There are now three confirmed cases of meningococcal disease with the same serogroup C strain in Greater Sudbury.
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Kelly Reilly says she is amazed at the community?s response to last week?s mass immunization campaign. |
?We now have three confirmed cases and no new cases of meningitis,? said Kelly Reilly, manager of clinic services at the health unit.
Last week the Sudbury and District Health Unit launched a mass immunization program.
The total number of young people between the ages of 14 and 20 in the City of Greater Sudbury who were immunized Thursday was 2,255, bringing the total across the Greater City to 7,300.
The immunization program?s goal was to give the vaccine to 15,000 young people between the ages of 14 and 20 across the City of Greater Sudbury.
One additional clinic was held Saturday at the health unit on Paris Street.
Northern Life?s Keith Lacey had a conversation with Reilly about events of the past week.
Needless to say, it?s been a busy few days for everyone at the Sudbury and District Health Unit.
Absolutely. I guess one of the first things I need to say is how absolutely amazed I am at the response of the whole community. It started with the health unit staff and their willingness to come in and do what needed to be
done, especially starting on a holiday long-weekend, to our community partners. Then there was the school boards that opened up their places to us. The hospital that assisted us in our need for additional nursing support.
Explain meningitis and meningococcal disease. What is the difference between the two?
It does get a bit confusing because people tend to use the terms interchangeably. First of all, meningitis by itself is an inflammation of the brain and the spinal cord and it can be caused by a number of agents. There?s spinal
meningitis and there?s bacterial meningitis.
When we speak of meningococcal disease, it?s a specific type of disease caused by bacteria called niceria meningitavis. The specific bacteria that causes the disease depends on where the infection sets up. If it sets up in your blood, it becomes meningococcal septocemia. It the infection sets up in your spine or in your brain, then it becomes meningococcal meningitis. We often group the two of them together under meningococcal disease.
What do doctors and medical professionals know in relation to how it?s spread?
We know how it?s spread. To back up a bit, in terms of where it comes from; there?s about 15 or 20 per cent of the population, who walk around every day, with this bacteria living harmlessly in their upper nose and throat. It doesn?t make them sick.
We don?t know what happens, but something changes and all of a sudden the bacteria that?s been harmlessly living there forever in one of five people, all of a sudden it sets up an infection.
The good news, is it?s rare. The normal rates are between three and five a year (in Greater Sudbury). It doesn?t happen very often, but when it does, it sets up a really, really serious infection.
We do know that it spreads by direct, intimate contact by anything that involves the exchange of saliva. So, the number one thing we want to get out, not just today, but every day, and it?s not the sexiest message in the world, is ?wash your hands, wash your hands, wash your hands.?
Second of all, don?t share things that go in your mouth with other people. You look at sports teams. They pass the water bottle back and forth.
Teenagers, they share cigarettes. If you avoid those risk behaviours, not only will you avoid meningococcal disease, but a whole host of others things like colds, the flu and other viruses that are there.
That?s the message we want to get out to protect members of the public.
Explain the health unit?s protocol in ordering the mass immunization process after confirmation of the one case
and two suspected cases of meningococcal disease. Who made the call and when?
To be accurate, we had one case in January and we had a second case in April. When we had the third case in September, we did our routine medical public health followup, concentrating on the contact person. Then we get in touch with close immediate contacts, the ones who might have shared saliva; that?s who we had to find first. And that?s part of our routine public health policy. We found those and treated them.
Then we had the second case reported to us in that short time period. That moved the total number to four. With each and every case, our first priority is those in close contact, to make sure they get a dose of antibiotics. That does two things. It prevents them from getting sick and from passing it on to other people.
We did our case investigation and the only thing is when we had the one in September and the one in October, we asked ourselves ?how closely spaced are they? Are we used to seeing such cases.?
In addition to the regular follow up that we always do, now we?re looking at other things. Is there anything that ties the two together. And the answer then, was no. And the answer now, is still no.
We?re looking at that and we?re trying to get information out to the schools because we had requests from the schools. Getting the public education out there is a big part of what we do, as is responding to all the calls that came in here.
On Friday (Oct. 10), we had the third case in a short time period identified to us. With meningococcal disease and with most diseases that are really serious in nature, we don?t wait until we get confirmation to do our public health followup. We start right away.
We launched another full followup with the third patient and got that list of close contacts and did our regular routine.
Even though our investigation is now over and we can?t find any links, we, at that point in time, said we have three much more closely spaced than is normal, which is very unusual, so we need to contact the Ministry of Health and Long Term Care. They?re experts.
We?ve obviously had our medical officer of health involved all along, but now is the time to talk to them because if we?re going to launch a mass immunization campaign, it is the decision of the Ministry of Health and Long Term Care to make that vaccine available at no cost.
Meningococcal vaccine is not a publicly funded vaccine. So we had a teleconference with them on Friday and made plans. We wouldn?t be able to launch a mass immunization program until we knew what the type was.
There?s no point giving out a vaccine unless it?s effective. We had one patient identified as Type C. So we had to wait. We didn?t get our second identification (of Type C) from the lab until Saturday at 12:20 pm.
With that information, we contacted the ministry and they said, ?OK. You now have our approval to launch your mass immunization campaign.
That teleconference took place at 1 in the afternoon and by 10 the next morning, like 21 hours later, we had needles in people?s arms.
The goal of the mass immunization program, from what we understand, was to immunize everyone in the City of Greater Sudbury between the ages of 14 and 20? Is that accurate and why that age group?
That age group was decided upon in consultation with the Ministry of Health and Long Term Care because all of our cases were between ages 15 and 19. What we did is decide this is obviously the age group at risk right now and so what we did is go one year below and one year above just to make sure it was a wide enough net.
Our first priority, actually, was the youth; 14 to 20-year-olds in Valley East. That was Phase I, because they were a higher priority than the other students. So we did them first and then we opened it up to all young people aged 14 to 20 in the City of Greater Sudbury.
Does getting the menningococcal disease immunization shot guarantee you will not get the virus or bacteria?
There are no guarantees in life, but we do know that the vaccine is about 90 per cent effective, which is very good and it protects you not only from one type of meningitis, but four different types.
It?s effective against what?s called the C strain. It?s effective against the A strain and the Y strain and it?s also effective against the strain called the W-135.
Whenever meningitis is brought into the public consciousness, it tends to raise fear and panic. Has this happened in Sudbury over the past week?
I think we certainly have seen a high level of concern in the community and a lot of that is based on fear. It?s a
very significant illness and it?s something we don?t have any control; over the things you can?t see, the bacteria that surround us all.
The most important message people want to know is how to protect themselves and their families? The vaccine is that extra measure of protection for those groups who have been identified as high risk.
When does the period of concern pass with this particular disease?
What I can tell you is, the incubation period for meningococcal disease is about two to 10 days and most commonly, it lasts three to four days. So, we hope that period elapses at least 10 days from our last case and we don?t see any new cases coming.
Obviously, it would be a wonderful thing to not see any new cases. Generally, two weeks would be outside the limit for the incubation period. Hopefully, we won?t see any new cases at all.
Has this exercise prepared the health unit, should there be an outbreak of this disease in this community in the future?
It?s actually been an opportunity for us to put our plan into place. We do have a mass immunization plan and we were ready to mobilize it and from that I think what we can do is we can fine-tune some of the points.
It has also given us incredible insight into what a strong community Sudbury is and how everyone has really come together to make sure that our community is protected.
And that, in itself, inspires a lot of confidence to know that this health unit can respond to whatever comes its
way.
