Abstract
In 2007, a European survey identified variation in country policies on public health management of invasive meningococcal disease (IMD). In 2009-10, the European Centre for Disease Prevention and Control (ECDC) published evidence-based guidance on IMD. We therefore surveyed again European countries to describe policies for managing IMD cases and contacts in 2013. We asked national IMD public health experts from 32 European countries to complete a questionnaire focusing on post-exposure prophylaxis (PEP) for IMD contacts and meningococcal vaccination. Proportions in 2007 and 2013 were compared using the chi-squared test. All 32 countries responded, with responses from two regions for Belgium and Italy; half stated having used ECDC guidance to update national recommendations. PEP was recommended to close contacts in 33 of 34 countries/regions, mainly ciprofloxacin for adults (29/32 countries) and rifampicin for children (29/32 countries). ECDC guidance for managing IMD contacts in airplanes was strictly followed by five countries/regions. Twenty-three countries/regions participated in both surveys. Compared with 2007, in 2013, more countries/regions recommended i) ceftriaxone for children (15/23 vs 6/20; p = 0.03), ii) PEP for all children in the same preschool group (8/23 vs 17/23; p = 0.02). More countries/regions recommended evidence-based measures for IMD public health management in 2013 than 2007. However, some discrepancies remain and they call for further harmonisation.
Highlights
Invasive meningococcal disease (IMD) is associated with high case fatality (9% in 26 European countries in 2011 [1]) and substantial risk of long-term sequelae among survivors [2,3,4]
In 2009–10, risk assessment guidelines for diseases transmitted on aircraft (RAGIDA) including recommendations on the management of contacts to an IMD case were published by European Centre for Disease Prevention and Control (ECDC) [13,14] (Box)
The following 23 of the 34 countries/regions responded to both surveys: Austria, Belgium (Flanders and Wallonia), Czech Republic, Denmark, Estonia, Finland, France, Germany, Hungary, Iceland, Ireland, Lithuania, Malta, the Netherlands, Norway, Poland, Romania, Slovakia, Spain, Sweden, Switzerland, and the United Kingdom (UK)
Summary
Invasive meningococcal disease (IMD) is associated with high case fatality (9% in 26 European countries in 2011 [1]) and substantial risk of long-term sequelae among survivors [2,3,4] This explains the high level of concern associated with cases of IMD despite a low incidence in Europe of under one case per 100,000 population annually in the past decade [4,5]. A survey in 2007, performed by the public health management working group of the European Meningococcal Disease Society (EMGM), documented that recommendation of these and other public health control measures varied widely among European countries [12]. This heterogeneity was thought to reflect uncertainty on effectiveness of public health measures, and pragmatic, economic or legal constraints of policymakers in different countries
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