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Overview

Generalities
Agents Several agents:
 
1) Bacteria:
- Neisseria meningitides (meningococcus): the serotypes responsible of invasive infection are A, B, C, W135, Y, X
- Haemophilus influenza: there are 6 serotypes from (a) to (f). The serotype (b) is responsible of invasive infection
- Streptococcus pneumonia (pneumococcus): there are more than 90 serotypes
- Other bacterial agents: listeria, staphylococcus, enteric bacteria, group B streptococci, tuberculosis …
 
2) Virus:
- Mumps
- Measles
- West Nile virus: a flavivirus
- Enterovirus: including Coxsackieviruses A (1-11, 14, 16-18, 22, 24), Coxsackieviruses B (1-6), Echoviruses (1-7, 9-23, 25, 27, 30-33), Enterovirus 71, Poliovirus (1-3)
- Herpes Simplex virus: with 2 types 1 and 2
- Varicella / Chicken-pox: Human (alpha) herpesvirus 3 (varicella-zoster) from the group Herpesvirus
- Adenovirus: Adenovirus, several types (1, 2, 3, 4, 5 and 7), genus Mastadenovirus, family Adenoviridae,
- Lymphocytic choriomeningitis: lymphocytic choriomeningitis virus (arenavirus)
- Sandfly fever viruses: genus phlebovirus, family Bunyaviridae. They include more than 60 antigenically distinct virus serotypes. Two main groups are identified: the sandfly fever group including the Naples serocomplex (Karimabad virus, Arabia virus, Massilia virus, Punique virus, Tehran virus, Toscana virus …) and Sicilian serocomplex; and the Uukuniemi group.
-Other virus: arboviruses…
 
3) Parasites and fungi:
- Leptospirosis: Spirochetes, Leptospira interrogans  (25 serogroups)
- Other:  Candida albicans, cryptococcal, syphilis …
Incubation The incubation varies with the agent.
 
Agent Incubation
Bacteria  
Neisseria meningitidis 3-4 days (2-10 days)
Haemophilus influenza 2-4 days
Streptococcus pneumoniae 1-4 days
Listeria monocytogenes 3-70 days (median of 3 weeks)
Virus  
West Nile virus 3-12 days
Enterovirus 7-14 days (2-35 days)
Herpes 2-12 days
Varicella / Chicken-pox 2-3 weeks
Lymphocytic choriomeningitis virus 8-13 days (15-21 days for meningitis)
Adenovirus 1-10 days
Sandfly fever viruses 3-4 days (up to 6 days)
Parasites and Mycoses  
Leptospira 2-30 days (10 days)
 
 
 
Period of communicability The period of communicability varies with the agent.
 
Agent Period of communicability
Bacteria  
Neisseria meningitidis From onset and up to 24 hours after starting antibiotherapy that has effective concentrations in nasopharynx.
Haemophilus influenza From onset and up to 24-48 hours of starting effective antibiotherapy.
Streptococcus pneumoniae As long as the bacteria is present in the upper respiratory tract.
Listeria monocytogenes - Mothers of infected newborns can shed the bacteria in vaginal discharges and urine 7-0 days after delivery
- Infected patients can shed the bacteria in stool for several months
Virus  
West Nile virus No person-to-person transmission.
Enterovirus - Virus excreted in stools for several weeks
- Virus excreted in pharynx for the first 2 weeks post infection
Herpes 2-7 weeks after skin lesions onset.
Varicella / Chicken-pox 2 days before until the skin lesions are crusted (5 days).
Lymphocytic choriomeningitis virus No person to person transmission.
Adenovirus Shortly prior to and for the duration of the active disease
Sandfly fever viruses Virus present in blood of infected patients 1 day before and 1 day after onset of illness.
Parasites and Mycoses  
Leptospira Excreted in urine for 1 month
 
 
Reservoir The reservoir varies with the agent.
 
Agent Reservoir
Bacteria  
Neisseria meningitidis Humans
Haemophilus influenza Humans
Streptococcus pneumoniae Humans, possible carriage.
Listeria monocytogenes Soil, forage, water, mud and silage.
Virus  
West Nile virus Birds
Enterovirus Humans
Herpes Humans
Varicella / Chicken-pox Humans
Lymphocytic choriomeningitis virus House mouse (Mus musculus), hamster colonies. The mouse excretes the virus in saliva, feces and urine.
Adenovirus Humans
Sandfly fever viruses Humans, rodents.
Parasites and Mycoses  
Leptospira Wild and domestic animals
 
 
Modes of transmission The modes of transmission vary with the agent.
 
