Meningococcal disease in the Netherlands: media hype, but not an epidemic

An outbreak of meningococcal disease caused by Neisseria meningitidis C, type 2a recently occurred in the Dutch province of West-Brabant. Five children were affected and two of these died. The Outbreak Management Team decided to start a local vaccination campaign with a meningococcal group C conjugate vaccine. The publicity surrounding these cases of meningococcal disease led to much anxiety throughout the Netherlands. Despite parent's concerns, there is nothing to indicate the presence of an epidemic.     

湖南省B群脑膜炎奈瑟菌药物敏感性及分型

流行性脑脊髓膜炎（流脑）是由脑膜炎奈瑟菌感染引起的以脑脊髓膜炎和菌血症为主的呼吸道传染病,由于缺乏有效的预防手段,B血清群已经成为流脑主要的流行菌群之一。近年来,反向疫苗学技术的出现极大地推动了B群流脑疫苗的研究工作,疫苗的研制也取得了突破性进展,为研究出更为有效的流脑疫苗,本文对B群流脑疫苗领域中新型蛋白抗原疫苗、外膜囊泡疫苗和重组蛋白疫苗等方面的研究进展进行了综述。     

Meningococcal disease in Italy in 1989

Meningococcal disease in Italy decreased by 13.4% from 1988 to 1989. The incidence rate was 0.5/100,000 in the general population and 1.3/100,000 in army recruits. The highest proportion of cases (27%) was seen in subjects 5-14 years old. The sex ratio was 1.3. Forty-four percent of the isolates belonged to serogroup B; 37% belonged to group C. Forty-six percent of the strains were resistant to sulphonamides and 10% were resistant to minocycline; only 4% were resistant to rifampicin. None of the four military cases observed could be attributed to vaccine failure. One secondary case and no coprimary cases were observed among civilians. The shift in prevalence from serogroup C to serogroup B isolates is the most important finding of this study.     

Meningococcal disease in Louisiana 1978–1985

Data were analyzed from 729 meningococcal cases reported to the Epidemiology Section, Office of Preventive and Public Health Services, Louisiana Department of Health and Human Resources from 1978 through 1985. A total of 122 deaths (16.8%) occurred from these cases, with the highest case fatality rate (23.7%) noted in 1981. The eight-year average incidence rate per 100,000 population was 2.1. For individual years, the incidence rate was highest (3.6) in 1978 and lowest (0.8) in 1985. Although incidence rates per 100,000 population were greater for males during all years except 1978 and 1985 and greater for nonwhites in 1978, 1980, 1981, 1983 and 1984, the eight-year average incidence rates by sex and race were almost the same. Incidence rates were found to be highest in the less than one, and one to four-year age groups. For all eight years, over half of the cases were in the four years and under age group; the same was true for deaths, except in 1982 (46.7%). February was found to be the month with the highest frequency of reported case onset and death. The mean difference between date of disease onset and death for all fatal cases was 2.716 days (S.D.=6.48). Ten of the 64 Louisiana parishes reported no meningococcal disease cases from 1978–1985. There were 25 parishes with an eight-year average incidence rate of greater than 2.1. The overall incidence rates in Louisiana were greater than rates in the United States for the time periods reviewed.John B. Vaughn, D.V.M., M.P.H. Chairman and Professor, Department of Applied Health Sciences, Tulane University School of Public Health and Tropical Medicine, Theresa J. Forti, B.S.N., M.S. Hyg., Dr. P.H. Associate Professor, Department of Applied Health Sciences, Tulane University School of Public Health and Tropical Medicine. James E. Banta, M.D., M.P.H. Dean and Professor Tulane University School of Public Health and Tropical Medicine, Louise McFarland, M.P.H., Dr. P.H. is Chief, Epidemiology Section State of Louisiana Department of Health and Human Resources, and Karen Y. Kelso, C.R.N., B.S. is Nurse Epidemiologist State of Louisiana Department of health and Human Resources.The authors extend thanks to Mrs. Audrey P. Collins, Biostatistician, Louisiana Department of Health and Human Resources, and Barbara H. Denton, Demographer, Louisiana Tech University for their assistance in providing population data. Gratitude is also expressed to Dr. Charles T. Caraway for help with review of data.     

Meningococcal disease in the Asia-Pacific region: Findings and recommendations from the Global Meningococcal Initiative

The Global Meningococcal Initiative (GMI) is a global expert group that includes scientists, clinicians, and public health officials with a wide range of specialties. The purpose of the Initiative is to promote the global prevention of meningococcal disease (MD) through education, research, and cooperation. The first Asia-Pacific regional meeting was held in November 2014. The GMI reviewed the epidemiology of MD, surveillance, and prevention strategies, and outbreak control practices from participating countries in the Asia-Pacific region. Although, in general, MD is underreported in this region, serogroup A disease is most prominent in low-income countries such as India and the Philippines, while Taiwan, Japan, and Korea reported disease from serogroups C, W, and Y. China has a mixed epidemiology of serogroups A, B, C, and W.Perspectives from countries outside of the region were also provided to provide insight into lessons learnt. Based on the available data and meeting discussions, a number of challenges and data gaps were identified and, as a consequence, several recommendations were formulated: strengthen surveillance; improve diagnosis, typing and case reporting; standardize case definitions; develop guidelines for outbreak management; and promote awareness of MD among healthcare professionals, public health officials, and the general public.     

