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International Notes Epidemic Meningococcal Disease -- Kenya and Tanzania: Recommendations for Travelers, 1990
Publication date: 01/12/1990
Table of Contents
ArticleEpidemic meningococcal disease has occurred in Nairobi, Kenya, and the Arusha area of northern Tanzania. From April through October 1989, approximately 4000 cases of meningitis due to Neisseria meningitidis serogroup A were reported in Nairobi, an attack rate of 267 per 100,000 during this period. Cases have also been reported in other regions of Kenya. Attack rates in Nairobi were equally distributed by sex; the highest rate occurred among children 0-4 years of age. Control measures in Nairobi included a vaccination program directed at persons in areas most affected by disease; the incidence appears to be decreasing.
In Tanzania, from July through November 1989, 1249 cases of meningococcal disease were reported in four northern districts, including the Arusha area--an attack rate of 172 per 100,000. The Tanzanian Ministry of Health has implemented control measures and has reported a decrease in meningococcal disease. No cases of meningococcal disease have been reported in U.S. travelers returning from Kenya or Tanzania.
Reported by: FE Onyango, MD, Dept of Pediatrics, Univ of Nairobi, NN Agata, MD, Kenyatta National Hospital, Nairobi; JS Oliech, MD, Kenya Ministry of Health. PR Hiza, MD, Chief Medical Officer, Ministry of Health, Tanzania. Div of Immunization, Div of Quarantine, Center for Prevention Svcs; Meningitis and Special Pathogens Br, Div of Bacterial Diseases, Center for Infectious Diseases, CDC.
Editorial NoteEditorial Note: Epidemic meningococcal disease in Kenya and Tanzania is uncommon. These outbreaks may be caused by the same III-1 clonal group of N. meningitidis serogroup A responsible for recent major epidemics in Nepal (1983-1984), Saudi Arabia (1987), and Chad (1988) (1).
Because of the potential risk for exposure in Kenya and northern Tanzania, CDC recommends that U.S. travelers to these areas receive the meningococcal polysaccharide vaccine. The serogroup A meningococcal vaccine is 85%-95% effective for at least 1 year in persons greater than or equal to 4 years of age (2,3). Vaccine efficacy data for children less than 4 years of age are limited. However, vaccine immunogenicity increases progressively with age from 3 months to 4 years. Adverse reactions to the meningococcal vaccine are mild and infrequent, consisting primarily of localized erythema lasting 1-2 days (2). Protective immunity is achieved 10-14 days after vaccination. Quadrivalent polysaccharide vaccine containing serogroups A, C, Y, and W135 is available to physicians from local distributors or Connaught Laboratories at (800) 822-2463.
Although group A meningococcal disease is rare in the United States, carriage of group A meningococcus has been reported in travelers returning from countries with epidemics (4). Physicians are encouraged to report all cases of meningococcal disease to their local and state health departments and to forward meningococcal isolates to CDC through their state public health laboratories.
- Moore PS, Reeves M, Schwartz B, Gellin BG, Broome CV. Intercontinental spread of an epidemic group A Neisseria meningitidis strain. Lancet 1989;2:260-3.
- ACIP. Meningococcal vaccines. MMWR 1985;34:255-9.
- Reingold AL, Broome CV, Hightower AW, et al. Age-specific differences in duration of clinical protection after vaccination with meningococcal polysaccharide A vaccine. Lancet 1985;2:114-8.
- Moore PS, Harrison LH, Telzak EE, Ajello GW, Broome CV. Group A meningococcal carriage in travelers returning from Saudi Arabia. JAMA 1988;260:2686-9.
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