International Notes
Epidemic Meningococcal Disease -- Kenya and Tanzania:
Recommendations for Travelers, 1990
Epidemic meningococcal disease has occurred in Nairobi, Kenya,
and the Arusha area of northern Tanzania. From April through
October 1989, approximately 4000 cases of meningitis due to
Neisseria meningitidis serogroup A were reported in Nairobi, an
attack rate of 267 per 100,000 during this period. Cases have
also been reported in other regions of Kenya. Attack rates in
Nairobi were equally distributed by sex; the highest rate
occurred among children 0-4 years of age. Control measures in
Nairobi included a vaccination program directed at persons in
areas most affected by disease; the incidence appears to be
decreasing.
In Tanzania, from July through November 1989, 1249 cases of
meningococcal disease were reported in four northern districts,
including the Arusha area--an attack rate of 172 per 100,000. The
Tanzanian Ministry of Health has implemented control measures and
has reported a decrease in meningococcal disease. No cases of
meningococcal disease have been reported in U.S. travelers
returning from Kenya or Tanzania.
Reported by: FE Onyango, MD, Dept of Pediatrics, Univ of Nairobi,
NN Agata, MD, Kenyatta National Hospital, Nairobi; JS Oliech, MD,
Kenya Ministry of Health. PR Hiza, MD, Chief Medical Officer,
Ministry of Health, Tanzania. Div of Immunization, Div of
Quarantine, Center for Prevention Svcs; Meningitis and Special
Pathogens Br, Div of Bacterial Diseases, Center for Infectious
Diseases, CDC.
Editorial Note
Editorial Note: Epidemic meningococcal disease in Kenya and
Tanzania is uncommon. These outbreaks may be caused by the same
III-1 clonal group of N. meningitidis serogroup A responsible for
recent major epidemics in Nepal (1983-1984), Saudi Arabia (1987),
and Chad (1988) (1).
Because of the potential risk for exposure in Kenya and
northern Tanzania, CDC recommends that U.S. travelers to these
areas receive the meningococcal polysaccharide vaccine. The
serogroup A meningococcal vaccine is 85%-95% effective for at
least 1 year in persons greater than or equal to 4 years of age
(2,3). Vaccine efficacy data for children less than 4 years of
age are limited. However, vaccine immunogenicity increases
progressively with age from 3 months to 4 years. Adverse
reactions to the meningococcal vaccine are mild and infrequent,
consisting primarily of localized erythema lasting 1-2 days (2).
Protective immunity is achieved 10-14 days after vaccination.
Quadrivalent polysaccharide vaccine containing serogroups A, C,
Y, and W135 is available to physicians from local distributors or
Connaught Laboratories at (800) 822-2463.
Although group A meningococcal disease is rare in the United
States, carriage of group A meningococcus has been reported in
travelers returning from countries with epidemics (4). Physicians
are encouraged to report all cases of meningococcal disease to
their local and state health departments and to forward
meningococcal isolates to CDC through their state public health
laboratories.
References
Moore PS, Reeves M, Schwartz B, Gellin BG, Broome CV.
Intercontinental spread of an epidemic group A Neisseria
meningitidis strain. Lancet 1989;2:260-3.
ACIP. Meningococcal vaccines. MMWR 1985;34:255-9.
Reingold AL, Broome CV, Hightower AW, et al. Age-specific
differences in duration of clinical protection after vaccination
with meningococcal polysaccharide A vaccine. Lancet 1985;2:114-8.
Moore PS, Harrison LH, Telzak EE, Ajello GW, Broome CV. Group
A meningococcal carriage in travelers returning from Saudi
Arabia. JAMA 1988;260:2686-9.
Disclaimer
All MMWR HTML documents published before January 1993 are electronic conversions from ASCII text into HTML. This conversion may have resulted in character translation or format errors in the HTML version. Users should not rely on this HTML document, but are referred to the original MMWR paper copy for the official text, figures, and tables. An original paper copy of this issue can be obtained from the Superintendent of Documents, U.S. Government Printing Office (GPO), Washington, DC 20402-9371; telephone: (202) 512-1800. Contact GPO for current prices.
**Questions or messages regarding errors in formatting should be addressed to mmwrq@cdc.gov.