Agent Modes of transmission
Bacteria  
Neisseria meningitidis Person to person transmission: direct contact with droplet, nasal and throat discharge
Haemophilus influenza Person to person transmission: direct contact with respiratory, nasal and throat discharge.
Streptococcus pneumoniae Person to person transmission: direct contact with respiratory discharge
Listeria monocytogenes - Food-borne: ingestion of raw or contaminated milk, soft cheese vegetables and ready-to-eat meats (Pate)
- Direct contact with infectious material
- Neonatal: from mother to fetus or from mother to newborn (through the infected birth canal)
- Nosocomial transmission in nursery: via contaminated equipment or material
Virus  
West Nile virus Bite by infected mosquitoes (Culex sp, or Anophele sp)
Enterovirus - Person-to-person:
- Fecal-oral
- Contact with respiratory secretions
- Contact with conjunctival secretions
- Contaminated water / swimming pools
- Flies
Herpes - Person-to-person:
- Contact with saliva
- Sexual contact
- Soiled hands
- Neonatal (infected birth canal)
Varicella / Chicken-pox - Person-to-person:
- Contact with droplets
- Contact with vesicle fluid
- Indirect contact
- Airborne
Lymphocytic choriomeningitis virus - Airborne: contaminated dust
- Food-borne: ingestion of contaminated food
- Direct contact: skin contamination or cuts
Adenovirus - Person-to-person:
- Fecal-oral route
- Respiratory transmission
- Inoculation with conjunctival secretions
- Nosocomial
- Contaminated water and swimming pools
Sandfly fever viruses Bite of infective phlebotomine (Phlebotomus papatasi, P. perfiliewi , P. perniciosus, P. major sensu lato )
Parasites and Mycoses  
Leptospira - Contact with abraded skin or mucous membranes with soil, vegetation, contaminated with urine of infected animals or contaminated water
- Direct contact with urine or tissues of infected animals
- Ingestion of food or water contaminated with urine of infected animals
 
 
Clinical The symptoms vary with the agent.
 
Agent Clinical picture
Bacteria  
Neisseria meningitidis Meningitis, septicaemia
Haemophilus influenza Meningitis, epiglottitis, pneumonia …
Streptococcus pneumoniae Meningitis, pneumonia, septicaemia
Listeria monocytogenes  
Virus  
West Nile virus - Usually asymptomatic.
- Complication: meningitis and encephalitis
Enterovirus - Asymptomatic,
- Gastro-enteritis, flu-like illness, aseptic meningitis, paralysis
Herpes - Gingivostomatitis (type1), genital infection (type 2)
- Complications: meningoencephalitis
- Reactivation is possible
Varicella / Chicken-pox - Skin eruption: first maculo-papular then vesicular.
- Complications: pneumonia, hemorrhage, meningoencephalitis
Lymphocytic choriomeningitis virus - Influenza-like illness.
- Complications: meningitis, parotiditis, arthritis, myocarditis…
Adenovirus - Epidemic herato-conjunctivitis, gastro-enteritis, pharyngo-conjunctival fever, acute respiratory infection
- Complications: meningoencephalitis
Sandfly fever viruses - Usually self-limited disease: fever, myalgia, headache, photophobia …
- Complications: Aseptic meningitis and meningoencephalitis (Toscana),
Parasites and Mycoses  
Leptospira Rash, hemolytic anemia, hemorrhage, hepato-renal failure, mental confusion, myocarditis…
 
 
Worldwide  
Agent Profil
Bacteria  
Neisseria meningitidis Endemic in the African meninigitis belt (from Senegal to Ethiopa)
Haemophilus influenza Worldwide under 5 years
Streptococcus pneumoniae Worldwide
Listeria monocytogenes Worldwide
Virus  
West Nile virus Widespread in Africa, Middle East, North America, India.
 
Enterovirus Worldwide
Herpes Worldwide
Varicella / Chicken-pox Worldwide
Lymphocytic choriomeningitis virus America, Europe.
Adenovirus Worldwide
Sandfly fever viruses In Mediterranean counties, Europe and Middle East
Parasites and Mycoses  
Leptospirose Worldwide
 
 
Lebanon The annual average of reported cases of meningitis is 192.
Among them, meningitis due to Neisseria meningitis occurs with 6 (2-12) cases per year.
Among them, meningitis due to Haemophilus influenza occurs with 1 (0-2) cases per year.
Among them, meningitis due to Streptococcus pneumoniae occurs with 19 (16-21) cases per year.
 
