Meningococcal Disease in Travellers · a mandatory entry requirement for the Hajj or Umrah...

Meningococcal Disease in Travellers

UK/VAC/0023/16a Date of preparation: July 2016

For UK Healthcare Professionals

Please find product Prescribing Information at the end of this presentation

Meningococcal disease A rare but potentially serious illness in travellers1

1.  Travel Health Pro Factsheet. Available at http://travelhealthpro.org.uk/meningococcal-disease/. Accessed February 2016. 2.  Goodman AL et al. Awareness of Meningococcal Disease among Travelers from the United Kingdom to the Meningitis Belt in Africa. Am J Trop Med Hyg. 2014 Aug 6;91(2):281–286. 3.  HPA. Meningococcal Infection Factsheet Last updated 30 June 2011. Available at http://www.hpa.org.uk/web/HPAweb&HPAwebStandard/HPAweb_C/1195733822509#WhatIsMeningo

Accessed February 2016.

200-640 Estimated incidence of infection in high-risk travellers (per month of stay)2

/ 100,000

Caused by the bacterium Neisseria meningitidis3

0.4 100,000 Estimated incidence in

general travellers (per month of stay)2

/ UK/VAC/0023/16a

Date of preparation: July 2016


5 of Neisseria meningitidis cause the majority of disease1,2

SEROGROUPS

A

C

W-135

Y Vaccination against serogroup B meningococcal bacteria is not usually recommended for travel to high-risk regions because serogroup B is not highly prevalent in these regions4

Serogroups vary around the world Travellers to high-risk areas should vaccinate against A, C, W-135 and Y serogroups2,3

B

1.  WHO. Meningococcal vaccines: WHO position paper, November 2011. Wkly Epidemiol Rec. 2011;86:521–539. 2.  Halperin SA et al. The changing and dynamic epidemiology of meningococcal disease. Vaccine (2011), doi:10.1016/j.vaccine.2011.12.032. 3.  NHS Choices, Meningitis Vaccination, 2014. Available at http://www.nhs.uk/Conditions/Meningitis/Pages/Prevention.aspx. Accessed February 2016. 4.  CDC. Yellow book, chapter 3. Meningococcal Disease. Novartis Vaccines. Available at http://wwwnc.cdc.gov/travel/yellowbook/2016/infectious-diseases-related-to-travel/meningococcal-

disease. Accessed February 2016.



UK general population

PERSON-TO-PERSON spread

Neisseria meningitidis in the back of their nose or throat without ill effects1

The bacteria invade the body causing serious disease1

Meningitis infection of the protective lining of the brain

Septicaemiablood poisoning

10-20%

are carriers

1.  WHO. Fact sheet no. 141. Meningococcal meningitis, February 2015. Available at http://www.who.int/mediacentre/factsheets/fs141/en/. Accessed February 2016.



The carriage rate may be higher in epidemic situations1

Septicaemia1 Meningococcal meningitis1

Fever Sudden onset of fever & intense headache

Neck stiffness Vomiting

Nausea

Non-blanching petechial rash

meningococcal disease SYMPTOMS of

1. Centers for Disease Prevention and Control. Yellow Book: Meningococcal disease. 2014. Available at http://wwwnc.cdc.gov/travel/yellowbook/2014/chapter-3-infectious-diseases-related-to-travel/meningococcal-disease. Accessed February 2016.



meningococcal disease SYMPTOMS of

1. WHO. Meningococcal vaccines: WHO position paper, November 2011. Wkly Epidemiol Rec. 2011;86:521–539.

Meningococcal disease is rapidly progressive and can be fatal within

R.I.P

24-48 hours1

– ``````````````````````` ̀



Press the glass firmly against the suspected rash

Tumbler Test A quick diagnostic test for travellers1

Seek help immediately if the rash doesn’t fade under pressure, as shown

1.  Meningitis UK. The rash. Available at https://www.meningitisnow.org/meningitis-explained/signs-and-symptoms/glass-test/. Accessed February 2016.



PERSON-TO-PERSON through infected saliva or respiratory secretions1

How can travellers get the disease?

Coughs & sneezes

Kissing

Close prolonged contact

Sharing kitchen utensils

1.  WHO. Fact sheet no. 141. Meningococcal meningitis, February 2015. Available at http://www.who.int/mediacentre/factsheets/fs141/en/. Accessed February 2016.



