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Epidemiology of invasive meningococcal disease in France in 2003
A Perrocheau1, M K Taha2, D Lévy-Bruhl1
1Unité des maladies à prévention vaccinale, Département des maladies infectieuses, Institut de Veille Sanitaire, Saint Maurice, France.
Abstract:
National surveillance of invasive meningococcal disease (IMD) is based on mandatory reporting. The case definition for surveillance notification was changed in mid-2002 to include cases without microbiological confirmation. The IMD alert detection system was enhanced in 2003 with daily reporting and weekly analysis by district, serogroup, and age. Evaluation of the exhaustivity of the surveillance with capture-recapture analysis allowed correcting for underreporting. In 2003, 803 cases were reported. After correction for under-reporting, the estimated incidence was 1.78 / 100 000. After excluding 'new' cases reported with new definition criteria, the 2002-2003 increase was 4%. Incidence decreased with age, with the highest values in infants less than 1 year (20/100 000), children aged between 1 and 2 years (11/100 000) and in teenagers of 17 years old(7/100 000). The overall case fatality rate was 12%. Fifty nine per cent of cases were due to serogroup B, 32% to C, 5% to W135, and 4% to Y and non-groupable meningococci. Patients with purpura fulminans treated with intravenous antibiotics before admission to hospital were shown to have lower fatality rates than those not treated. In 2001-2003, 5 situations required particular attention: two clusters of serogroup B IMD had set off mass prophylaxis, one outbreak due to a specific B IMD clonal complex with high case fatality rate, and two districts crossed the alert threshold for serogroup C IMD, 2/100 000, and mass vaccination was recommended.
Insights
National surveillance of invasive meningococcal disease (IMD) improved with enhanced reporting and analysis. Estimated incidence was 1.78/100,000, with highest rates in infants and young children, and serogroup B being most common.
Area of Science:
- Epidemiology
- Infectious Disease Surveillance
- Public Health
Background:
- National surveillance of invasive meningococcal disease (IMD) relies on mandatory reporting.
- Changes in case definitions and enhanced alert systems were implemented in 2002-2003.
- Capture-recapture analysis was used to evaluate surveillance completeness.
Purpose of the Study:
- To assess the incidence and epidemiology of invasive meningococcal disease (IMD) in the national surveillance system.
- To evaluate the impact of enhanced surveillance methods and case definition changes.
- To identify high-risk age groups and serogroups for IMD.
Main Methods:
- Utilized mandatory reporting data for invasive meningococcal disease (IMD).
- Implemented enhanced daily reporting and weekly analysis by district, serogroup, and age.
- Employed capture-recapture analysis to correct for underreporting.
- Analyzed case fatality rates and serogroup distribution.
Main Results:
- An estimated incidence of 1.78 per 100,000 was determined after correcting for underreporting.
- Incidence was highest in infants under 1 year (20/100,000) and young children (11/100,000).
- Serogroup B accounted for 59% of cases, followed by serogroup C (32%).
- Case fatality rate was 12%, with lower rates in patients treated pre-hospitalization.
Conclusions:
- Enhanced surveillance systems provide more accurate estimates of invasive meningococcal disease (IMD) burden.
- Targeted interventions are crucial for high-incidence age groups and specific serogroups.
- Prompt antibiotic treatment for purpura fulminans is associated with improved survival outcomes.
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