Control of an epidemic peak of meningococcal disease by N. meningitidis serogroup B
Abstract
Background. In July 2001, some events indicated a possible variation in the course of invasive meningococcal disease (EIM) by Neisseria meningitidis serogroup B showing a transformation from an endemic to an epidemic form of the disease. The epidemic peak occurred from May to July 2001in Santa Lucía with an incident rate of 30 cases/100 000 inhabitants, led to a discussion within the public health authorities and concluded with a vaccination for children over 4 years and youths under 19 years all over the country.
BC antimeningococcal vaccine from Finlay (Cuba) was chosen to prevent the disease.
Objective. To analize EIM cases occurred after vaccination with BC antimeningococcal vaccine in Canelones (443 053 inhabitants) from April 2002 to March 2003 and Montevideo (1 344 839 inhabitants) from August 2002 to July 2003.
Methods. EIM cases reported to the Epidemiologic Department of the Public Health Minister (Area de Vigilancia Epidemiológica-MSP) after vaccination were analyzed and compared to cases occurred the prior two years. Variables analyzed were age, clinical presentation, BC antimeningococcal vaccine, clinical evolution, serotype and subserotype N. meningitidis serogroup B.
Results. a) Canelones: From April 1, 2000 to March 31, 2001 the incidence was 1.5 cases/100 000 inhabitants, from April 1, 2001 to March 31, 2002 the incidence doubled to 3.4/100 000, but decreased to 1.8/100 000 after vaccination. Mortality was 27% during epidemic peak and 12.5% after vaccination. In the 4-19 years old group incidence was 7.4/100 000 (from April 1, 2001 to March 31, 2002) with 3 deaths (all associated with strain B: 4.7: P11.19,15; there were no cases after vaccination.
b) Montevideo: From August 1, 2000 to July 31, 2001 the incidence was 1.5 cases/100 000 inhabitants, from August 1, 2001 to July , 2002 the incidence increased to 2.3/100 000, and decreased to 1.8/100 000 after vaccination. Strain B was predominant in the first and second periods. Mortality was 5% from August 1, 2000 to July 31, 2001, 10% from August 1, 2001 to July 31, 2002 and 4.5% after vaccination. Out of the 24 cases occurred after vaccination, 6 presented in immunized patients. There were 15 cases in the 4-19 years old group from August 1, 2001 to July 31, 2002 and 11 after vaccination.
Discussion. The incidence of the disease was similar both for the period after the vaccination campaign and the period previous to 2001. There were no cases in the 4-19 years old group (objective population) in Canelones. There were no changes for the same age group in Montevideo. Vaccination-related deaths decreased.
Conclusion. BC antimeningococcal vaccine controlled the epidemic peak of 2001. Incidence and fatal deaths were reduced after vaccination.
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