Meningococcal disease. The situation in Spain in the 1998-1999 period

BACKGROUND: The change in the epidemiological pattern undergone by meningococcal disease in a large part of the country in the 1996-1997 season and the decision to intervene by means of a mass vaccination campaign in the age group between 18 months and 19 years of age, using a bivalent polysaccharide vaccine, justified to enhance the epidemiological surveillance of this disease. METHODS: Rates and other indicators of incidence and mortality were calculated for the 1998-1999 campaign by serogroup and age, according to the data notified to the Compulsory Disease Reporting System. RESULTS: The overall incidence was higher than the previous season, although, the rate ratio did not indicate a significantly greater risk. A statistically significant increase in the rate of incidence caused by serogroup B was registered, and for the second consecutive year, the serogroup C rate dropped, although not significantly. There was an increase in the number of deaths. The fatality rate due to serogroup C increased in the group between 1 and 4 years of age. The incidence remained high and with a clear seasonal pattern in the Communities that did not vaccinate. In the remainder, the incidence dropped and the seasonal pattern disappeared. CONCLUSIONS: Two years after the campaign, the predominance of serogroup B cases is generalised in all of the Autonomous Communities, except in the three where the immunisation was not performed. In the latter, in the course of the last two years, serogroup C has predominated. In the Communities where the vaccination campaign was carried out, there is an increase in the incidence, although not significantly, among children under 4 years of age.     

Meningococcal disease: clinical presentation and sequelae

The clinical spectrum of invasive meningococcal disease is diverse with meningitis and/or septicaemia being the commonest modes of presentation. The severity of manifestations of meningococcal infection ranges from bacteraemia, associated with mild non-specific symptoms, to fulminant sepsis with multiorgan failure and death in approximately 10-15% of cases. Localised infections (such as conjunctivitis or septic arthritis) as well as chronic disease may be the sole clinical manifestations but can also lead to disseminated fulminant disease. Among survivors, disabling long-term sequelae can complicate meningococcal disease and result in potentially devastating effects on the quality of life of survivors, most of whom are infants, children and adolescents. The only rational approach to the prevention of meningococcal disease and the associated human suffering is through vaccination.     

Meningococcal disease in South Africa, 1999-2002

We describe the epidemiology of invasive meningococcal disease in South Africa from August 1999 through July 2002, as reported to a laboratory-based surveillance system. Neisseria meningitidis isolates were further characterized. In total, 854 cases of laboratory-confirmed disease were reported, with an annual incidence rate of 0.64/100,000 population. Incidence was highest in infants < 1 year of age. Serogroup B caused 41% of cases; serogroup A, 23%; serogroup Y, 21%; serogroup C, 8%; and serogroup W135, 5%. Serogroup B was the predominant serogroup in Western Cape Province, and disease rates remained stable. Serogroup A was most prevalent in Gauteng Province and increased over the 3 years. On pulsed-field gel electrophoresis analysis, serogroup A strains showed clonality, and serogroup B demonstrated considerable diversity. Selected isolates of serogroup A belonged to sequence type (ST)-1 (subgroup I/II) complex, serogroup B to ST-32/electrophoretic type (ET)-5 complex, and serogroup W135 to ST-11/ET-37 complex.     

Tropical eosinophilia as an imported disease in The Netherlands

Tropical eosinophilia was diagnosed in two patients from India. This appears to be the first report on this exotic condition in the Netherlands. Tropical eosinophilia is characterised by hypereosinophilia, asthma-like attacks of wheezing and non-productive cough, non-specific findings on the chest X-ray in combination with general malaise, subfebrile temperatures, weight loss and lymphadenopathy. Although the syndrome is caused by an infection with Filaria, classical symptoms of filarial infection are characteristically absent. The main diagnostic criteria are hypereosinophilia and asthma-like attacks in subjects from regions where Filaria is endemic, high IgE titers, high antifilarial antibody titers and cure following one or more treatment courses with diethylcarbamazine. These case reports illustrate the importance of the assessment of the number of eosinophil cells in the peripheral blood in the diagnosis of tropical disease.     

Meningococcal disease from the public health policy perspective

The incidence and serogroup distribution of meningococcal disease vary by country and over time. In the United States, the annual incidence has been 0.5-1.1/100,000 or about 1400-2800 cases annually with the highest incidence being in infants less than six months of age [1]. Given the availability of conjugate vaccines against serogroups A, C, W-135 and Y and the possible future availability of a group B vaccine, there is now the potential to effectively control meningococcal disease globally. The question then arises as to how public health policy can best serve this goal. MCV-D (Menactra) is not immunogenic in the first six months of life. For this reason, it has been proposed that immunization with this vaccine begin at nine months of age with a second dose at 12 months. This proposal would rely upon indirect or "herd protection" to protect young infants with the highest disease incidence. A second vaccine, MCV-CRM (Menveo), is immunogenic in the first months of life and is under consideration by the FDA for use in infants two months of age and older. MCV-CRM could provide direct protection of this high risk group, but three primary doses plus a toddler booster are required for this approach. In developing public health recommendations to protect infants, policy makers must weigh the additional cost of immunizing with four doses versus the possibility that relying on herd protection using a lower cost immunization schedule beginning at nine months of age may leave young infants unprotected. Optimal control of meningococcal disease will require both the public will and public policy to best serve this goal. The decision as to what ages to target and which schedules to use should not only take into account the cost of the program, but also the severity of the disease and the high level public concern regarding meningococcal disease.