Date: Mon 1 Feb 2010

Source: El Diario [edited and translated by Jorge Gonzalez-Mendoza]

<http://www.impre.com/eldiariony/noticias/nuestros-paises/2010/2/1/bacteria-mata-a-pastor-evangel-171172-1.html>

The Ministry of Public Health of the Dominican Republic put the relatives of an evangelical preacher under close surveillance for meningococcal disease. He died in the early morning Saturday (30 Jan 2010) because of meningococcemia, after becoming infected in Haiti, where he went to help the victims of the recent earthquake.

The Dominican Republic's Ministry of Health, Dr. Bautista Rojas-Gomez, declared that prophylactic measures have been set in place for close contacts of the late 63-year-old evangelical preacher who came to Port-Au-Prince together with 12 other members of his congregation, The Church Of God Of Prophecy, located in Villa Faron, in Santo Domingo (Capital City of Dominican Republic).

The victim stayed in Haiti for one week, from 21 - 28 Jan 2010. His congregation worked in fixing a temporary shelter for orphan children that was destroyed by the earthquake. He died some days after having been admitted to the UCE Medical Center in Santo Domingo.

"We located the place where the evangelical mission came from, the places where the victim was in Port-Au-Prince, as well as his close contacts, in order to start surveillance and chemoprophylaxis indicated for these cases," Dr. Rojas-Gomez pointed out. He affirmed that the (Dominican Republic) Government is working [very] hard in preventing diseases such as meningococcemia, a bloodstream infection caused by _Neisseria meningitidis_, a bacterium frequently living in the respiratory tract.

Dr. Rojas Gomez said the Ministry of Public Health [has maintained] surveillance measures since shortly after the earthquake. He also [said] that Haitians crossing the Dominican Republic border are given malaria prophylaxis and vaccination against tetanus. However, illegal aliens do not go through legal migration posts while trying to avoid authorities and regulatory control.

Neither the Pastor nor his fellow congregation members received any vaccine when entering Haiti, in spite of sanitary control measures in force.

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[Meningococcal disease is caused by a Gram-negative diplococcus, _Neisseria meningitidis_. Meningococci are classified into serogroups on the basis of the composition of the capsular polysaccharide. The 5 major meningococcal serogroups associated with disease are A, B, C, Y, and W-135. At any time, 5-10 percent of the population may be asymptomatic nasopharyngeal carriers of _N. meningitidis_. Person-to-person transmission occurs via respiratory secretions or saliva. Transmission is facilitated by close contact and crowded living conditions. Meningococcal disease occurs worldwide. In non-epidemic situations, invasive disease (e.g., meningococcemia and meningitis) occurs at a rate of 0.5-10 cases per 100 000 population and hundreds of cases per 100 000 population occur in epidemic situations <http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5407a1.htm>.

No patient with meningococcal disease, other than the Dominican preacher, has apparently been reported among Haitians or Dominicans.Photographs of lesions that accompany meningococcemia can be found at <http://www.vaccineinformation.org/photos/meni_mt002.jpg>.

Close contacts of patients with invasive meningococcal disease who are themselves at increased risk of acquiring the disease are household members, day care center contacts, and persons directly exposed to the patient's oral secretions (e.g., through mouth-to-mouth resuscitation or kissing). Chemoprophylaxis is given to these close contacts because their attack rate for secondary meningococcal disease is 500-800 times greater than among the general population <http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5407a1.htm>.

Rifampin, ciprofloxacin and ceftriaxone are 90-95 percent effective in reducing nasopharyngeal carriage of _N. meningitdis_ and are all acceptable antimicrobial agents for chemoprophylaxis. Administering chemoprophylaxis to persons who are not close contacts of patients usually is not recommended. Neither oropharyngeal nor nasopharyngeal cultures for _N. meningitidis_ are useful in deciding who should receive chemoprophylaxis.

Haiti suffered an earthquake on 12 Jan 2010 with a magnitude of 7.0. Multiple aftershocks, with magnitudes as high as 6.0, followed. The earthquake centered about 10 miles (15 kilometers) southwest of Port-au-Prince, Haiti's capital. Approximately 3.5 million people live in the earthquake-affected areas. Much of the capital area, particularly critical infrastructure that includes basic utilities (power, water, sanitation), transportation, communication and health care facilities, has been destroyed, with heavy loss of staff. This has severely compromised the ability to respond to this crisis. Prime Minister Jean-Max Bellerive stated on 3 Feb 2010 that 200 000 people have died and 300 000 have been injured <http://www.telegraph.co.uk/news/worldnews/centralamericaandthecaribbean/haiti/7152315/Haiti-earthquake-death-toll-reaches-200000.html>.

WHO has issued a public health risk assessment to facilitate the response of those aiding the earthquake-affected population in Haiti <http://www.who.int/diseasecontrol_emergencies/publications/haiti_earthquake_20100118.pdf>.

Haiti and the Dominican Republic occupy the Caribbean island of Hispaniola in the Greater Antillean archipelago. A HealthMap/ProMED-mail interactive map of Hispaniola can be found at <http://healthmap.org/promed/en?name=Dominican%20Republic,%20Dominican%20Republic&g=3508796&v=19,-70.667,6>. - ProMed Mod.ML]