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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
J07BK01 VARIVAX B Varicella virus, live attenuated - 1350PFU Injectable powder for suspension+diluent 4,102,751 L.L
L01EF03 VERZENIO B Abemaciclib - 50mg 50mg Tablet 76,122,299 L.L
R05X ACTISOUFRE B Sulfure de Sodium - 13mg, Saccharomyces Cerevisiae - 500mg Solution 729,706 L.L
B05 20 MEQ POTASSIUM OF 5% DEXTROSE AND 0.45% SODIUM CHLORIDE INJECTION USP B Dextrose, H2O - 5%, Sodium chloride - 0.45%, Potassium chloride - 20meq Injectable solution 229,959 L.L
C09DA03 CO-DIOVAN B Valsartan - 160mg, Hydrochlorothiazide - 25mg Tablet, film coated 901,718 L.L
C10BA05 ATOZET B Atorvastatin - 10mg, Ezetimibe - 10mg Tablet, film coated 1,624,706 L.L
L01EF03 VERZENIO B Abemaciclib - 100mg 100mg Tablet 76,122,299 L.L
N02AA01 MST CONTINUS B Morphine sulfate - 10mg 10mg Tablet, film coated, prolonged release 972,942 L.L
R05X FERVEX CHILDREN SUGAR FREE B Paracetamol - 280mg, Ascorbic acid - 100mg, Pheniramine maleate - 10mg Granules for solution 425,998 L.L
V03AC03 JADENU B Deferasirox - 360mg 360mg Tablet, film coated 28,030,805 L.L
A03BB01 BUSCOPAN B Butylscopolamine bromide - 10mg 10mg Tablet, sugar coated 692,079 L.L
A10BA02 GLUCOPHAGE XR B Metformin HCl - 750mg 750mg Tablet, prolonged release 692,244 L.L
A12AX DECALCIT B Vitamin D3 - 750IU, Calcium - 600mg Powder 1,075,074 L.L
B05 20 MEQ POTASSIUM OF 0.9% SODIUM CHLORIDE INJECTION USP B Sodium chloride - 0.9%, Potassium chloride - 20meq Injectable solution 278,102 L.L
C10BA05 ATOZET B Atorvastatin - 10mg, Ezetimibe - 10mg Tablet, film coated 1,624,706 L.L
L01EG02 AFINITOR B Everolimus - 5mg 5mg Tablet 154,115,122 L.L
M01AE01 SPIDIFEN B Ibuprofen alginate - 400mg 400mg Tablet, film coated 330,585 L.L
N05CF02 STILNOX B Zolpidem (tartrate) - 10mg 10mg Tablet, film coated, scored 96,757 L.L
R05X FERVEX ADULTS SUGAR FREE B Paracetamol - 500mg, Ascorbic acid - 200mg, Pheniramine maleate - 25mg Granules for solution 425,998 L.L
L01XX52 VENCLEXTA B Venetoclax - 10mg week 1, Venetoclax - 50mg week 2, Venetoclax - 100mg week 3&4 Tablet L.L
A03BB01 BUSCOPAN B Butylscopolamine bromide - 10mg 10mg Tablet, sugar coated 291,614 L.L
A12AX CALPEROS D3 A SUCER B Vitamin D3 - 400IU, Calcium - 500mg Tablet, chewable 658,483 L.L
B05 20 MEQ POTASSIUM OF 0.9% SODIUM CHLORIDE INJECTION USP B Sodium chloride - 0.9%, Potassium chloride - 20mEq Injectable solution 229,959 L.L
J07BM03 GARDASIL 9 HUMAN PAPILLOMAVIRUS 9- VALENT VACCINE RECOMBINANT B Papillomavirus (human type 6) - 30mcg/0.5ml, Papillomavirus (human type 11) - 40mcg/0.5ml, Papillomavirus (human type 16) - 60mcg/0.5ml, Papillomavirus (human type 18) - 40mcg/0.5ml, Papillomavirus (human type 31) - 20mcg/0.5ml, Papillomavirus (human type 33) - 20mcg/0.5ml, Papillomavirus (human type 45) - 20mcg/0.5ml, Papillomavirus (human type 52) - 20mcg/0.5ml, Papillomavirus (human type 58) - 20mcg/0.5ml Injectable suspension 14,139,396 L.L
M01AE01 ADVIL B Ibuprofen - 200mg 200mg Tablet 321,178 L.L
N02AA01 MST CONTINUS B Morphine sulfate - 30mg 30mg Tablet, film coated, prolonged release 2,289,908 L.L
R05X FERVEX ADULTS RASPBERRY B Paracetamol - 500mg, Ascorbic acid - 200mg, Pheniramine maleate - 25mg Granules for solution 425,998 L.L
N05AX13 INVEGA SUSTENNA B Paliperidone palmitate - 100mg 100mg Injectable suspension, prolonged release L.L
A12AX CI-CAL+D B Calcium citrate - 250mg, Vitamin D3 - 125IU Tablet 796,899 L.L
C07AB05 KERLONE B Betaxolol HCl - 20mg 20mg Tablet, film coated, scored 575,165 L.L
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