Those living/working with local people

Backpackers

Healthcare workers

Individuals with immune deficiencies

Incidence of meningococcal disease in high-risk travellers (per month of stay)3

200-640 100,000 /

1.  Department of Health. The Green Book - Chapter 22: Meningococcal, 2013. Available at https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/302904/Green_Book_Chapter_22_v2_5.pdf. Accessed February 2016.

2.  Travel Health Pro Factsheet. Available at http://travelhealthpro.org.uk/meningococcal-disease/. Accessed February 2016. 3.  Goodman AL et al. Awareness of Meningococcal Disease among Travelers from the United Kingdom to the Meningitis Belt in Africa. Am J Trop Med Hyg. 2014 Aug 6;91(2):281–286.

The disease is primarily a risk for those travelling to the meningitis belt, Mecca or an area where a known outbreak is occurring1,2

High-risk traveller populations

Individuals with no spleen or a poorly functioning spleen

Hajj or Umrah pilgrims (Mecca)



Disease outbreaks can occur anywhere worldwide, but there are differences in disease incidence1

Meningitis belt: a high-risk area for travellers

This map represents all 26 countries of the extended African meningitis belt.

Countries at high epidemic risk Travellers are also at risk in an area where a known outbreak is occurring2

Meningitis belt Sub-Saharan Africa poses the greatest risk to travellers2-6

highest meningococcal disease rates globally

frequent epidemics, every 5-10 years

1.  Halperin SA et al. The changing and dynamic epidemiology of meningococcal disease. Vaccine (2011), doi:10.1016/j.vaccine.2011.12.032. 2.  Travel Health Pro Factsheet. Available at http://travelhealthpro.org.uk/meningococcal-disease/. Accessed February 2016. 3.  Wilder-Smith A. Meningococcal disease: risk for international travellers and vaccine strategies. Travel Med Infect Dis 2008;6:182–18. 4.  Stephens DS et al. Epidemic meningitis, meningococcaemia, and Neisseria meningitidis. Lancet 2007;369:2196–2210. 5.  Centers for Disease Prevention and Control. Yellow Book: Meningococcal disease. 2014. Available at http://wwwnc.cdc.gov/travel/yellowbook/2014/chapter-3-infectious-diseases-related-to-travel/

meningococcal-disease. Accessed February 2016. 6.  National Travel Health Network and Centre (NaTHNac). Meningococcal meningitis, June 2014. Available at http://www.nathnac.org/pro/factsheets/meningococcal.htm. Accessed February 2016.



2 m

N. meningitidis quadrivalent (A,C,W and Y) vaccination is a mandatory entry requirement for the Hajj or Umrah pilgrimages1,2

Mecca: Hajj and Umrah travellers

Hajj & Umrah pilgrims3

Severely crowded conditions favour increased carriage and transmission of Neisseria meningitidis4

1.  Wilder-Smith A. Meningococcal disease: risk for international travellers and vaccine strategies. Travel Med Infect Dis. 2008;6:182–186. 2.  Health requirements and recommendations for Hajj and Umrah performers and those working in Hajj areas - 2015 http://www.moh.gov.sa/en/Hajj/HealthGuidelines/HealthGuidelinesDuringHajj/

Pages/HealthRegulations1436.aspx. Accessed February 2016. 3.  Memish ZA, Venkatesh S, Ahmed QA. Travel epidemiology: the Saudi perspective. Int J Antimicrob Agents. 2003;21:96–101. 4.  Al-Gahtani, YM, Al-Bushra, Al-Qarawi, SM et al, Epidemiological investigation of an outbreak of meningococcal meningitis in Makkah, Saudi Arabia, 1992. Epidemiol Infect. 1995;115:399–409. 5.  Lingappa JR, et al. Serogroup W-135 Meningococcal Disease during the Hajj, 2000. Emerg Infect Dis. 2003;9:665–671. 6.  Memish ZA, et al. Travel epidemiology: the Saudi perspective. Int J Antimicrob Agents. 2003;21:96–101.

A W-135



How can travellers prevent meningococcal disease?

MenACWY vaccines available in the UK as conjugate vaccines

The majority receiving the vaccination will be travellers to the African meningitis belt and Hajj or Umrah pilgrims1,2

1.  Department of Health. The Green Book - Chapter 22: Meningococcal, 2013. Available at https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/302904/Green_Book_Chapter_22_v2_5.pdf. Accessed February 2016.

