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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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ATC Name B/G Ingredients Dosage Form Price
B03XA06 REBLOZYL BioTech Luspatarcept - 25mg 25mg Injectable powder for solution 125,960,784 L.L
B03XA06 REBLOZYL BioTech Luspatercept - 75mg 75mg Injectable powder for solution 377,881,318 L.L
L03AB07 RECIGEN 44 BioTech Interferon beta-1a - 44mcg/0.5ml 44mcg/0.5ml Injectable solution 15,147,973 L.L
L03AB07 RECIGEN 44 BioTech Interferon beta-1a - 44mcg/0.5ml 44mcg/0.5ml Injectable solution L.L
B02BD08 RECOFACT VII BioTech Eptacog alfa (activated) recombinant - 1.2mg 1.2mg Injectable powder for solution+diluent 47,533,131 L.L
B02BD02 RECOFACT VIII BioTech Moroctocog alfa - 500IU 500IU Injectable powder for solution+diluent 12,049,005 L.L
C05AE01 RECTOGESIC G Glyceryl trinitrate - 0.2% w/w 0.2% w/w Ointment 2,553,301 L.L
A11GA01 REDOXON EFF.ORANGE B Ascorbic acid (vit C) - 1g 1g Tablet, effervescent 366,869 L.L
A02AH REFCON DOUBLE ACTION G Sodium alginate - 50mg/ml, Sodium bicarbonate - 21.3mg/ml, Calcium (carbonate) - 32.50mg/ml Suspension 399,121 L.L
B02BD04 REFIXIA BioTech Nonacog beta pegol (factor IX) - 500IU 500IU Injectable powder for solution+solvent 76,080,435 L.L
B02BD04 REFIXIA BioTech Nonacog beta pegol (factor IX) - 1000IU 1000IU Injectable powder for solution+solvent 149,006,584 L.L
B02BD04 REFIXIA BioTech Nonacog beta pegol (factor IX) - 2000IU 2000IU Injectable powder for solution+solvent 298,171,597 L.L
D11AX01 REGAINE FOAM FOR MEN B Minoxidil - 5% Foam 1,370,719 L.L
D11AX01 REGAINE FOAM FOR MEN B Minoxidil - 5% Foam 3,090,838 L.L
V03AB35 RELANCIUM G Sugammadex - 100mg/ml 100mg/ml Injectable solution 45,660,028 L.L
N05CM09 RELAXINE TRENKER G Valerian extract - 500mg 500mg Tablet, coated 1,134,203 L.L
M03BB53 RELAXON G Paracetamol - 300mg, Chlorzoxazone - 250mg Capsule 296,989 L.L
M01AE51 RELI-FLU G Ibuprofen - 200mg, Pseudoephedrine HCl - 30mg Tablet, film coated 139,504 L.L
R03DC03 RELIEFAST G Montelukast (sodium) - 5mg 5mg Tablet, chewable 1,034,119 L.L
R03DC03 RELIEFAST G Montelukast (sodium) - 10mg 10mg Tablet, film coated 844,701 L.L
R03DC03 RELIEFAST G Montelukast (sodium) - 4mg 4mg Tablet, chewable 1,034,119 L.L
R03AK10 RELVAR ELLIPTA B Vilanterol (trifenatate) - 25mcg/dose, Fluticasone furoate - 200mcg/dose Inhalation powder 3,928,052 L.L
R03AK10 RELVAR ELLIPTA B Vilanterol (trifenatate) - 25mcg/dose, Fluticasone furoate - 100mcg/dose Inhalation powder 3,928,052 L.L
N06AX11 REMERON SOLTAB B Mirtazapine - 30mg 30mg Tablet, orodispersible 1,486,290 L.L
M01AB05 REMETHAN G Diclofenac sodium - 50mg 50mg Tablet 196,201 L.L
L04AB02 REMICADE BioTech Infliximab - 100mg 100mg Injectable concentrated powder for solution 30,111,023 L.L
N02BE51 REMIDOL G Paracetamol - 650mg, Dextromethorphan HBr - 20mg, Chlorphenamine maleate - 4mg Granules for solution 537,537 L.L
N01AH06 REMIFENTANIL MEDIS G Remifentanil (HCl) - 1mg 1mg Injectable powder 1,101,951 L.L
N01AH06 REMIFENTANIL MEDIS G Remifentanil (HCl) - 5mg 5mg Injectable powder 2,576,146 L.L
L04AB02 REMSIMA BioTech Infliximab - 100mg 100mg Injectable concentrated powder for solution 24,943,134 L.L
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