Meningococcal Disease in Europe: Surveillance and Support

1
Meningococcal Disease in Europe Surveillance and
Support

• Daphne E Holt PhD MBA
• Business Development Manager

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The function of surveillance

• Facilitates the calculation of incidence and case
  fatality rates
• Identifies groups at risk
• Informs health economics decisions
• Informs intervention decisions
• Informs support decisions

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Eurosurveillance

• 1998 European Parliament decided on
  decentralised networks rather than a
  purpose-built European Surveillance Centre
• 2001 MacLehose et al (BMJ 2001323,861-3)
  examined how decentralised networks functioned in
  international infectious disease outbreaks

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From the 2001 report- MacLehose et al (BMJ
2001323,861-3)

• Meningococcal disease was used as one of the case
  studies
• Existing networks have a large value in data
  collection
• Some critical points were identified in the
  network system
• Failures in case identification and reporting
• Difficulties in the transfer of information to
  other countries
• Therefore coordination at a European level is
  essential
• Available data needs to be assessed against this
  background

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Coordinating eurosurveillance

• Eurosurveillance Project of the European
  Commission www.eurosurv.org
• United States Centre for Disease Control,
  Morbidity and Mortality Weekly Reports
  www.cdc.gov
• World Health Organisation, Weekly Epidemiological
  Record www.who.int/wer
• United Kingdom Public Health Laboratory Service,
  European Bacterial Meningitis Surveillance
  Project www.phls.co.uk

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European incidence of meningococcal disease

• During the period July 1999 June 2000 29
  European contributors reported 8279 laboratory
  confirmed cases
• 4 countries contributed only 2 quarters thus 25
  countries reported 8143 cases
• Crude incidence 1.8/100,000
• Range 0.05 (Romania) 13.0 (Republic of Ireland)

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Meningococcal disease by country 1999-2000
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Core data set

• 16 countries reported consistently over past
  three years
• Data set used to assess changes over time
• Used also to assess reliability of the reporting
  system
• Crude incidence from data set 2.4/100,000

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Age-related incidence
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Case fatality rates

• In 12 countries where outcomes of all reported
  cases known CFR 9.1
• Range 0 (Denmark, Sweden) 25 (Slovenia)
• Complete data set CFR 6.9
• Interpret with care, outcome was not recorded in
  all cases
• High CFR may indicate better reporting of more
  severe cases

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Serogroup distribution
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Serogroup distribution by country
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Individual country data remains important

• For determining changes over time within a
  country
• For determining changes in areas within a country
• Two examples illustrated- Hungary, France

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Incidence in Hungary
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Age-related incidence in Hungary
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Incidence in France

• In 2000 104 cases of disease caused by Group C
  0.24/100,000
• In 2001 176 cases reported 0.4/100,000
• Between 1st January and 4th October 2002, 25
  cases were reported in the South West of the
  Country 2.2/100,000
• In the same time period the incidence in the rest
  of France 0.26/100,000

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Distribution of cases of serogroup C disease in
South-west Francewww.eurosurveillance.org/ew/2002
/021024.asp4

• Haute-Pyrénées 3.1/100,000
• Pyrénées Atlantiques 2.0/100,000
• Landes 1.8/100,000

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Eurosurveillance summary

• Collated data gives a picture of meningococcal
  disease across Europe
• Overall incidence ranges from less than 1/100,000
  in many countries of continental Europe to above
  4/100,000 in the islands
• Children up to 5 years are the group most at risk
  in every reporting country
• In general serogroup B is more prevalent than
  serogroup C

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European support networks

• No organisations of the size and type of the
  Meningitis Trust or the Meningitis Research
  Foundation
• No European helpline
• Information on support groups very difficult to
  find
• Searches of world wide web need to be conducted
  in languages other than English

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France

• Association Audrey http//associationaudrey.free.
  fr
• Head office in Maine-et-Loire (North of the
  country)
• Contact groups in the Landes (South west) and in
  the Paris region

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The Netherlands

• Nederlandse Meningitis Stichting
  www.meningitis-stichting.nl
• Association formed in 1996, covers The
  Netherlands and Belgium
• Website has chat-room and is available in eight
  languages

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Information available on www

• Very large amount of information on the disease
  available in English
• Individual Ministries of Health are a source of
  information in European languages
• Public Health organisations provide information
• Media response to reported cases is different
  across Europe, media websites can be useful
• Websites of pharmaceutical companies also provide
  public information

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Traditional information

• Information in the form of leaflets and posters
  is sometimes available from Ministries of Health
  and pharmaceutical companies
• Distribution coverage is often incomplete
• Sources of the information contained within the
  leaflets are sometimes not acredited

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Support and information summary

• Support groups are likely to be very small, thus
  finding information about them is difficult
• There is only a limited independant voice in
  Europe providing public information specifically
  on meningitis
• The public in low incidence countries may not be
  well informed about the devastating effects of
  meningitis and meningococcal disease.