LAS VEGAS — While physicians are the first line of defense against meningococcal disease – an aggressive form of meningitis – the long-term effects often are left to O&P practitioners, according to Paul J. Lee, MD, of the Division of Pediatric Infectious Diseases at Winthrop University Hospital and assistant clinical professor of pediatrics for State University of New York at Stony Brook.
Meningococcal disease is a persistent global health problem with high morbidity and mortality. Of the 800 cases to 1,200 cases per year in the United States, more than 90% occur in people age 45 years or younger and fatality is highest for adolescent patients. Lee said meningococcal disease is easy to miss because early symptoms resemble the flu, and the diseases progresses rapidly. Nearly half of patients hospitalized within the first 24 hours of their illness will die, he said. Unfortunately many patients will not get help until they develop late stage symptoms. After the flulike symptoms, patients are hit with an aggressive rash.
“This is usually when patients start to say, ‘Something is wrong. Maybe I should go to the emergency room.’ The problem is that the rash typically comes up at about 15 [hours] to 19 hours [after the onset of the disease],” Lee said. “In those last 8 hours, seizures occur, you develop sepsis … and unfortunately death often occurs.”
O&P often enters the picture for patients after they develop gangrene, which can lead to amputations.
“There is often a lot of long-term fallout from this that sometimes we physicians do not get to see but that you probably will if you are working with these children,” Lee said, citing a 2010 study of 48 children who survived the disease. Ongoing problems included “growth disturbances, stump overgrowth, scar contractures, soft tissue and bone infections … These patients have ongoing health problems that continue to plague them for the rest of their lives.”
Patients often will also have physical and developmental limitations which can range from headaches to epilepsy to deafness to post-traumatic stress disorder. Lee urged O&P practitioners to keep this in mind.
“They are dealing with challenges and health issues every single day, in addition to having to use prostheses and orthoses,” he said.
Lee also emphasized the importance of immunization, since 95% of cases of meningococcal disease in the United States are sporadic and isolated. A booster vaccine is officially recommended for children at age 11 years or 12 years, he said, but this is also safe for younger children. Lee hopes research will lead to the ability to better fight meningococcal disease and lower the mortality rate, but he said the rapid onset provides the rationale for immunization.
“The main way to really target this disease is through prevention and that is through vaccines.” – by Amanda Alexander
Reference:
Lee P. The what, why and who of meningococcal disease. Presented at: Hanger Education Fair and National Meeting. Feb. 3-6, 2015. Las Vegas.
