Meningococcal meningitis

Disease Risk Areas
The epidemic (type A) strains occur predominantly in Sub-Saharan Africa from Senegal and Gambia in the west to Ethiopia and Somalia in the east. In recent years outbreaks have occurred as far south as Zambia, Malawi and Namibia.
North African countries along the Mediteranean coast are not normally involved.
Epidemics occur annually and are most likely towards the end of the dry seasons. There are occasional cases at other times of year. Very large epidemics have occurred recently every 5-10 years. These larger epidemics tended to start in West Africa and spread eastwards.
Outbreaks in Nepal, northern India and Brazil have occurred but have been localized and unpredictable.

Transmission
Droplet spread via direct contact from nasal carriers or those in the early stage of illness.

Recommendations for travellers
Advised for those going to risk areas when going to be in close contact with the local population or staying for long periods. On this basis the risk is usually small for package tourists.
Although epidemics tend to occur during the dry seasons in Africa we usually hear of outbreaks only after they are established.
'Close contact with locals' seems a more practical way of assessing risk than advice relating to seasons or the start of the outbreaks themselves.

Vaccination

Always confirm details with manufacturer's literature
Type: Polysaccaride vaccine (not live).
No of doses: One (effective from 7 days).
Route: S/C or I/M.
Length of protection: 3 years (Pasteur Merieux), 5 years (Smith Kline Beecham).
Boosters: 3 to 5 years as above depending on which vaccine is used.
The vaccine is less effective in those under 2 years so they should receive a booster after 1 year to gain maximum protection. 'AC' Vax can be given from 2 months and Meningivax from 18 months.

Side effects
Local reactions sometimes occur but generalised reactions are rare.

Contraindications
Acute febrile reactions

Availability
'AC Vax' - Smith Kline Beecham
'Meningivax' - Pasteur Merieux