Public health management of meningococcal disease: Indications from a one year national survey in italy

Abstract

Results from a one year national survey in Italy show that 75.8% of the meningococcal meningitis cases in 1985 were due to serogroup C, while group B accounted for only 14.3% of the cases. Resistance of isolate strains to sulphonamides was 71% as well, with group C showing a resistance of 86.5%, and in contrast, only one strain showing resistance to rifampin, and none to minocyclin. A single coprimary case and seven secondary cases occurred. The occurrence of seven secondary cases indicates a failure in the administration of chemoprophylaxis: inappropriate (sulphonamides) in five cases and no drug given in two cases. Among recruits, the attack rate was much higher (17.3/100,000) than in the general population (1/100,000), and 92% of the cases were due to serogroup C. We conclude that in our country sulphonamides should not be used for chemoprophylaxis of those with a high risk of contact, and instead we strongly advise the use of rifampin or minocyclin given within 24 hours of onset of illness in the index case. While vaccination in this setting does not appear very valuable, vaccination of army recruits does appear valuable, and is a promising method of attack on meningococcal disease.