An Examination of Measles and Meningococcal Meningitis from a Broad Public Health Perspective

This assignment will focus on Measles and Meningococcal Meningitis, both are communicable diseases. “A communicable disease is an illness that is transmitted from a person, animal, or inanimate source to another person either directly, with the assistance of an intermediate host or by a vector”. The assignment will look at the epidemiology of the diseases, the risk related to the diseases and the prevalence within the United Kingdom.

The characteristics of the diseases will be focused on, how it is transmitted from one person to another, what the disease does to an infected person, the incubation period, the assignment will then go onto focus on the mortality and morbidity rate of the diseases. It will look at statistics of incidences of the communicable diseases within the United Kingdom and note whether they are declining or increasing.

Meningococcal Meningitis is the bacterial form of meningitis, it is a serious infection that infects the protective membranes that surround the brain and spinal cord. It can affect anyone however, it is more predominant in babies, young children, teenagers and young adults. If it not treated quickly it can be very serious, it could potentially result in permanent damage to the brain or nerves or lead to septicemia which is blood poisoning. According to the NHS (2016), the symptoms of Meningococcal Meningitis are, a high temperature of 38 degrees of above, sickness, a rash however the rash does not always develop the rash for meningitis won’t fade when a glass is rolled over it, stiff neck, bright lights will cause discomfort and will not be tolerated, drowsiness or unresponsiveness and a person may start having seizures.

Meningococcal Meningitis will initially be diagnosed through clinical examination from a doctor, a lumber puncture will then be carried out. A lumber puncture comprises of a thin needle being inserted between the bones in the lower spine. The lumber puncture allows a sample of cerebrospinal fluid to be taken and tested under a microscope to look for bacteria. A computerized tomography also known as a CT scan will be taken to check for problems with the brain such as swelling. A blood test will be taken to determine whether it is bacterial or viral.

Meningococcal Meningitis can be potentially fatal so treatment for the disease is crucial and it should always be classed as a medical emergency. People who are diagnosed with Meningococcal Meningitis don’t have to be isolated, a broad-spectrum antibiotic treatment should be started as soon as meningitis is suspected, and that should be changed when the lumber puncture test has determined the strain. If the strain is determined to be viral the antibiotics will be stopped. If swelling of the brain is detected from the CT, then steroid medication will also be given to help reduce this. If the Meningococcal Meningitis cause breathing problems, oxygen will be given, and fluids will be given to prevent dehydration. Pain killers and anti-sickness medication can also be administered to treat the vomiting and general aches and pains caused by the disease.

According to the Meningitis Research Foundation, Meningococcal Meningitis can cause a range of health problems that can alter lives. They go onto state the after effects most likely to be caused by Meningitis as being, memory loss, lack of concentration, difficulty retaining information, clumsiness, co-ordination problems, headaches, deafness, hearing problems, tinnitus, dizziness, loss of balance, epilepsy, seizures, weakness, paralysis, spasms, speech problems, loss of sight and vision problems. Physical disabilities may be obvious, however neurological and emotional problems may not always be immediately apparent but can also cause a wide range of challenges.

Humans are the only known carries of Meningococcal Meningitis also known as Neisseria meningitides with Public Health England (2014), stating that around 10% of the population carry the infection in the back of their throat or nose without it causing them ill effect. It is transmitted through droplets of respiratory or throat secretions from carries, person to person. Smoking, kissing, sneezing or coughing or living closely with someone who carries the disease will facilitate the spread of the disease. The incubation period of Meningococcal Meningitis is between two and ten days. There are different strains of Meningococcal Meningitis which are A, B, C, W, X and Y, these strains cause epidemics.

According to the World Health Organization (2018), there are no reliable estimates of global Meningococcal Meningitis due to inadequate observation in several parts of the world, however it is more prevalent in sub-Saharan Africa. This is known as the meningitis belt, it stretches from Senegal to Ethiopia it covers 26 countries. The reason it is more predominant in sub-Saharan Africa, is due to the dry season between December and June the dust winds, cold nights cause upper respiratory tract infections, this leads to damage of the nasopharyngeal mucosa, increasing the risk of Meningococcal Meningitis.

According to Public Health England (2018), cases of Meningococcal Meningitis have remained stable at one per 100,000 incidences, there have been an overall decline of reported cases over the last two decades. The highest number of cases were reported between 1999 to 2000 where there were 2,595 cases confirmed. They believe the decline is because of the introduction of immunisations against group c diseases in 1999. People aged 25 years and older made up 46% of all reported cases in the year 2017/18. They published that that fatality ratio in England was 6.9% in 2017/18 with meningococcal disease being the underlying cause.

