Meningococcal Leadership Forum APRIL 1-2, Thursday – Friday, SINGAPORE

1. Meningococcal Leadership Forum APRIL 1-2, Thursday – Friday, SINGAPORE Singapore Perspective – Dr Mohamed Ghazali Impact of meningococcal disease and policies surrounding its prevention in Southeast and South Asia Regions

2. Meningitis – Singapore Experience • Major Outbreak was in Mar 2000 (330 cases wordwide)‏ • Year 2000 : 6 cases • 1st case 45 yr Australian worker from Saudi who died fulminent septicaemia (W135) on 21st April 2000 • 2nd and 3rd case were of close contacts of returning pilgrims (W135)‏ • 4th case was a Haj pilgrim May 2000 (W135)‏ • 2 hospitalised in Saudi (?subtype)‏

3. Meningitis – Singapore Experience • Year 2001 : Another 4 cases • 1st case : 33 yr British who had travelled in from Morocco (W135 from CSF)‏ • 1 case had contact with Haj travel agent • The other 2 cases had contact with returning Haj pilgrims • Unlike in 2000, no Haj Pilgrims contracted W135 disease.

4. Vaccination Programme • ACYW135 made mandatory in 2000 for all Haj pilgrims (Prev only A and C)‏ • Recommended for sub Sahara Africa meningitis belt travel • Routine vaccination recommended for high risk groups such as asplenia and complement component deficiencies • Recommended for Industrial / Research Staff who may be exposed

5. Vaccination • Only the polysaccharide ACWY available • Poor immunogenecity in children • Some still give for under 2 year old just for Haj cover. Parents need to be warned that the vaccine may not be effective and probably lasts for a few months at most.

6. Asymptomatic Carriage and Spread • 10 % in general population • Carriage rate 17% of returning Haj pilgrims in 2001 • 90% due to W135 • Spread to home communities • 23% returning singapore pilgrims with W135 carriage transmitted to family contact • 13% of all household contacts of singapore pilgrims with W135 acquired this clone

7. Eradication of Carriage and Chemoprophylaxis • Recommended for contacts (household, school or childcare contacts) of patients with meningococcal disease • Single dose Ciproflox 500mg • Rifampicin for children • Ceftriaxone for pregnant women • MOH does not recommended routine prophylaxis for all returning pilgrims

8. Haj Medical Cover • Every year about 4000 Haj and 9000 Umrah pilgrims • 4 to 5 doctors and 20 nurses and 5 admin staff follow for Haj • Medical briefing by Travel Agent and a centralised one by MUIS (Islamic Religious Council)‏ • Each pilgrim is also given a medical booklet for health screening and travel advise by their personal physician.

9. Post Haj screening • Returning pilgrims are routinely advised to lookout for symptoms and signs of disease • Personal hygiene to prevent transmission • Close contacts are advised to inform doctors of their proximity with Haj pilgrim when they fall ill • MOH circular to remind GP of meningococcal disease in pilgrims and contacts

10. Monitoring and Control of disease • Compulsory to Notify all suspected cases within 24 hrs • Routine Childhood immunization not recommended by MOH due to poor response and short lived immunity.

11. Meningitis cases in Singapore

12. Age Distribution

13. Meningitis since 2000 • Sporadic cases • No new Haj cases since 2001 • Only cases are Streptococcal meningitis seen by the Haj team