Investigating the aetiology of and evaluating the impact of the Men C vaccination programme on probable meningococcal disease in England and Wales

Abstract

The aims were to (1) investigate the aetiology of probable meningococcal disease, where a clinical diagnosis is made in the absence of laboratory data, and (2) evaluate the impact of the Men C vaccination programme in England and Wales. Multiple linear regression analyses were carried out using data reported to Enhanced Surveillance of Meningococcal Disease (ESMD) and laboratory reports of isolates of organisms causing symptoms that mimic meningococcal disease. Confirmed meningococcal disease appeared to be a significant predictor of probable disease. Thus, an additional reduction in meningococcal disease attributable to the serogroup C vaccination campaign was evident in probable disease over and above that observed in confirmed cases alone. Enteroviruses were a significant contributor to cases of probable meningitis and influenza appeared to be a significant contributor to probable cases of septicaemia. This analysis confirms the success seen following the Men C vaccination campaign and gives an indication of the aetiologies of other causes of probable meningitis and septicaemia reported to ESMD.

Fig. 1

Cases of confirmed and probable meningococcal disease as reported to ESMD by week (week 1, 1999 to week 27, 2003).

Fig. 2

Seasonal patterns of meningitis and septicaemia (confirmed and probable) reported to ESMD, January 1999 to June 2003.

Fig. 3

Seasonal patterns (weeks 14–39=summer half year; week 40 to week 13 the following year=winter half year) of confirmed meningococcal disease, S. pneumoniae, enterovirus, influenza, echovirus, RSV, and coxsackie B virus.

Fig. 4

Multiple regression models, fitted to probable cases of meningococcal meningitis, for age groups where model had ‘good fit’ (R²>0·40).

Fig. 5

Multiple regression models fitted to probable cases of meningococcal septicaemia, by age group.