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Meningococcal disease in Italy
T Stroffolini1, M E Congiu, M Occhionero
1Department of Epidemiology, National Institute of Health, Rome, Italy.
Abstract:
In 1985, nationwide surveillance of meningococcal disease aimed at establishing appropriate guidelines for prophylaxis started in Italy. The incidence of disease was 1.1/100,000 in 1985 and 0.6/100,000 in 1987. This decreasing trend was particularly evident among military recruits (from 17.3/100,000 in 1985 to 5/100,000 in 1987), reflecting the use of bivalent serogroup (A + C) meningococcal polysaccharide vaccine in all new recruits since January 1987. The age distribution of cases was statistically different from that observed during the 1970s (P less than 0.001), with a shift towards older age groups. Men have been in the majority (516 vs. 358, P less than 0.0000001). Group C has been the most common serogroup encountered (72.2%), while only 18% of the isolates belonged to serogroup B. Among military recruits, serogroup C accounted for 92% (81/88) of the cases. The proportion of strains resistant to sulphonamides was 67%, while only 3% strains were resistant to rifampicin and to minocycline. Reduced susceptibility to ampicillin and to penicillin was observed in 3 and 4% strains respectively. Nine secondary cases were all due to failure in the administration of chemoprophylaxis (sulphonamide given in seven cases, prophylaxis not attempted in two cases). Immunisation of all new military recruits and effective chemoprophylaxis of close contacts of cases are the major guidelines provided by the National Meningitis Surveillance Programme.
Insights
Nationwide surveillance of meningococcal disease in Italy reduced incidence, especially in military recruits, following vaccination and chemoprophylaxis guidelines. Group C strains were most common, with some antibiotic resistance observed.
Area of Science:
- Epidemiology
- Infectious Diseases
- Public Health
Background:
- Meningococcal disease surveillance initiated in Italy in 1985 to establish prophylaxis guidelines.
- Observed incidence of meningococcal disease was 1.1/100,000 in 1985, decreasing to 0.6/100,000 by 1987.
Purpose of the Study:
- To monitor meningococcal disease trends and inform prophylaxis strategies.
- To evaluate the impact of vaccination and chemoprophylaxis on disease incidence.
Main Methods:
- Nationwide surveillance data collection from 1985 to 1987.
- Analysis of disease incidence, age distribution, serogroup prevalence, and antimicrobial resistance patterns.
- Evaluation of secondary cases and chemoprophylaxis effectiveness.
Main Results:
- Significant decrease in meningococcal disease incidence, particularly among military recruits (17.3/100,000 to 5/100,000).
- Shift in age distribution towards older groups; males predominated cases.
- Serogroup C was most prevalent (72.2%), especially in recruits (92%).
- High resistance to sulphonamides (67%), low resistance to rifampicin and minocycline.
- Secondary cases resulted from chemoprophylaxis failures.
Conclusions:
- Bivalent (A+C) meningococcal polysaccharide vaccine in recruits and effective chemoprophylaxis for contacts are key public health guidelines.
- Surveillance data informed effective control strategies for meningococcal disease.