The 131st Annual Meeting (November 15-19, 2003) of APHA

The 131st Annual Meeting (November 15-19, 2003) of APHA

4263.0: Tuesday, November 18, 2003 - Board 8

Abstract #55091

Primary amoebic meningo-encephalitis deaths in Maricopa County and implications for public health practice

Alisa Diggs-Gooding, PA-C, MPH and Vjollca Berisha, MD, MPH. Division of Epidemiology Biodefense Preparedness and Response, Maricopa County Department of Public Health, 1825 E. Roosevelt, Phoenix, AZ 85006

On the same day in October 2002 two five year old boys died of suspected bacterial meningitis within 72 hours of admission to hospitals in Maricopa County, Arizona. This unusual, unfortunate event resulted in highly complex epidemiological investigations involving local, state and federal agencies, the affected community, municipal and private water companies.

Post mortem examinations detected the presence of Naegleria fowleri in brain tissues and cerebral spinal fluids of both cases, resulting in primary amoebic meningo-encephalitis (PAM) as final cause of death. This is a rare, usually fatal form of central nervous system infection. Only seven cases were reported in the U.S. in 2002, including the Arizona cases.

Naegleria is found in warm, fresh, surface water. When this pathogen is forced into nasal passages, it can invade the brain and spinal cord. The Arizona cases had no common fresh, surface water exposure. The only common water exposure was the untreated groundwater supplied by a private water company to one boy’s home and to the home of the grandparents of the other boy, where he spent a great deal of time.

Samples from some components of the water system showed the presence of Naegleria when tested using newly developed laboratory methods. Previously, there had not been documented findings of Naegleria in groundwater.

The investigation resulted in major changes in the water delivery methods, new policies for investigation of unexplained deaths from meningitis or encephalitis, and plans for research regarding standardized laboratory methods to detect the prevalence of Naegleria in groundwater.

Learning Objectives:

Keywords: Outbreaks, Epidemiology

Presenting author's disclosure statement:
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.

Tuberculosis and Outbreaks: Poster Session

The 131st Annual Meeting (November 15-19, 2003) of APHA