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Anomalous Transmission of Meningococcemia-like Illness

Recombinomics Commentary
January 20, 2005

>> Health Secretary Manuel Dayrit said they still do not know if the new case has something to do with the chain of infections that occurred in Baguio from December to early January but noted the four cases recorded in Benguet in January were linked to those in Baguio City.
"They either had contact with a previous case, attended a funeral [of an infected person], or have gone shopping [and were exposed]," said Dayrit Thursday.
There are still 13 suspected cases in Benguet, while Baguio has seven confirmed cases of the disease. The Mountain Province, on the other hand, has 12 suspect cases with no confirmed case. <<

The chain of infections above extends the list of anomalies associated with meningococcemia-like (meningo-like) illness.  Meningo is a bacterial secondary infection of patients with respiratory illness such as colds or flu. It generally affects children under the age of 4, is transmitted via nasal secretions after prolonged close contact, has a case fatality rate of 5-10%, but can be treated with an antibiotic.   Meningo-like disease is lab negative for bacteria, frequently affects those over 4, is transmitted human to human after brief encounters, and has a case fatality rate approaching 70% in some clusters.  Both meningo and meningo-like illness presents with fever and hemorrhagic rashes, but those two symptoms have been associated with pandemic influenza of 1918.

In addition to the comments above, there have been several well publicized clusters of cases involving older children and adult. The index case for the largest cluster had died of meningo-like illness.  He was 41 and four attendees at his wake developed meningo-like illness and all 4 died within a few days of each other.  They were all women between 33 and 61 years of age.  Another cluster involved another wake.  The index case was a neighbor of 10 and 12 year old brothers.  The 12 year old recovered but the younger brother died from meningo-like illness,  A third cluster involved a 34 year old engineer who developed meningo-like illness after getting a haircut near the market mentioned above.  He and the person who drove him to the hospital died.  Thus, in these three clusters 9 of 10 victims died and all were over the age of 4.

Several of the cases in Baguio have been linked to the market, which again raises the issue of transmission. Meningococcemia is not usually passed via inanimate objects.  However colds and flu can be.  In Vietnam there is an outbreak of H5N1 bird flu that in some instances appears to be linked to eating infected chickens.  The infection control is difficult because the lethal H5N1 can grow to high levels in ducks without making then ill.  The virus is excreted at high concentrations in feces and is unusually stable.

WHO issued a warning to Sagada residents near Baguio because of the potential transmission of avian influenza by migrating birds.  Since some birds appear to settle in the area during the winter, the potential of their feces contaminating vegetables that eventually are sold in the market in Baguio should be considered.  Testing of feces from these birds as well as patients with meningo-like illness should have been done long ago. There still are no media reports indicating such testing has been done or is even being considered.

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