Control objective Control
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All
ATC Name B/G Ingredients Dosage Form Price
J01DD13 ZAKON G Cefpodoxime (proxetil) - 100mg/5ml 100mg/5ml Powder for suspension 1,116,733 L.L
P02CA03 ZALBENDOL G Albendazole - 200mg 200mg Tablet 127,985 L.L
C08DB01 ZALDEM G Diltiazem HCl - 60mg 60mg Tablet, scored 199,657 L.L
C08DB01 ZALDEM CR G Diltiazem HCl - 180mg 180mg Capsule, controlled release 966,287 L.L
C08DB01 ZALDEM CR G Diltiazem HCl - 120mg 120mg Capsule, controlled release 517,059 L.L
C08DB01 ZALDEM CR G Diltiazem HCl - 240mg 240mg Capsule, controlled release 1,002,123 L.L
N02AJ13 ZALDIAR B Paracetamol - 325mg, Tramadol - 37.5mg Tablet, film coated 704,173 L.L
S01GX08 ZALERG G Ketotifen - 0.25mg/ml 0.25mg/ml Drops solution 446,156 L.L
N05AX12 ZALONIL G Aripiprazole - 10mg 10mg Tablet, orodispersible 1,988,887 L.L
N05AX12 ZALONIL G Aripiprazole - 15mg 15mg Tablet, orodispersible 2,426,980 L.L
L01XX44 ZALTRAP BioTech Aflibercept - 100mg/4ml 100mg/4ml Injectable concentrate for solution 35,658,713 L.L
L01XX44 ZALTRAP BioTech Aflibercept - 100mg/4ml 100mg/4ml Injectable concentrate for solution 35,658,713 L.L
L01XX44 ZALTRAP BioTech Aflibercept - 200mg/8ml 200mg/8ml Injectable concentrate for solution 63,807,499 L.L
L01XX44 ZALTRAP BioTech Aflibercept - 200mg/8ml 200mg/8ml Injectable concentrate for solution 63,807,499 L.L
B01AF01 ZARLAN G Rivaroxaban - 15mg 15mg Tablet, film coated 2,015,764 L.L
B01AF01 ZARLAN G Rivaroxaban - 15mg 15mg Tablet, film coated 1,343,843 L.L
B01AF01 ZARLAN G Rivaroxaban - 20mg 20mg Tablet, film coated 1,343,843 L.L
B01AF01 ZARLAN G Rivaroxaban - 10mg 10mg Tablet, film coated 1,439,255 L.L
L03AA02 ZARZIO BioTech Filgrastim - 300mcg/0.5ml 30MU/0.5ml Injectable solution 13,053,190 L.L
L03AA02 ZARZIO BioTech Filgrastim - 300mcg/0.5ml 30MU/0.5ml Injectable solution 13,053,190 L.L
L01DB06 ZAVEDOS B Idarubicin HCl - 10mg 10mg Injectable freeze dried material 12,071,013 L.L
J01DD52 ZAVICEFTA B Ceftazidime - 2g, Avibactam - 0.5g Injectable powder for concentrate for solution 101,659,975 L.L
N03AF04 ZEBINIX B Eslicarbazepine acetate - 800mg 800mg Tablet 10,075,439 L.L
N06AB10 ZELAX 10 G Escitalopram (oxalate) - 10mg 10mg Caplet 833,182 L.L
N06AB10 ZELAX 20 G Escitalopram (oxalate) - 20mg 20mg Caplet 1,544,075 L.L
L01EC01 ZELBORAF B Vemurafenib - 240mg 240mg Tablet, film coated L.L
L01EC01 ZELBORAF B Vemurafenib - 240mg 240mg Tablet, film coated 142,041,587 L.L
C10AX09 ZEMIL G Ezetimibe - 10mg 10mg Tablet 944,529 L.L
P02CA03 ZENTEL B Albendazole - 400mg 400mg Tablet 169,324 L.L
R03AK12 ZEPHIRUS B Salmeterol - 20mcg, Budesonide - 120mcg Capsule, inhalation 1,412,378 L.L
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