Prevention Of Secondary Cases Research Articles

The Cost and Public Health Burden of Invasive Meningococcal Disease Outbreaks: A Systematic Review

BackgroundInvasive meningococcal disease (IMD) is a serious disease with a rapid onset, high mortality rate, and risk of long-term complications. Numerous reports in the literature conclude that IMD outbreaks are associated with substantial costs to society and significant burden on communities due to the cost associated with the prevention of secondary cases.ObjectiveTo systematically review the literature on the costs and public health burden associated with IMD outbreaks.MethodsStudies were primarily identified through searching MEDLINE and EMBASE. Reports were included if they provided cost data related to the containment of an IMD outbreak after 1990 and were written in English, French, or Spanish. Costs were converted to 2010 United States dollars. Outbreaks were categorized by low-income countries (LIC) and high-income countries (HIC) based on gross domestic product per capita. Outbreak containment strategies were classified as small (e.g., targeting members of the school/institution where the outbreak occurred) or large (e.g., targeting everyone in the community).ResultsSixteen articles reporting data on 93 IMD outbreaks fulfilled the eligibility criteria and were included. The majority of outbreaks occurred in HIC. Five studies reported the use of small containment strategies including targeted vaccination and chemoprophylaxis, all occurring in HIC. The average cost per small containment strategy was $299,641 and the average cost per IMD case was $41,857. Eight studies reported large containment strategies involving widespread vaccination targeting a specific age group or community. For HIC, the average cost per large containment strategy was $579,851 and the average cost per IMD case was $55,755. In LIC, the average cost per large containment strategy was $3,407,590 and the average cost per IMD case was $2,222.ConclusionIMD outbreaks were associated with substantial costs. We found that although there were numerous reports on IMD outbreaks, data on containment costs were very limited. More research in this area is warranted.

3-Phosphoglycerate Dehydrogenase Deficiency: Description of Two New Cases in Tunisia and Review of the Literature

3-Phosphoglycerate dehydrogenase (3-PGDH) deficiency is a rare autosomal recessive disorder of serine biosynthesis. It is typically characterized by congenital microcephaly, intractable seizures of infantile onset, and severe psychomotor retardation. Diagnosis is suspected on decreased l-serine levels in plasma and cerebrospinal fluid (CSF) and confirmed by genetic study. Early diagnosis in index cases allows supplementation in serine and prevention of fixed lesions. Prenatal diagnosis and genetic counseling allows prevention of secondary cases. We report on the two first unrelated Tunisian families with 3-PGDH deficiency confirmed by biochemical and genetic study. We discuss clinical, biochemical, imaging, electroencephalographic, and therapeutic aspects and review the literature.

Invasive meningococcal disease in Malta: an epidemiological overview, 1994–2007

Since 1996, Malta has experienced an upsurge of invasive meningococcal disease (IMD) following an almost 30 year period with a negligible number of annually reported cases. We reviewed the 233 IMD cases notified during a 14 year period (1994-2007), and analysed epidemiological and laboratory surveillance data. The crude incidence per 100,000 inhabitants peaked in 2000 at 8.1 [95 % confidence interval (CI) 5.7-11.6] and again in 2006 at 8.9 (95 % CI 6.4-12.4), thereby placing Malta amongst the countries with the highest incidence of the disease in Europe. Of the total cases, 137 (59 %) were confirmed and 30 (13 %) were classified as probable. However, 66 cases (28 %) had no laboratory evidence of the disease and were classified as possible. Information on the serogroup was available for 114 cases. Serogroup B formed the largest proportion (76 %, n=87) followed by serogroup C (16 %, n=18). B : 4 : P1.19,15 strains (n=46) predominated throughout the study period since their first identification in 1998. With 28 deaths attributed to IMD, the overall case fatality rate was 12 %. Apart from stressing the importance of maintaining high vigilance for IMD, our findings underscore the importance of enhancing laboratory surveillance of the disease, including characterization of the meningococci. Until vaccines against a broad range of serogroup B meningococci become available for universal use, the main methods of control remain the early treatment of cases and the prevention of secondary cases.

Preventing the Spread of Meningococcal Infection

Meningococcal disease is a much-feared infectious disease with high mortality, unpredictable epidemiology and a predilection for the young. Primary prevention by vaccination cannot yet be fully achieved, so control of the disease must focus on the prevention of secondary cases among contacts of patients. Three strategies are possible: information, vaccination and chemoprophylaxis. This article focuses on the latter.

