News
Meningococcal infection in Galle – prompt action by Karapitiya Hospital & health officials at ground level
View(s):- Only “small” stock of vaccine available
By Kumudini Hettiarachchi
As the Galle Prison faced an outbreak by the rare but serious meningococcal bacterium, grave concerns were raised whether there are adequate stocks of vaccines in Sri Lanka.
“We have adequate stocks for vaccination against the meningococcal bacterium at the Port Health Office located at the Medical Research Institute (MRI), Colombo,” assured a source. However, when pressed for numbers, the Sunday Times was requested to seek the information from the Medical Supplies Division (MSD).
The MSD was not contactable but other sources said there is a “small” stock of vaccines at the Port Health Office.
Those who need vaccination before departure from Sri Lanka include mainly Haj pilgrims heading to West Asia and students going to countries such as the United States of America (USA), the United Kingdom (United Kingdom) and Australia. It is a one dose per person vaccine.
Specialist in Family Medicine Dr. Ruvaiz Haniffa, when contacted, said that he checked both the state and private sectors for the vaccine against the meningococcal bacterium for Haj pilgrims in June-July. None was available.
He also expressed serious concern how some people heading abroad got their so-called ‘meningococcal vaccine certificate’ when the vaccine was not available in Sri Lanka then. Were there forged certificates in circulation, he asked.
Explaining the gravity of the meningococcal infection, he said the incubation period (the time between exposure to the bacterium and the appearance of symptoms and signs) is very short and thus a person could be dead soon after getting infected.
The Sunday Times also traced the course of events in Galle where an outbreak has been reported from the prison there and how the Karapitiya Teaching Hospital doctors and the Regional Epidemiologist responded quickly and effectively to limit its harm. This was as questions arose as to how the infection had been triggered. (See box on endemicity)
It is Karapitiya Hospital’s Consultant Microbiologist, Dr. Bhagya Piyasiri who gave an insight on the developments in the past week:
Saturday, August 19 – Dr. Piyasiri and her team had tested a sample of cerebrospinal fluid (CSF) sent by Ward 19 and found a high count of neutrophils (a type of white blood cell). The sample was from a patient having high fever. The count was suggestive of an ongoing bacterial infection in the brain (meningitis).
A CSF culture, however, had come negative but an antigen test had been positive for the Neisseria meningitidis bacterium.
While the patient was also having a rash, when looking at the history, Dr. Piyasiri had found that the patient had been in prison from August 9-14. After release from prison, he had developed fever on the 16th and the rash on the 17th and got himself admitted the same day. He is still in hospital and on the road to recovery.
Sunday, August 20 – A prisoner who had been admitted to the Emergency Treatment Unit (ETU) with fever and rash had died within two hours.
It was then that Consultant Physician Dr. Krishantha Jayasekara informed Dr. Piyasiri that two more prisoners had been brought to hospital – one who had died in the hospital on the 13th and the other who had fever, rash and severe sepsis who was in Ward 34. This patient’s condition is improving now.
Seeing the bigger picture, Dr. Piyasiri had immediately connected the dots of what seemed to be related events. She had also alerted hospital Director Dr. S.D.U.M. Ranga, while advising the hospital staff to take infection control measures through the infection control team. The Director, in turn, had speedily informed the prison authorities about a possible outbreak of a meningococcal infection.
Sunday night, August 20 – Two more prisoners had been admitted to Ward 34 with fever but no rash. They had been treated and discharged later. There was no evidence that it was a meningococcal infection, says Dr. Piyasiri.
Monday, August 21 – Dr. Piyasiri had extracted fluid from a blister on the sepsis patient from Ward 34 and tested it to find that it was positive, suggestive of a meningococcal infection.
The same day a team of health experts including Dr. Piyasiri and ETU Consultant Physician Dr. Ganaka Senaratne from the Karapitiya Hospital; Community Physician Dr. Amila Chandrasiri and Regional Epidemiologist Dr. Eranda Hettiarachchi, visited the prison, on the request of the Regional Director Dr. Somaratne.
Observing the overcrowded conditions, the team had advised that all prisoners and staff, around 1,200, be given prophylactic antibiotics to prevent catching the infection and also that precautions such as wearing masks should be implemented.
On the same evening (August 21), two more prisoners had been admitted once again with fever but no rash to Ward 12. They too had been treated and discharged later. In them too, there was no evidence that it was a meningococcal infection, says Dr. Piyasiri.
She adds: “As early as August 20, I concluded that the illness was a possible meningococcal infection in the others initially, solely on clinical grounds, circumstantial evidence and one antigen positivity.”
| Possibility of endemicity & need for more diagnostic facilities In a ‘Case series of meningococcal sepsis: are we seeing the real picture?’ published in the ‘Sri Lankan Journal of Infectious Diseases 2021, J. Galappaththi et al had studied 11 cases of invasive meningococcal sepsis in Sri Lanka during a period of eight months. The age of the patients had ranged from 1.5 to 67 years. There had been 7 (63.6%) males. Four patients had been associated with inmates of two prisons. The majority of patients had been from urban, crowded areas in Colombo and the adult working population. Four (36.3%) patients had died and the others had recovered without any complications. The team had concluded: “Invasive meningococcal infection is reported as sporadic cases in Sri Lanka. However, this case series suggests the possibility of endemicity. The disease burden is not known at the moment. | |
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