2.  Travel Health Pro Factsheet. Available at http://travelhealthpro.org.uk/meningococcal-disease/. Accessed February 2016.



MenACWY vaccines

MenACWY conjugate vaccines available for travellers

Menveo® (meningococcal

conjugate vaccine)1

Nimenrix® (meningococcal

A,C,W-135 & Y vaccine)2

Y A W-135 C A C W-135 Y

All conjugated to Corynebacterium diphtheriae CRM 197 protein

All conjugated to tetanus toxoid carrier protein

Powder + solution for injection in 2 vials for reconstitution

1.  Menveo Summary of Product Characteristics. Available at https://www.medicines.org.uk/emc/medicine/27347. Accessed February 2016. 2.  Nimenrix Summary of Product Characteristics.



Powder in vial + solvent for solution for injection in pre-filled syringe

WHAT? WHY?

WHO? HOW?

Helps protect against disease caused by Neisseria meningitidis serogroups A, C, W-135 and Y

A conjugate MenACWY vaccine

Children (from 2 years of age)

Adolescents Adults

A single dose vaccine (0.5ml) administered intramuscularly

Can be given concomitantly with routine vaccinations

conjugate MenACWY vaccine for travellers1,2 Menveo®

1.  Menveo Summary of Product Characteristics. Available at https://www.medicines.org.uk/emc/medicine/27347. Accessed February 2016. 2.  Menveo product overview. Available at https://gsksource.com/pharma/content/gsk/source/us/en/brands/menveo/pi/po.html. Accessed February 2016.



Pregnancy or breast-feeding women may receive Menveo® if the benefit outweighs the risk given the lack of data in these populations

Common adverse events Injection site reactions

Headache Nausea

Rash Malaise

adverse events & special warnings1,2 Menveo®

1.  Menveo Summary of Product Characteristics. Available at https://www.medicines.org.uk/emc/medicine/27347. Accessed February 2016. 2.  Menveo product overview. Available at https://gsksource.com/pharma/content/gsk/source/us/en/brands/menveo/pi/po.html. Accessed February 2016.



Case scenario

Name Saleem Age 26 year old Gender Male Occupation Medical Student He has up-to-date MMR, hepatitis A + B, diphtheria, tetanus and typhoid

Which vaccines and other general travel advice would you recommend for this patient?



Menveo® Prescribing Information



MENVEO®. Powder and solution, for injection. Meningococcal group A, C, W135 and Y conjugate vaccine. Indications: Active immunisation against Neisseria meningitides serogroups A, C, W135 and Y for children (from 2 years of age), adolescents and adults. Dosage: A single dose of 0.5 ml into the deltoid muscle. Booster vaccination: Refer to SPC and nat ional recommendation. Contraindications: Hypersensitivity to the active substance or to any of the excipients, including diphtheria toxoid (CRM197). Postpone use in persons with acute, severe febrile conditions. Precautions: Separate injection sites should be used if administering more than one vaccine. See SPC for advice on use in immunocompromised individuals. Dizziness has rarely been reported after vaccination which may temporarily affect the ability to drive or use machines. Interactions: See SPC. Pregnancy and lactation: Insufficient

clinical data on exposed pregnancies are available. Adverse reactions: See SPC for full details. Common: irritability, malaise, injection site pain or erythema, injection site induration, sleepiness, headache, chills, fever (38oC), eating disorder, nausea, vomiting, diarrhoea, rash, myalgia, arthralgia. Serious: hypersensitivity, convulsions, anaphylaxis, cellulitis. Legal category: POM. Presentation and basic NHS cost: Pack of two vials. MENVEO® must be prepared for administration by reconstituting powder (in vial) with solution (in vial), £30.00 per dose. MA holder: GSK Vaccines, Via Fiorentina 1, 53100 Siena, Italy. MA number: EU/1/10/614/002, EU/1/10/614/003. Further information is available from: Customer Contact Centre, GlaxoSmithKline, Stockley Park West, Uxbridge, Middlesex UB11 1BT; [email protected]; Freephone: 0800 221 441. Date of preparation: November 2015 UK/MEN/15-0018.

Adverse events should be reported. Reporting forms and information can be found at www.mhra.gov.uk/yellowcard. Adverse events should also be reported to GlaxoSmithKline on 0800 221 441. Please refer to the full Summary Product Characteristics before prescribing.

Meningococcal Disease in Travellers · a mandatory entry requirement for the Hajj or Umrah...

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