Vroege kenmerken en klinisch beloop van meningokokkenziekte in Nederland na de invoering van meningokokken C-vaccinatie*

Objective

To describe the epidemiology of meningococcal disease after introduction of conjugated serogroup C vaccination in the Dutch National Immunisation Programme in 2002 and to study the disease characteristics in relation to disease outcome so as to gain a better understanding of factors that contribute to an early recognition of the disease and the timely start of treatment.

Design

Descriptive.

Methods

Microbiological laboratory results were combined with to the notification system and supplemented with clinical data about the disease progress.

Results

Between January 2003 and April 2005 a total of 752 patients with meningococcal disease were notified in the Netherlands. Serogroup C disease was found in 8% and did not occur in vaccinated persons. Serogroup B caused 88% of the cases. Upon admission purpura were found in 60% of the patients. The overall case fatality rate (CFR) was 6.7%, but reached 16% among adults over 50 years. The median time to admission was 17 h after the onset of symptoms. A fulminant disease course was associated with a higher mortality. The CFR in patients admitted within 12 h, 12-17 h, 18-35 h or ≥ 36 h after first symptoms, was 10, 8, 3 and 2% respectively.

Conclusion

Until the time that vaccination provides protection against all serogroups the disease burden due to meningococcal infections can only be managed by early recognition and earlier treatment. Early detection of patients in primary care or at the A&E department requires physicians being aware of alarm symptoms, such as the presence of purpura and, in particular, a rapid deterioration of the clinical picture.