Concern over antibiotic resistant meningitis strains in the Asia-Pacific

06 Aug 2020
Concern over antibiotic resistant meningitis strains in the Asia-Pacific
In a new report published in Journal of Infection, The Global Meningococcal Initiative (GMI) – a leading group of scientists, doctors and public health officials – warns that antibiotic resistance in meningococcal disease, a major cause of meningitis, remains an on-going cause for concern in the Asia-Pacific region.

Accurate disease surveillance is essential for controlling meningitis, and some countries are now using whole genome sequencing, which involves studying the complete genetic blueprint of bacteria to analyse outbreaks, and the emergence of new strains.

This genetic information has revealed that strains of meningococcal bacteria that are resistant to the antibiotic ciprofloxacin continue to emerge in some parts of Asia. This has led to warnings that the antibiotic should be used with caution as a preventative treatment for contacts of suspected cases of meningitis.  

“It is well known that strains of bacteria can rapidly spread across the globe. If the resistant strain reaches sub-Saharan Africa this could have major implications in the Kingdom of Saudi Arabia. Here, ciprofloxacin is one of the preventative measures for people making the pilgrimage from the meningitis belt in sub-Saharan Africa (where frequent meningitis epidemics occur) to Makkah (Mecca) during the Hajj.” - Professor Ray Borrow, GMI Chair

The paper also highlighted that while the reported incidence of meningococcal disease is relatively low across the region, this is based on limited information as some countries in the region lack a system for routinely reporting and investigating cases, while in others, widespread use of antibiotics and reliance on traditional culture methods, and lack of awareness amongst health professionals means cases are missed.

Only few countries in the Asia-Pacific region currently have routine meningococcal vaccination programmes. Instead vaccines are only recommended for high risk groups including those who are immunocompromised or those who attend mass gatherings or pilgrimages, such as the Hajj.

While the reported vaccine uptake is very high among pilgrims of the Hajj, a number of potential barriers remain, including lack of knowledge about vaccines and availability. The paper also reports evidence of certain Muslim communities refusing vaccination on religious grounds, although the Islamic faith generally recognises vaccination as a means to protect life.

MenACWY vaccination has been a compulsory entry requirement into Saudi Arabia for pilgrims on Hajj and Umrah since 2002.

Elsewhere in the region, barriers to vaccine uptake include cost of vaccines and vaccine hesitancy, which is a complex issue but may occasionally stem from misconceptions surrounding vaccination.

Linda Glennie, Director of Research at Meningitis Research Foundation, a GMI Steering Group Member, said: “Advocacy has a critical role to play in addressing genuine barriers to uptake of vaccines, so that vaccines can reach all those who need them. The Global Roadmap to Defeat Meningitis by 2030 is committed to improving access to meningitis prevention, and to treatment and support for people affected by the disease.”
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