Terror in the air: Meningococcal disease outbreak in the Philippines

ABSTRACT

Introduction: Meningococcal disease is caused by Neisseria meningitidis that can present as fever or respiratory infection developing into a fulminant course. In February 2005, WHO experts confirmed that the Cordillera Administrative Region of the Philippines experienced an outbreak of Serogroup A Meningococcal Disease where there was an unusually large proportion of meningococcemia cases. Objectives: This study aims to describe the clinical profile of pediatric patients discharged from a tertiary hospital with a diagnosis of meningococcal disease and to identify the etiologic agent. Methodology: This is a retrospective descriptive study involving chart review of patients 0-18 years of age discharged from October 2004 to October 2006 with a diagnosis of either meningococcemia, meningococcal meningitis or both. Results: There were 217 discharges with this diagnosis. Of these, 100 (46.08%) belonged to the 0-18 years of age, 47% of who were male, 64% were Baguio residents, 28% were 0-1 year old, 19% were between 2-5 years old and 26% were 15-18 years old. 100% had a history of fever and 90% had rashes. 51% had a discharge diagnosis of Meningococcemia. 32% died due to septic shock, DIC. The etiologic agent was identified as Neisseria meningitidis. Conclusion: Of the study population, 53% were female. Children 0-5 years of age were most affected (47%). 100% had a history of fever. 32% died of septic shock. 62% were confirmed by laboratory. The culprit of this epidemic was a hypervirulent strain of Neisseria meningitidis Serogroup A Subtype A 1.9 sensitive to Penicillin.