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[The Madrid autonomous community epidemiological bulletin. A survey on its dissemination and opinion thereof on among primary care physicians for the year 2000].

BACKGROUND: The Autonomous Community of Madrid Epidemiological Bulletin is the main communications link between epidemiological monitoring system and health care professionals. The purpose of this study is that of ascertaining the dissemination and opinion of this Autonomous Community of Madrid Epidemiological Bulletin among primary care physicians for the purpose of adapting this publication to its readers' interests. METHOD: A telephone survey among primary care physicians in the Autonomous Community of Madrid, asking how often they read the Bulletin, the interest and usefulness of the information included in it. The sample size was estimated at 346 physicians. A two-stage sampling process was carried out-by cluster sampling in the first stage, randomly selecting 125 health care centers and 2.7 physicians per center, 17% being primary care team coordinators. A comparison is made of the results among physicians and coordinators by means of the Chi-square and Fisher's Exact Test method, with Epi-Info v.6. RESULTS: A total of 305 surveys were conducted (245 physicians and 60 coordinators). There was an awareness of the existence of the Autonomous Community of Madrid Epidemiological Bulletin on the part of 91.5% (CI 95%: 88.1-94.8), and 27.2% (CI 95%: 21.9-32.5) were familiar with more than 50% of the last issues published. A total of 92.4% (CI 95%: 89.4-95.8) considered the Bulletin to be interesting or highly interesting, grading its usefulness an average of 3.5 on a maximum scale of 5. Of the permanent sections, the most highly-valued was Epidemic Outbreaks, those reports related to meningococcal infection, tuberculosis and HIV/AIDS being the most highly-valued. CONCLUSIONS: The Autonomous Community of Madrid Epidemiological Bulletin is a publication which, although not widely-known by the primary care physicians in the Community, is well-valued when it is read, thus being a useful feedback tool within the Epidemiological Monitoring System.

Adult↗
PubMed2002

Estimating the burden of serogroup C meningococcal disease in England and Wales.

In 1999 a new conjugate vaccine for serogroup C meningococcal disease was licensed for use in the UK. In order for an appropriate vaccination strategy to be developed the burden of serogroup C disease in England and Wales needed to be established. This was done using data from an enhanced surveillance scheme alongside routine laboratory reports and a total of 5,052 cases of serogroup C disease in England and Wales between 1993 and 1998 were estimated. Among these, an estimated 398 died and 1,767 were admitted to intensive care units (ITUs). The greatest burden of disease was in young children and teenagers. The current literature identified four studies reporting sequelae following serogroup C meningococcal disease. These provided estimates of sequelae in the range of 6.5% and 45% and presented some evidence of higher levels than occur following serogroup B meningococcal disease. This information was provided to the Joint Committee on Vaccination and Immunisation to inform policy to implement a serogroup C conjugate vaccination programme in the UK. The vaccination programme has since been justified by the dramatic reduction in serogroup C meningococcal cases.

Adolescent↗
PubMed2002

Meningococcal serogroup C conjugate vaccination in England and Wales: coverage and initial impact of the campaign.

The UK was the first country to introduce meningococcal serogroup C conjugate vaccination. The vaccine was incorporated into the routine infant immunisation schedule and was offered to all under 18 year olds in a catch-up campaign. The vaccine has been well accepted in infants receiving routine vaccination, with coverage around 89%. Coverage in older children targeted in the catch-up campaign was above 85% up to the age of 14, and was lowest (43%) in 15-17 year olds not in education. The winter of 2000-01 was the first meningococcal season following the offer of the vaccination to all children and adolescents. The incidence of serogroup C disease in the targeted age groups fell by 80%, and the number of deaths in laboratory confirmed cases in 0-19 year olds decreased from 78 to 8 between 1998-99 and 2000-01. The incidence of serogroup B disease in all age groups was slightly higher in 2000-01 than previous years, and there was an increase in the incidence of serogroup C disease in those aged over 20 during the study period, leading to the extension of the vaccination campaign to 20-24 year olds.

Adolescent↗
PubMed2003

Clinical and microbiological spectrum of meningococcal disease in adults during Hajj 2000: an implication of quadrivalent vaccination policy.

