II.7 PREVENTION OF BACTERIAL MENINGITIS IN CHILDREN
II.7.1) VACCINATION
Vaccination is the immunisation of someone against an
infectious disease through the administration of a vaccine. These vaccins act
by stimulating the immune system, thereby protecting from infection and / or
disease (WHO)[49]. Bacterial meningitis even though still an aggressive
infection, is preventable with the use of vaccines against its different
etiologies introduced and served mostly in children with less than 2 years of
age. This is because these children are more susceptible to infection with
encapsulated bacteria because of their immature immune system to respond
against the bacterium polysaccharide antigens[50].
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Approximately 3/4 of deaths due to meningitis are prevented
with Hib and pneumococcal conjugate vaccines,which reduce nasopharyngeal
carriage of these organisms in the host and induce immunity[51].
Pneumococcal vaccins are available in two forms [52]:
Pneumococcal conjugate vaccine which is served in children
with less than 2 years of age and protects them against severe forms of
pneumococcal disease like; pneumoniae, meningitis and bacteremia.Two conjugates
are used PCV 13 with 13 serotypes and PCV 10 with 10 serotypes which are
relatively well tolerated. WHO recommends three primary doses starting as early
as 6 weeks of age or as an alternative, two primary doses could be given at the
age of 6 months plus a booster dose at 9- 15 months of age[53].
Pneumococcal polysaccharide vaccine which is served in adults
of greater than or equal to 65 years of age[53].
The different meningococcal polysaccharide vaccines include:
Bivalent(A and C)
Trivalent (A,C and W135)
Tetravalent (A,C,Y and W135)[54]
The Group A and C vaccines have a short term immunisation
effects in older children and adults and it should be noted that group C only
does not prevent disease in children with less than 2 years of age. Meanwhile
polysaccharide Y and W135 are efficient in children greater than 2 years of
age.Tetravalent vaccines are administered in single dose and in children as
from 1 year.These vaccines have as role to induce T cell 6 dependent immune
response and to reduce the nasopharyngeal carriage of meningococci[54].
The anti-Hib vaccine is mixed with a set of four other
vaccines (Pentavalent vaccine) which are vaccines against; diphtheria,
hepatitis B, tetanus and pertussis.Normally three doses are to be administered
for a good immunity, and the first dose is served as from 6 weeks. It can be
administered to 18 months maximum with atleast four weeks spacing in between
the doses[55].
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II.7.2) CHEMOPROPHYLAXIS
Close contacts of all children with meningococcal meningitis
should receive chemoprophylaxis (ceftriaxone, rifampin, or ciprofloxacin), and
contacts of those with Hib should receive ceftriaxone or
rifampin[21].
Rifampin is administered 10 mg /Kg of body weight every 12
hours for children greater than or equal to 1 month of age, and 5 mg /Kg every
12 hours for infants less than 1 month of age. Rifampin is effective in the
eradication of nasopharyngeal carriage of Neisseria meningitidis. In
addition to rifampin, other antimicrobials are effective in the reduction of
nasopharyngeal carriage of meningococcal pathogens, like ciprofloxacin but
generally not recommended for persons less than 18 years of age because of its
destructive effect on cartilage. Whereas ceftriaxone administered in a single
dose of 125 mg in children is also effective [55].
Unvaccinated children less than 5 years of age should also be
vaccinated against H. influenzae as soon as possible. Patients should
be kept in respiratory isolation for at least the first 24 hours after
commencing antibiotic therapy [21].
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