The answer to your first question is no. Neisseria meningitides, the microorganism that causes meningococcemia is a delicate bacterium that is not highly communicable.

Now, with regard to your second question, the answer is a qualified yes. Infection with N. meningitides is highly fatal, but only if the patient develops either fulminant meningococcemia or meningococcal meningitis, the two severe forms of the infection.

Even with the best treatment, about half of those who get either disease die. What’s more, death often occurs within hours of the onset of the symptoms.

Yet, despite its highly fatal nature (which unfortunately is what is often highlighted by media), meningococcemia is not really a serious public health problem. In the first place, only a small percentage of people who get infected with N. meningitides develop the severe forms of the disease.

Secondly, although the disease is endemic all over the world (not just the Philippines, by the way) outbreaks of the disease occur only sporadically, and most involve isolated cases.

In the Philippines, the most noteworthy occurrence of the disease in recent years, which resulted in at least nine deaths, happened in Baguio in 2004. Since then, only occasional isolated cases of the disease have been reported.

Last month for example, meningococcemia has caused two deaths, those of a young girl in Davao and a five year-old boy in Sarangani.

Man is the only specie that is affected by N. meningitides. The natural habitat of the bacteria is the throat. It is able to survive because about 10 percent of the population (up to 40 percent in close populations) act as carriers for the microorganism, i.e., they harbor the bacteria without getting sick. It is transmitted to susceptible individuals through the inhalation of infected droplets from the throat and by direct (e.g. kissing) or indirect oral contact.

Meningococcal disease typically starts as an upper respiratory tract infection that presents as sore throat, cough, headache and nasal discharge. In some patients, the disease does not progress, but in most, the disease progresses into meningococcemia (i.e., invasion of the bloodstream by the bacteria).

Meningococcemia usually manifest as high fever accompanied by chills, nausea and vomiting, muscle and joint pains, and the appearance of a skin rash (small, two to 10mm, purplish spots on the skin resulting from rupture of small blood vessels). About 10-20 percent of patients who develop meningococcemia develop fulminant meningococcemia, a form of the disease that is characterized by rapid development of shock, disseminated intravascular coagulation and multiple organ failure.

In some patients with meningococcemia, the bacteria attack the brain resulting in meningitis that manifest as headache, stiffness of the neck, vomiting and various other nervous system signs and symptoms.

In its later stages, meningitis leads to sensorium changes - disorientation, incoherence, etc. - before it progresses to coma and ultimately, death.

There is no real threat of meningococcemia becoming a nationwide epidemic. The only ones very susceptible to the infection are young children.

Infants are protected from meningococcal infections during the first few months of life because of passive immunity which they acquire from their mother. With loss of passive immunity, children become susceptible to the infection (peak susceptibility is at six to 12 months).

But as children grow older, most acquire active immunity from meningococcal infections because of antibodies they develop as a result of asymptomatic exposure to non-virulent strains of N. meningitides or other bacteria that have the same immunologic properties.

Most adults (experts estimate that as many as 95 percent) are already immune from meningococcal infections.

There are antibiotics that are effective against N. meningitides. However, because severe forms of meningococcal disease are rapidly fatal (death comes within hours to two days), treatment is often given late in the illness such that 50-60 percent of patients die while many of those who survive have permanent disabilities that include deafness, cranial nerve palsy and mental deficiency.

Those who have been in close contact (e.g., household, day-care center, nursery school) with meningococcemia are sometimes given prophylactic antibiotics to prevent them from acquiring the disease. Such prophylactic treatment however, is not recommended for the general public.

How can you prevent meningococcemia? The Department of Health (DoH) is recommending the following measures:

·Wash hands frequently with soap and water.

·Avoid close contact with meningococcemia patients.

·Increase resistance by having healthy diet, regular exercise, adequate rest and sleep, no alcohol and cigarette smoking.

·Maintain clean environment/surroundings.

·Don’t share utensils, cups, water bottles, lipstick, cigarettes, dishes, glasses, cups, musical instruments with mouthpieces, mouth guards, or anything else that has been in the mouth of an infected person.

·Avoid crowded places.

Address inquiries on health matters to Dr. Eduardo G. Gonzales, DLSU College of Medicine, Dasmariñas, Cavite 4114.