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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
C10AA01 VASCOR G Simvastatin - 40mg 40mg Tablet, scored 284,127 L.L
D05AA VASELINE ICHTYOLEE G Ichthyamol - 10% 10% Ointment 103,668 L.L
D02AC VASELINE PURE G Vaseline pure - 20g 20g Ointment 103,668 L.L
D02AC VASIDEX G Vaseline pure - 15g 15g Ointment 78,071 L.L
N07CA01 VASOSERC G Betahistine dihydrochloride - 8mg 8mg Tablet 1,334,884 L.L
N07CA01 VASOSERC BID G Betahistine dihydrochloride - 24mg 24mg Tablet 840,861 L.L
N07CA01 VASOSERC FORTE G Betahistine dihydrochloride - 16mg 16mg Tablet 944,529 L.L
C01EB15 VASTAREL B Trimetazidine - 35mg 35mg Tablet, film coated, modified release 1,053,573 L.L
J07BB01 VAXIGRIP B Influenza vaccine virus inactivated - 15mcg/3strains/0.5ml 15mcg/3strains/0.5ml Injectable suspension 768,678 L.L
J07BB01 VAXIGRIPTETRA, VACCIN GRIPPAL QUADRIVALENT (INACTIVE A VIRION FRAGMENTE) B Influenza vaccine virus (inactivated, split) - 15mcg/4strains/0.5ml Injectable suspension 970,254 L.L
J07AL02 VAXNEUVANCE B Pneumococcal polysaccharide for serotypes 1, 3, 4, 5 , 6A, 7F, 9V,14, 18C, 19A, 19F, 22F, 23F,33F (2mcg) Pneumococcal polysaccharide for serotypes 6B (4.4mcg) Conjugated to CRM197 carrier protein and adsorbed on aluminium phosphate adjuvant - Injectable suspension 6,988,413 L.L
L01FE02 VECTIBIX BioTech Panitumumab - 400mg/20ml 400mg/20ml Injectable concentrated solution L.L
L01FE02 VECTIBIX BioTech Panitumumab - 100mg/5ml 100mg/5ml Injectable concentrated solution L.L
L01FE02 VECTIBIX BioTech Panitumumab - 400mg/20ml 400mg/20ml Injectable concentrated solution 147,763,999 L.L
L01FE02 VECTIBIX BioTech Panitumumab - 100mg/5ml 100mg/5ml Injectable concentrated solution 40,364,800 L.L
L01XG01 VELCADE B Bortezomib - 3.5mg 3.5mg Injectable lyophilised powder for solution 23,616,000 L.L
L01XG01 VELZOME G Bortezomib - 3.5mg 3.5mg Injectable powder for solution 18,154,041 L.L
J05AF13 VEMLIDY B Tenofovir alafenamide fumarate - 25mg 25mg Tablet, film coated 26,997,299 L.L
L01XX52 VENCLEXTA B Venetoclax - 100mg 100mg Tablet L.L
L01XX52 VENCLEXTA B Venetoclax - 100mg 100mg Tablet 707,858,935 L.L
L01XX52 VENCLEXTA B Venetoclax - 10mg week 1, Venetoclax - 50mg week 2, Venetoclax - 100mg week 3&4 Tablet 190,943,809 L.L
L01XX52 VENCLEXTA B Venetoclax - 10mg week 1, Venetoclax - 50mg week 2, Venetoclax - 100mg week 3&4 Tablet L.L
N06AX16 VENLAFAXINE ARROW GENERIQUES LP G Venlafaxine - 150mg 150mg Capsule, prolonged release 987,724 L.L
N06AX16 VENLAFAXINE ARROW GENERIQUES LP G Venlafaxine - 37.5mg 37.5mg Capsule, prolonged release 1,075,074 L.L
N06AX16 VENLAFAXINE ARROW GENERIQUES LP G Venlafaxine - 75mg 75mg Capsule, prolonged release 1,075,074 L.L
N06AX16 VENLAFAXINE BIOGARAN LP G Venlafaxine HCl - 37.5mg 37.5mg Capsule, prolonged release 538,881 L.L
N06AX16 VENLAFAXINE BIOGARAN LP G Venlafaxine HCl - 75mg 75mg Capsule, prolonged release 584,571 L.L
N06AX16 VENLAX XR 150 G Venlafaxine HCl - 150mg 150mg Capsule, extended release 944,529 L.L
N06AX16 VENLAX XR 150 G Venlafaxine HCl - 150mg 150mg Capsule, extended release 1,416,794 L.L
N06AX16 VENLAX XR 37.5 G Venlafaxine - 37.5mg 37.5mg Capsule, extended release 383,955 L.L
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