Meningococcal meningitis and meningococcemia : epidemiological study, France (1985–1991)

Summary In France, meningococcal meningitis and meningococcemia occur at an incidence of 0.8 per 100.000. As about 10 % of cases are fatal, these two diseases pose a serious threat to public health. Doctors are obliged to declare cases to the French Direction Generale de la Sante (DGS). Cases (2817) declared at the DGS from 1985 to 1991 reveal that the death rate from meningitis and meningococcemia is elevated in young children and young adults (with a predominance of serogroup C in the latter) when meningitis is associated with meningococcemia or extensive purpura fulminans, and when certain serogroups are present (A and C). For such cases, the use of rifampicin appears to have become normal practice since distribution of a circular by the French Ministry of Health (Department of Health) in February 1990; however, it is necessary to improve vaccinal practice against meningococci A and C. In addition, analysis of the meningococcal strains (1569) addressed to the Centre National de Reference des Meningocoques et Neisseria apparentees (CNRM) from 1989 to 1992 for complementary examination (serotypes, subtypes) revealed a stronger incidence of serogroup B in extremely heterogeneous antigenic formulae of which the strains B:15:P1.7,16 are encountered most frequently. Also noted, were progressions of serogroup C (42 % of isolates in 1992; major antigenic formula, C:2a:P1.1,2) and serogroup Y (2–3 %). The clinical evolution of cases associated with 556 strains examined at both the DGS and the CNRM revealed elevated death rates associated with serotype 2a and subtype P1.1,2 and a low death rate associated with serotype 4. Improved channels for declaration of cases (more exhaustive, more rapid) and research on other antigenic markers ought to enhance prevention of secondary cases and allow better monitoring of epidemic and/or virulent strains.

Chemoprophylaxis of bacterial meningitis.

Bacterial meningitis continues to be a life-threatening disease and an important cause of severe disability in otherwise healthy individuals. This article reviews the aspects related to the prevention of secondary cases. Our understanding about the factors leading to an epidemic and the identification of high risk groups remains limited. For this reason, chemoprophylaxis can be used only for the prevention of secondary cases once an index case has been identified. The objectives of prophylaxis are threefold: (i) to eliminate nasopharyngeal carriage in household contacts; (ii) to prevent contacts from acquiring the disease and (iii) to treat infection in those incubating the disease. Chemoprophylaxis can only achieve the first of these objectives. Nasopharyngeal carriage of meningococci and Haemophilus influenzae can be eradicated with the use of antibiotics and their advantages and disadvantages are discussed. Prophylaxis should be given to household members and kissing and saliva-exchanging contacts of a case of meningococcal meningitis. The decision to give prophylaxis to extended family contacts, close neighbour contacts or children attending day-care centres where a case has occurred is controversial. It does not alter the course of an epidemic and close contacts are liable to become reinfected soon after prophylaxis. Prophylaxis of H. influenzae should be given to households in which there is at least one child (other than the index case) under 48 months of age. There is no agreement on the need to provide chemoprophylaxis to children in day-care centres because the risk of secondary infections is uncertain. An alternative to chemoprophylaxis is protective chemotherapy which can prevent the development of meningitis in individuals incubating the disease.

Attitudes of mothers to neonatal screening for Duchenne muscular dystrophy.

Early diagnosis of Duchenne musclar dystrophy is crucial if genetic counselling is to be offered to women at risk of carrying the relevant gene. The age at diagnosis is still unacceptably late,1 and we recently showed that screening programmes in infants are inadequate2; thus interest in neonatal screening has increased. Screening of infants has shown that assay of creatine kinase activity fulfils the criteria that should be satisfied by any technique used in neonatal screening programmes.3 Despite the lack of effective treat? ment neonatal screening programmes exist in some countries4 and the prevention of secondary cases has been put forward as a justifiable reason for introducing neonatal screening,5 although there are ethical prob? lems with this argument. We determined the attitudes of mothers towards neonatal screening for Duchenne muscular dystrophy.

Tuberculous meningitis in an urban medical center.

Forty-five cases of tuberculous meningitis at a large urban medical center were reviewed. Reasons for the continued incidence, prognostic factors, and current therapy of this life-threatening form of tuberculosis were examined. Thirty-nine of 45 patients were black, Hispanic, and/or 65 years of age or older (87%). Underlying conditions included alcohol abuse in 12, intravenous drug abuse in 7, recent steroid therapy in 4, head trauma in 4, recent pregnancy in 4, and the acquired immunodeficiency syndrome in 1. Thirty-four patients (76%) presented with altered mental status and/or focal neurologic findings. Significant mortality (31%) occurred despite the administration of antituberculous therapy to all but 1 patient. Six of 14 deaths (43%) occurred in the first week of hospitalization. One-third of survivors had neurologic sequelae at the time of follow-up. Neurologic deficits on admission, advanced age, and alcohol abuse were frequent among those who succumbed. Early recognition and treatment in hospital failed to improve outcome in advanced cases. From these findings we conclude that both aggressive treatment of primary tuberculous infections as well as prevention of secondary cases are necessary to effect any further reduction in the incidence, morbidity, and mortality of tuberculous meningitis.