Meningococcal Meningitis is preventable and in the United Kingdom vaccinations are given, free of charge at specific times to help prevent the disease from occurring. According to the NHS (2016), the vaccinations are given at the following ages, 8 weeks, 16 weeks and 1 year old the MenB vaccine will be given, this will help protect babies against the meningococcal group B bacteria, this strain is responsible for more than 90% of infections in young children. At 1 years old they will also receive their Hib/MenC vaccine, this vaccine protects children against meningitis C and it’s their fourth dose of Hib. When a child reaches the age of 14, they will receive a single dose vaccination for MenACWY this aims to protect them against meningitis A, C, W and Y, these are the different strains that cause Meningococcal Meningitis and blood poisoning. This vaccination is also offered to first-time university students who have not had the injection previously, it can be given to a young person who was born after September 1st 1996, who missed their routine school vaccinations up until their 25th birthday.

The World Health Organization (2018), describes Measles as being a highly contagious, serious disease. It is caused by paramyxovirus family and it is transmitted through direct contact and through the air. The virus will infect the respiratory tract, and then spreads throughout the body. Measles is a human disease and not found in animals. Anyone can contract Measles however it is most commonly found in young children. They go onto say that the signs and symptoms of Measles are usually a high fever, the fever normal begins about 10 to 12 days after exposure to the virus and the high fever is expected to last 4 to 7 days, a runny nose, a cough, red and watery eyes and small white spots inside of the cheeks can develop in the initial stages of the infection. After the initial incubation stages have passed, they note that a rash will develop on the face and upper neck, after several days the rash will spread to the hands and feet. The rash will occur 14 days after exposure to the virus and will last for 5 to 6 days.

NHS (2018) say that people will often recover from Measles after 7 to 10 10 days, however it can sometimes lead to serious complications. The most at risk group of developing complications are, babies younger than 1, children whose diet is poor, children with a weakened immune system, teenagers and adults. The serious complications can range from, diarrhea and vomiting which can lead to dehydration, eye infections, infections in the airways and lungs, fits caused by the fever, it can also lead to the person developing meningitis or encephalitis. The NHS state that a person can develop a fatal brain complication known as subacute sclerosing panencephalitis, this normally develops many years after measles this is very rare and occurs in only 1 in evert 25,000.

Diagnosis of Measles is based on the disease characteristics, which are the symptoms mentioned above. A blood test can also confirm if it is measles. There are no specific treatments for Measles however, it’s mostly about controlling the fever and reliving the pain, staying hydrated and spotting the signs of serious illness if it develops. Vitamin A can also be given to replenish low vitamin A levels that can occur due to the virus. Giving Vitamin A can help prevent deaths from measles.

In the United Kingdom as mentioned in the section about Meningitis there is a routine vaccination program. The Mumps, measles and rubella (MMR) vaccination is given out as part of this program. This vaccination can help prevent Measles, and can help stop the spread of the virus. The vaccination is given in two doses, the first dose is given to children a month after their first birthday and the second dose is given to children just before school commences. The NHS (2018) state that the vaccination is not given to babies under 6 months old as antibodies to MMR are passed from the mother to the baby at the time of birth, however these are nearly all depleted by the age of one. It can be given to older children who missed out on one of their doses.

The NHS (2008) published a rebuttal against a journal article published by Doctor Andrew Wakefield, he wrote that the MMR vaccine might cause autism. The rebuttal noted studies which have been carried out dispute the claims of Doctor Andrew Wakefield, and there is no link between the MMR Vaccine and autism. The controversy caused by Doctor Andrew Wakefield caused a rise in parents not getting their children vaccinated against MMR, which has caused the number of incidences to rise.

In 2019 Public Health England published a report called UK Measles and Rubella elimination strategy 2019, in the report it outlines the strategy the UK can use to achieve a future free of Measles, rubella and congenital rubella syndrome. The report goes on to show how since the introduction of the measles vaccine in 1968 an estimated 4,500 deaths have been avoided and 20 million cases have been avoided in the UK. The report notes that the United Kingdom successfully eliminated Measles in 2016. In 2016/17 95% of 5 year olds were successfully vaccinated against MMR. The United Kingdom is aiming to get 95% coverage with both doses of the MMR vaccine and are having targeted catch-ups for those people who have missed it.

According to the data provided by Public Health England in 2017 there were 349 measles cases reported, that’s down from 562 cases in 2016. Even though there are still cases being reported the virus is still noted as being eliminated by the World Health Organization. The statistics show from 2010 there has been growing MMR vaccination coverage, the reported cases are up and down however overall the statistics show that the disease is eradicated. The statistics show in 2016 there was only 1 death caused by measles this is decreasing year upon year.

To conclude both Meningococcal Meningitis and Measles are communicable diseases, however they are preventable. Communicable diseases are often easily preventable and can be treated if a person does contract them. In the UK the vaccination program works towards preventing the disease, and stopping epidemics from occurring. The United Kingdom have successfully eradicated Measles and the number of reported Meningococcal Meningitis cases remain stable. This can continue to happen through the vaccination programs and through people taking steps to stop infections from spreading. The deaths caused by Meningococcal Meningitis and Measles are declining as the United Kingdom get better and taking preventative action.

Reference List

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