Calon jemaah umroh dan haji perlu divaksinasi meningitis karena arab saudi masih menjadi daerah endemis meningitis (radang selaput otak) terutama jenis yang meningococcal.
Penyakit yang menyerang selaput otak ini memang bisa berakibat fatal atau meninggalkan kecacatan (menyerupai cacat mental), meskipun pada umumnya si penderita bisa disembuhkan secara total.
Selain meningitis, ada lagi penyakit sejenis yang lebih membahayakan yakni meningoensefalitis, berupa radang pada otak dengan penyebab bermacam kuman yang semula menyerang bagian meninges (selaput otak) kemudian ke substansi otak.
Penyakit radang otak meningitis bisa disebabkan oleh kuman nonspesifik seperti strastokok, pneumokok, hemofilus influenza, neisseria meningokok, atau kuman spesifik seperti tuberkulosis (TBC), virus, jamur, dan protozoa.
Jenis meningitis yang dilaporkan menyerang para jemaah haji, dan dianggap sebagai "kasus impor" karena tidak ditemukan di Indonesia (pada pemeriksaan klinis maupun laboratoris), adalah meningitis meningokok (meningococcal meningitis).
Meningitis meningokok menular melalui kontak langsung dengan bakteri lewat sekret hidung atau tenggorokan penderita melalui droplet infection atau percikan ludah. Umumnya penularan lebih sering terjadi melalui karier (pembawa) daripada langsung dari si penderita.
Selaput otak atau meninges terdiri atas 3 selaput jaringan ikat yang membungkus dan melindungi otak serta sumsum tulang belakang yang lunak. Ketiga selaput yang dinamai pia mater, arakhnoid, dan dura mater, itu berupa selaput terpisah tapi berkesinambungan dari dalam ke luar. Lapisan-lapisan tersebut menutup otak, berupa pembuluh darah yang memberi makan jaringan saraf. Selaput itu juga mencegah masuknya bahan-bahan yang merugikan otak.
Gejala peradangan otak umumnya mirip: panas tinggi, sakit kepala, mual dan muntah, disusul kaku pada tengkuk, kejang dan acap kali terjadi penurunan kesadaran. Namun pada meningitis meningokok disertai bercak-bercak perdarahan berwarna kemerahan pada kulit (rash). Bila perdarahannya banyak (echymosis), bisa membahayakan jiwa penderita (biasanya 50% meninggal).
Kementerian Kesehatan Kerajaan Arab Saudi pun mengharuskan semua orang yang mengunjungi negeri itu untuk menunaikan ibadah umrah dan haji agar sebelumnya mendapatkan vaksinasi meningitis (yang bertahan 2 - 3 tahun).
Selain mendapatkan vaksinasi dan obat, para jemaah selama mengadakan perjalanan hendaknya selalu memelihara kebersihan diri dan lingkungan.
Untuk membatasi penularan dari para karier bisa digunakan masker untuk menghindari percikan ludah dari jemaah lain dan sedapat mungkin menghindari kepadatan manusia.
Vaksinasi yang dianjurkan untuk jemaah umrah dan haji adalah vaksinasi meningitis ACWY 135
dan pelaksanaanya dianjurkan > 2 minggu sebelum tanggal keberangkatan.
dan pelaksanaanya dianjurkan > 2 minggu sebelum tanggal keberangkatan.
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Meningococcal meningitis (ENGLISH)
Overview
Meningitis is an infection of the meninges, the thin lining that surrounds the brain and the spinal cord. Several different bacteria can cause meningitis and Neisseria meningitidis is one of the most important because of its potential to cause epidemics.
Twelve subtypes or serogroups of N. meningitidis have been identified and four (N. meningitidis. A, B, C and W135) are recognized to cause epidemics.
How is the disease transmitted
The bacteria are transmitted from person to person through droplets of respiratory or throat secretions. Close and prolonged contact (e.g. kissing, sneezing and coughing on someone, living in close quarters or dormitories (military recruits, students), sharing eating or drinking utensils, etc.) facilitate the spread of the disease. The average incubation period is 4 days, ranging between 2 and 10 days.
N. meningitidis only infects humans; there is no animal reservoir. The bacteria can be carried in the pharynx and sometimes, for reasons not fully known, overwhelm the body’s defences allowing infection to spread through the bloodstream and to the brain.
