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A one year survey of meningococcal disease in Italy
T Stroffolini1, F Rosmini, C M Curianò
1Laboratory of Epidemiology and Biostatistics, Istituto Superiore di Sanità, Rome, Italy.
Abstract:
For the last ten years, meningococcal disease has been endemic in Italy with an annual average of 900 cases (rate of 1.6/100,000). The age specific attack rate has been highest for children under one year of age, and the majority of cases have been due to serogroup B. During 1985, the epidemiology of meningococcal disease changed substantially: twice as many cases were observed in males as in females. There was a shift toward older age groups, with the highest number of cases occurring in the 15-24 year old age group (25%). The frequency in army recruits was 17.3/100,000, as opposed to 1/100,000 for the general population. Serogroup C caused the majority of cases (75.8% of the isolates). The proportion of strains resistant to sulfonamides was 71.1%, while only one strain was resistant to rifampin and none to minocycline. Seven secondary cases occurred (2%): in five, chemoprophylaxis was inappropriate (sulfonamide), and in two, no drug was given. A single co-primary case was seen. We conclude that in Italy, the use of sulfa drugs as chemoprophylactic agents is not warranted at present, compulsory vaccination of army recruits with bivalent vaccine (A + C) is advisable, and the shift in age distribution of cases and the high predominance of serogroup C increases the need for careful surveys.
Insights
Meningococcal disease epidemiology shifted in Italy during 1985, with more cases in males and older age groups, predominantly serogroup C. Sulfonamide chemoprophylaxis is ineffective, and vaccination for army recruits is recommended.
Area of Science:
- Epidemiology
- Infectious Diseases
- Microbiology
Background:
- Meningococcal disease has been endemic in Italy for a decade, with a high attack rate in infants and predominantly serogroup B.
- A significant epidemiological shift occurred in 1985, altering case distribution and causative serogroups.
Purpose of the Study:
- To analyze the changing epidemiology of meningococcal disease in Italy during 1985.
- To assess the effectiveness of chemoprophylaxis and recommend public health interventions.
Main Methods:
- Retrospective analysis of meningococcal disease cases reported in Italy during 1985.
- Microbiological analysis of isolates to determine serogroups and antibiotic resistance patterns.
- Comparison of attack rates across different age groups, genders, and populations (e.g., army recruits).
Main Results:
- Cases doubled in males compared to females, with a shift towards the 15-24 year age group (25%).
- Serogroup C became predominant (75.8%), and army recruits showed a significantly higher incidence (17.3/100,000).
- High sulfonamide resistance (71.1%) was observed, while rifampin and minocycline resistance were minimal. Sulfonamide chemoprophylaxis failure was noted in 5 of 7 secondary cases.
Conclusions:
- Current sulfonamide use for chemoprophylaxis in Italy is not recommended due to high resistance.
- Compulsory vaccination of army recruits with a bivalent (A+C) vaccine is advised.
- The shift in age distribution and serogroup C predominance necessitate ongoing surveillance.