travel (CATMAT). The recommendations are intended as general advice about meningitis prevention for Canadians travelling internationally.
Disease profile
Meningococcal meningitis, a form of meningococcal disease, is a contagious disease caused by the bacterium, Neisseria meningitidis. Meningitis causes inflammation of the lining of the brain and spinal cord and can lead to rapid death or permanent brain damage, particularly in young children.
There are 13 recognized serogroups of N. meningitidis. The groups A, B and C account for roughly 90% of outbreaks of meningococcal disease; groups Y and W-135 are less common causes of infection. Vaccines have been developed for some strains. Meningococcemia, another form of meningococcal disease, results from an overwhelming infection of the blood and can be more serious with a higher fatality rate than meningitis.
Transmission
Transmission of meningitis occurs by direct contact with respiratory droplets from the nose and throat of infected persons. Fifty per cent of cases occur in infants, children and adolescents < 19 years of age, with the highest risk in children < 5 years of age.
Geographic distribution
Sporadic episodes of meningitis occur around the world with seasonal increases in winter and spring. A different cycle of disease is seen in the semi-arid area of sub-Saharan Africa where the largest and most frequently recurring outbreaks occur. Designated as the "meningitis belt", this area extends from Guinea, Senegal and southern Mauritania in the west to Ethiopia, northern Kenya and western Eritrea in the east (see Table 1).
Since the mid-1990s, epidemics in the meningitis belt have occurred on an unprecedented scale and have spread beyond the usual boundaries (see Table 2 and International Reports of Meningitis). Epidemics most often occur during the winter-spring period in temperate regions and in the dry season in tropical regions.
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Table 1: Countries in the traditional African meningitis belt
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Benin
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Gambia
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Burkina Faso
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Guinea
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(northern) Cameroon
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Guinea Bissau
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Chad
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Mali
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(northern) Côte d'Ivoire
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Niger
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(western) Eritrea
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(northern) Nigeria
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Ethiopia
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Senegal
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Ghana
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Sudan
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Table 2: African countries outside the usual boundaries of the African Meningitis Belt in which epidemics were reported in the late 1980s through the 1990s
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Angola (1998)
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Rwanda
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Burundi
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Tanzania
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| Central African Republic |
Togo |
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Democratic Republic of the Congo (1998)
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Uganda
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Kenya
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Zambia
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Malawi
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Zimbabwe (1997)
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Mozambique
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Source (Tables 1 and 2): Statement on Meningococcal Vaccination for Travellers, Committee to Advise on Tropical Medicine and Travel (CATMAT), 1999: Click here
Serogroups B and C are the most frequent causes of sporadic cases and outbreaks of meningitis in Europe and the Americas.
Serogroup A has historically been the main cause of epidemic disease worldwide and still dominates in Africa and Asia. During and immediately following the Hajj (pilgrimage to Mecca) in March 2000 - for which over 1,200,000 persons visited Saudi Arabia - there was an outbreak of meningococcal disease associated with pilgrims returning to their home countries. A substantial proportion of these cases were caused by the serogroup W-135. To enter Saudi Arabia for the 2001 Hajj, all travellers had to demonstrate proof of A and C meningitis vaccination. Therefore, many travellers may not have been protected against the W-135 outbreak that followed the Hajj. Countries reporting meningitis W-135 in returning Hajj pilgrims in 2001 included Central African Republic, Denmark, France, Norway, Saudi Arabia, Singapore and the UK.
Meningococcal disease occurs in Canada with periods of increased activity approximately every 10 to 15 years, but with no consistent pattern. Most of the cases occur in children < 5 years of age. From 1985 to 2000, an average of 303 cases of the disease were reported per year, with the majority of cases occurring in the winter months. Since 1986, serogroups B and C have been responsible for most of the cases of meningococcal disease in Canada.
Symptoms
The incubation period for meningitis is between two to 10 days, most often ranging between three and four days. Symptoms include the sudden onset of intense headache, fever, nausea, vomiting, photophobia (aversion to light) and stiff neck. Neurological signs include lethargy, delirium, coma and/or convulsions. Infants may have illness without sudden onset and stiff neck. Many infected people do not develop symptoms but can become carriers. The less common but more severe form of meningococcal disease, meningococcemia, is characterized by rapid circulatory collapse and a haemorrhagic rash.
Treatment
Meningococcal disease is a medical emergency, requiring early diagnosis, hospitalization, and effective treatment. When the infection is diagnosed and treated early, antibiotics can be effective in arresting the illness and reducing fatalities. With treatment, five to 10% of patients may not survive; without treatment, 50% may not survive. Up to 20% of those who survive a severe case, especially infants and young children, may have persistent neurologic defects after recovery.
Vaccine
There are three meningococcal vaccines licensed in Canada. Two purified capsular polysaccharide vaccines are available:
- a quadrivalent vaccine that protects against 4 serogroups (A, C, Y and W-135), and
- a bivalent vaccine that protects against 2 serogroups (A and C).
In addition, a conjugate monovalent vaccine has recently been introduced that protects against serogroup C disease only.
It is important to note that protection received from either the quadrivalent or the bivalent purified capsular polysaccharide vaccines is not long lasting in young children. Moreover, only a limited number of young children will receive protection following vaccination, particularly against serogroup C disease. The conjugate monovalent C vaccine however, is very effective in young children.
Recommendations for vaccination should be based on the travel destination, the nature and duration of travel, and the age and health of the traveller. The conjugate monovalent vaccine alone is not appropriate protection for travellers as it does not protect against the other serogroups, such as W-135 or A that are potential risks for travellers. The quadrivalent vaccine is recommended.
Prevention and personal precautions
Some international travellers may be at risk of acquiring meningitis abroad due to the nature and location of their travel. As meningitis can be spread person-to-person and is airborne, the risk of exposure is likely related to the duration of stay or travel in high meningitis-prevalent areas. The nature and circumstances of contact with local people is also important in determining a traveller's risk of exposure. Those who will be in close contact with the local population through accommodation, public transport or work are considered to be at higher risk. Medical personnel are at greater risk if they have close, unprotected contact with infected persons.
Health Canada strongly recommends all travellers obtain an individual risk assessment from a physician or travel medicine clinic before departure to determine their particular risk for meningitis.
As of June 22, 2001, the World Health Organization reports that in preparation for the Umrah and the Hajj seasons for 2002, the Ministry of Health of the Government of Saudi Arabia has notified the Ministries of Health of all countries from which pilgrims arrive, that the vaccination against meningococcal meningitis with the quadrivalent vaccine (serogroups A, C, Y and W135) has been added to the health requirements for arrivals coming to the Umrah and Hajj.
Some things to think about...
Travel in an area of high meningitis prevalence; prolonged duration of exposure; and activities which intensify exposure, such as health care work, work with refugees, and back-packing may increase the risk of exposure to meningitis.
For more information...
SOURCE: http://www.phac-aspc.gc.ca/index-eng.php
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