Features of the disease
The most common symptoms are stiff neck, high fever, sensitivity to light, confusion, headaches and vomiting. Even when the disease is diagnosed early and adequate therapy instituted, 5% to 10% of patients die, typically within 24-48 hours of onset of symptoms. Bacterial meningitis may result in brain damage, hearing loss, or learning disability in 10 to 20% of survivors. A less common but more severe (often fatal) form of meningococcal disease is meningococcal septicaemia which is characterized by a haemorrhagic rash and rapid circulatory collapse.
Diagnosis
The diagnosis of meningococcal meningitis is suspected by the clinical presentation and a lumbar puncture showing a purulent spinal fluid; sometimes the bacteria can be seen in microscopic examinations of the spinal fluid. The diagnosis is confirmed by growing the bacteria from specimens of spinal fluid or blood. More specialised laboratory tests are needed for the identification of the serogroups as well as for testing susceptibility to antibiotics.
Treatment
Meningococcal disease is potentially fatal and should always be viewed as a medical emergency. Admission to a hospital or health centre is necessary. Isolation of the patient is not necessary. Antimicrobial/antibiotik therapy must be commenced as soon as possible after the lumbar puncture has been carried out (if started before, it may be difficult to grow the bacteria from the spinal fluid and thus confirm the diagnosis).
Epidemiology of meningococcal meningitis:
Meningococcal meningitis occurs sporadically in small clusters throughout the world with seasonal variations and accounts for a variable proportion of endemic bacterial meningitis. In temperate regions the number of cases increases in winter and spring. Serogroups B and C together account for a large majority of cases in Europe and the Americas. Several local outbreaks due to N. meningitidis serogroup C have been reported in Canada and USA (1992-93) and in Spain (1995-97). For 10 years, the meningococcal meningitis activity has particularly increased in New Zealand where an average of 500 cases occurs every year. Most of these cases are now due to serogroup B.
Major African epidemics are associated with N. meningitidis serogroups A and C and serogroup A is usually the cause of meningococcal disease in Asia. Outside Africa, only Mongolia reported a large epidemic in the recent years (1994-95).
There is increasing evidence of serogroup W135 being associated with outbreaks of considerable size. In 2000 and 2001 several hundred pilgrims attending the Hajj in Saudia Arabia were infected with N. meningitidis W135. Then in 2002, W135 emerged in Burkina Faso, striking 13,000 people and killing 1,500.
The African Meningitis Belt
The highest burden of meningococcal disease occurs in sub-Saharan Africa, which is known as the “Meningitis Belt”, an area that stretches from Senegal in the west to Ethiopia in the east, with an estimated total population of 300 million people. This hyperendemic area is characterized by particular climate and social habits. During the dry season, between December and June, because of dust winds and upper respiratory tract infections due to cold nights, the local immunity of the pharynx is diminished increasing the risk of meningitis.
Prevention
Several vaccines are available to prevent the disease. Polysaccharide vaccines, which have been available for over 30 years, exist against serogroups A, C, Y, W135 in various combinations. A monovalent conjugate vaccine against serogroup C, has recently been licensed in developed countries for use in children and adolescents. This vaccine is immunogenic, particularly for children under 2 years of age whereas polysaccharide vaccines are not. All these vaccines have been proven to be safe and effective with infrequent and mild side effects. The vaccines may not provide adequate protection for 10 to 14 days following injection.
Several vaccines are available to prevent the disease. Polysaccharide vaccines, which have been available for over 30 years, exist against serogroups A, C, Y, W135 in various combinations. A monovalent conjugate vaccine against serogroup C, has recently been licensed in developed countries for use in children and adolescents. This vaccine is immunogenic, particularly for children under 2 years of age whereas polysaccharide vaccines are not. All these vaccines have been proven to be safe and effective with infrequent and mild side effects. The vaccines may not provide adequate protection for 10 to 14 days following injection.
Vaccination is used in the following circumstances:
Routine vaccination: Routine preventive mass vaccination has been attempted . Saudi Arabia, for example, offers routine immunization of its entire population. Sudan and other countries routinely vaccinate school children. Preventive vaccination can be used to protect individuals at risk (e.g. travellers, military, pilgrims).
Travellers’ health information
Travellers to areas affected by meningococcal outbreaks are advised to be vaccinated. For pilgrims to the Hajj and Omra,
Saudi Arabia requires visitors obtain a tetravalent vaccine (against A, C, Y, W135) at least ten days prior to their arrival in the country. (Ref: WHO International Travel and Health. Vaccination requirements and Health Advice).
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