Clusters of meningococcal disease in France (1987?1988)

Abstract

We analyzed 814 cases of meningococcal disease notified in 1987 and 1988 to the Ministry of Health. Data were obtained by report forms including informations about possible additional cases among contacts. Coprimary cases (occurring within 24 hours after the index case) and secondary cases (occurring more than 24 hours after index case) were all reviewed. Twenty eight clusters of meningococcal disease were identified involving 65 cases (8% of total cases). Twelve of the 814 cases (1.5%) were coprimary cases of an index case and 25 (3%) were secondary cases. The secondary attack rate was 530/100,000 among household contacts and 31/100,000 among school contacts. Seventy two per cent of the secondary cases occurred in the first week after index case. Thirty-eight percent of the secondary cases occurred in the 15-20 age group as opposed to 15% of single cases. Serogroup A was more often found in coprimary (33%) and secondary cases (17%) than in single cases (6%). In France, prophylaxis of secondary cases is administered to the classroom contacts of a case of meningococcal infection but is not required for the entire school except under epidemic conditions.

What is the evidence for giving chemoprophylaxis to children or students attending the same preschool, school or college as a case of meningococcal disease?

“…8) from one US [30] and three European studies [2,4,11], but with significant heterogeneity between these studies (Table 1). When only data from primary-school children were pooled (possible in three studies [2,4,11]), the RD estimate was 4 . 9/10 5 (95 % CI 2 .…”

“…In several European studies investigating the proportion of subsequent, epidemiologically linked cases, these comprised 3-16% of all cases [2][3][4][5][6], with higher proportions reported in higher incidence settings [3,5,6]. For instance, in Belgium the proportion of secondary cases (including co-primary cases) was 5 .…”

“…1 [6]. While observational studies have shown that chemoprophylaxis of household contacts of persons with IMD to eradicate nasopharyngeal carriage of Neisseria meningitidis reduces the risk of subsequent cases in those contacts [7,8], this has not been shown for contacts in other settings, although there are numerous reports on the occurrence of secondary cases in pre-school [2][3][4][5][9][10][11][12][13][14][15][16][17], school [2-5, 11, 17-30], and university or college settings [2,[31][32][33][34][35]. Asymptomatic transmission of the index strain has also been shown in these settings, although to a lesser extent than in household settings [10,16,36,37].…”

Antibiotic prescribing during an outbreak of meningococcal disease

“…In a study in southwest England, erythromycin prescriptions were not increased in the 2 weeks preceding onset of disease in meningococcal cases when compared with controls (J. M. Stuart, unpublished data), but exposure to antibiotics in the preceding months or in family members was not assessed. A high secondary attack rate among household contacts of cases was recently recorded in France during a time when another macrolide antibiotic, spiramycin, was routinely recommended for prophylaxis in household contacts [6].…”

Evidence for Indirect Nosocomial Transmission of Neisseria meningitidis Resulting in Two Cases of Invasive Meningococcal Disease

“…In industrialized countries, up to 10% of cases of IMD may occur in clusters (1,3,5,8,12). Two cases of IMD with a significant spatiotemporal association were identified by retrospective data analysis using the software SaTScan (version 5.1.1), developed by Martin Kulldorff of the National Cancer Institute and Farzad Mostashari of the New York Department of Health and Mental Hygiene (6).…”