OBJECTIVE: To describe the epidemiological, clinical and laboratory features of meningococcal disease and explore the factors responsible for its morbidity and mortality among the pilgrims during Hajj 2000. SETTING: This study was conducted at King Faisal Hospital, Makkah, Saudi Arabia. METHOD: Any patient suspected of meningococcal disease during the period of pilgrimage presenting with fever, head ache, signs of meningeal irritation and turbid CSF, confirmed on gram stain smears. Latex agglutination test and culture was included in this study. Their clinical features, management and outcome was recorded and analysed. RESULTS: Of 105 confirmed cases of meningococcal disease, 64% had predominantly meningitis, 36% meningococcaemia and meningitis. Meningococcal rash was found in 2% and co-morbidity in 18% of cases. Antibiotics used empirically were benzylpenicillin or ceftriaxone along or in combination. Overall case fatility rate was 34%. Delay in diagnosis, delay of antibiotic administration, older patients and patients with serious concurrent medical problems, were the factors leading to higher than expected mortality rate. Maximum number of patients were Pakistanis (18%) followed by Indians (15%) and Indonesians (12%). Overall serogrouping was as follows: group A (44), W135 (19), B (1) and untypable (1). Serogroup W135 appeared more invasive and more fatal. CONCLUSION: Quadrivalent vaccine ACYW135 is recommended for pilgrims to enter Saudi Arabia and for mass vaccination in local population.

Adult↗
PubMed2003

[The first effect of the national vaccination campaign against meningococcal-C disease: a rapid and sharp decrease in the number of patients].

OBJECTIVE: To describe the initial effects of the large-scale vaccination campaign in June-July of 2002 (1-5- and 15-18-year-olds) and September-November of 2002 (6-14-year-olds) on the incidence of group-C meningococcal disease in the Netherlands. DESIGN: Descriptive. METHOD: The incidence of meningococcal disease and the serogroup distribution were determined on the basis of the patient data associated with isolates of Neisseria meningitidis that were sent to the Netherlands Reference Laboratory for Bacterial Meningitis during the period from 1 January 1999 to 31 January 2003. RESULTS: The highest monthly incidence of serogroup-C disease was reported in January-April 2002 (2.2-3.1/100,000), after which the incidence remained more or less unchanged after September at a level of 0.1-0.4/100,000. The incidence of meningococcal-C disease was 73% lower in August-October 2002 compared with the same period in 2001. In the same months, the incidence of meningococcal-C disease for the 0, 1-5, 6-14, 15-18 and > 18 year-olds was 49%, 80%, 89%, 89% and 42%, respectively, lower than in the same months in the previous year. The percentage of meningococcal disease caused by serogroup-C fluctuated from 35 to 49% in January-August 2002 and decreased to 9-19% in September-December 2002. There was also a decrease in the unvaccinated age groups. CONCLUSION: The vaccination campaign led almost immediately to a sharp decrease in the number of patients with meningococcal serogroup-C disease.

Adolescent↗
PubMed2003

Immunologic memory with no detectable bactericidal antibody response to a first dose of meningococcal serogroup C conjugate vaccine at four years.

Fourteen children with no detectable bactericidal antibody response to a first dose of meningococcal C conjugate vaccine at 4 years of age were given a booster dose of the same vaccine 2 years later. A rapid 1000-fold rise in postimmunization bactericidal antibody titers, a measured either 7 or 14 days later, suggested previous immunologic priming.

Antibodies, Bacterial↗
PubMed2003

Expression and involvement of Toll-like receptors (TLR)2, TLR4, and CD14 in monocyte TNF-alpha production induced by lipopolysaccharides from Neisseria meningitidis.

BACKGROUND: The present study was undertaken to examine the ability of lipopolysaccharide-containing outer membrane vesicles (OMV-LPS) and purified LPS (P-LPS) from the same meningococcal strain to induce the expression of Toll-like receptors (TLR2 and TLR4) and TNF-alpha production in leukocytes, and further to study the involvement of TLRs, and CD14 in monocyte TNF- alpha production in an ex vivo human whole blood system. MATERIAL/METHODS: OMV-LPS or P-LPS were added to human whole blood and expression of TLR2/4 and production of TNF- alpha in leukocytes were measured by flow cytometry. To study involvement of TLRs and CD14 in monocyte cytokine production we used monoclonal antibodies against TLR2/4 and CD14. RESULTS: OMV-LPS and P-LPS induced surface expression (maximal at 120 min) of TLR2 and TLR4 on granulocytes and monocytes. LPS incorporated in OMV was less potent (weight basis) than P-LPS in inducing monocyte TNF- alpha production. When inducing monocyte TNF-alpha by OMV-LPS, antibodies directed against TLR2 and TLR4 caused 45 and 78% inhibition, respectively. When inducing TNF- alpha by P-LPS, antibodies against TLR2 had no effect, whereas anti-TLR4 antibodies caused 63% inhibition. Antibodies against CD14 inhibited nearly completely the monocyte TNF- alpha response induced by meningococcal LPS irrespective of whether LPS was presented in purified form or incorporated in membrane vesicles. CONCLUSIONS: OMV-LPS and P-LPS from the same meningococcal strain induced expression of TLR2/4 on monocytes and granulocytes. Surface receptors TLR2/4 and CD14 are essential for in vitro cellular activation induced by OMV-LPS and P-LPS, but the functional significance of these receptors during meningococcal infections remains elusive.

Humans↗