Public health management of invasive meningococcal disease in Baden-Wuerttemberg, Germany, 2012: adherence to guidance and estimation of resources required as determined in a survey of local health authorities.

Lukas Murajda,Elisabeth Aichinger,Guenter Pfaff,Wiebke Hellenbrand

doi:10.1186/s12889-015-1693-6

Abstract

BackgroundInvasive meningococcal disease (IMD) incidence in Germany is low, but management of contacts to prevent subsequent cases still requires resources. Local public health authorities (LHA) advise antibiotic post-exposure prophylaxis (PEP) and vaccination to close contacts as defined in national guidance. We aimed to audit implementation of recommendations for IMD public health management in the state of Baden-Wuerttemberg, Germany, and to estimate associated costs.MethodsWe surveyed all 38 LHAs in Baden-Wuerttemberg to evaluate knowledge of national guidance and implementation of IMD contact management using standardized questionnaires. For IMD cases notified in 2012, we requested numbers of household and other contacts ascertained, including advice given regarding PEP and post-exposure vaccination, plus staff time required for their management. We estimated costs for advised antibiotics, LHA staff time and visits to emergency departments according to published sources. The cost of preventing a subsequent case was estimated based on the number of household contacts that received PEP per IMD case and on the previous finding that ~284 household contacts must receive PEP to prevent one subsequent IMD case.ResultsAlthough LHAs were familiar with national recommendations, they did not advise PEP to 4% of household contacts, while 72% and 100% of school and health provider contacts, respectively, were advised PEP. Only 25% of household contacts of a case with a vaccine-preventable serogroup were advised post-exposure vaccination. A mean of 11.0 contacts/IMD case (range 0–51), of which 3.6 were household contacts, were recommended PEP. Per IMD case, mean costs for LHA staff were estimated at €440.86, for antibiotics at €219.14 and for emergency department visits to obtain PEP at €161.70 - a total of €821.17/IMD case. Preventing a subsequent IMD case would cost ~ €65,000.ConclusionsOur results provide insight into costs of IMD public health management in Germany. We identified marked underuse of post-exposure vaccination in household contacts and overuse of PEP in school and health care contacts. In view of an estimated 3–6 quality-adjusted life years lost per case of IMD, our estimated cost of €65,000 for preventing a subsequent case seems justifiable.

Highlights

Invasive meningococcal disease (IMD) incidence in Germany is low, but management of contacts to prevent subsequent cases still requires resources
Provision of antibiotic post-exposure prophylaxis (PEP) and, in case of a vaccine-preventable strain in the index case, post-exposure vaccination of defined contacts, are evidence-based measures to reduce the risk of subsequent IMD cases [7]
According to guidance of Standing Committee on vaccination and the Robert KochInstitute (RKI) [11,12], the following persons are defined as close contacts of an IMD index case: 1) all household members, 2) contacts in the same group of an index case in kindergarten/pre-schools with children under six years, 3) household-like contacts, such as persons living in the same dormitory or military barracks as an index case, 4) persons with contact to oropharyngeal secretions of an index case, e.g. sexual partner, close friends, school contacts seated next to an index case, 5) medical staff if exposed to oropharyngeal secretions of an index case, e.g. through mouth-tomouth resuscitation or unprotected intubation

Summary

Introduction

Invasive meningococcal disease (IMD) incidence in Germany is low, but management of contacts to prevent subsequent cases still requires resources. Household contacts of persons with IMD have a higher risk of acquiring the disease [8,9]. This holds for close contacts in preschool settings, albeit to a lesser extent [10]. The European Centre for Disease Prevention and Control (ECDC) estimated the number of contacts needed to be treated (NNT) with PEP to prevent one case at 284 (95% confidence interval (CI): 156–1515) [7]. According to guidance of Standing Committee on vaccination and the Robert KochInstitute (RKI) [11,12], the following persons are defined as close contacts of an IMD index case: 1) all household members, 2) contacts in the same group of an index case in kindergarten/pre-schools with children under six years, 3) household-like contacts, such as persons living in the same dormitory or military barracks as an index case, 4) persons with contact to oropharyngeal secretions of an index case, e.g. sexual partner, close friends, school contacts seated next to an index case, 5) medical staff if exposed to oropharyngeal secretions of an index case, e.g. through mouth-tomouth resuscitation or unprotected intubation

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