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Editor- Hoare1 describes the present fragmented approach to
research on meningococcal disease and reliance upon intuitive knowledge.
We believe that the evidence for some public health interventions is also
similarly lacking .
Mass chemoprophylaxis, particularly as a community based
intervention, appears to be of unproven benefit in reducing the incidence
of subsequent cases. Although mass chemoprophylaxis has shown a reduction
in naso-pharyngeal carriage of Neisseria meninigitidis it is unclear
whether or not this is beneficial. Neal et al. 2 failed to demonstrate a
reduction in carriage of pathogenic Group C strains in a community
meningococcal disease control programme, but showed an undesirable
reduction in the carriage of protective organisms such as Neisseria
lactamica.3 Mass chemoprophylaxis has also been associated with the
emergence of rifampicin resistance.4 We are well aware, through our own
experiences, that there is sometimes considerable public pressure for
intervention. However we suggest that there should be a moratorium on the
use of chemoprophylaxis in community clustersuntil there is clear evidence
of benefit.
Meanwhile important questions remain to be answered concerning other
public health interventions. Could existing polysaccharide meningococcal
vaccines be used more extensively as a preventive measure targeted at
older teenage groups with high age specific incidence and death rates ?
What should be the appropriate strategies and target groups for the
introduction of conjugate meningococcal Group C vaccines ?
We suggest that a multi-disciplinary meningococcal disease research
and intervention strategy is now urgently needed to address the
prevention, control and management of meningococcal disease and to respond
to the difficult public health situation we are currently facing.
Martyn Regan
Consultant in Communicable Disease Control/ Chair North West Communicable
Disease and Environment Group
Ruth Hussey
Director of Public Health
Department of Public Health
Liverpool Health Authority, Hamilton House, 24 Pall Mall, Liverpool L3 6AL
References
1. Hoare S. Research into meningococcal disease is to fragmented. BMJ
1999;318:196 (16 January).
2.Neal KR, Irwin DJ, Davies S, Kaczmarski EB, Wale MCJ. Sustained
reduction in the carriage of Neisseria meningitidis as a result of a
community meningococcal disease programme. Epidemiol Infect 1998;121:487-
493.
3.PHLS Meningococcal Infections Working Group and the Public Health
Medicine Environmental Group. Control of meningococcal disease: Guidance
for consultants in communicable disease control. CDR Review; 5 (R13):R189-
195.
4. Sivonen A, Renkonen OV, Weckstrom P, Kosenvuo K, Raunio V, Makela
PH. The effect of chemoprophylactic use of rifampicin and minocycline on
rates of carriage of Neisseria meningitidis in army recruits in Finland. J
Infect Dis 1978;137:238-44.
Prevention and Control of Meningococcal Disease; time for less art and more science?
Editor- Hoare1 describes the present fragmented approach to
research on meningococcal disease and reliance upon intuitive knowledge.
We believe that the evidence for some public health interventions is also
similarly lacking .
Mass chemoprophylaxis, particularly as a community based
intervention, appears to be of unproven benefit in reducing the incidence
of subsequent cases. Although mass chemoprophylaxis has shown a reduction
in naso-pharyngeal carriage of Neisseria meninigitidis it is unclear
whether or not this is beneficial. Neal et al. 2 failed to demonstrate a
reduction in carriage of pathogenic Group C strains in a community
meningococcal disease control programme, but showed an undesirable
reduction in the carriage of protective organisms such as Neisseria
lactamica.3 Mass chemoprophylaxis has also been associated with the
emergence of rifampicin resistance.4 We are well aware, through our own
experiences, that there is sometimes considerable public pressure for
intervention. However we suggest that there should be a moratorium on the
use of chemoprophylaxis in community clustersuntil there is clear evidence
of benefit.
Meanwhile important questions remain to be answered concerning other
public health interventions. Could existing polysaccharide meningococcal
vaccines be used more extensively as a preventive measure targeted at
older teenage groups with high age specific incidence and death rates ?
What should be the appropriate strategies and target groups for the
introduction of conjugate meningococcal Group C vaccines ?
We suggest that a multi-disciplinary meningococcal disease research
and intervention strategy is now urgently needed to address the
prevention, control and management of meningococcal disease and to respond
to the difficult public health situation we are currently facing.
Martyn Regan
Consultant in Communicable Disease Control/ Chair North West Communicable
Disease and Environment Group
Ruth Hussey
Director of Public Health
Department of Public Health
Liverpool Health Authority, Hamilton House, 24 Pall Mall, Liverpool L3 6AL
References
1. Hoare S. Research into meningococcal disease is to fragmented. BMJ
1999;318:196 (16 January).
2.Neal KR, Irwin DJ, Davies S, Kaczmarski EB, Wale MCJ. Sustained
reduction in the carriage of Neisseria meningitidis as a result of a
community meningococcal disease programme. Epidemiol Infect 1998;121:487-
493.
3.PHLS Meningococcal Infections Working Group and the Public Health
Medicine Environmental Group. Control of meningococcal disease: Guidance
for consultants in communicable disease control. CDR Review; 5 (R13):R189-
195.
4. Sivonen A, Renkonen OV, Weckstrom P, Kosenvuo K, Raunio V, Makela
PH. The effect of chemoprophylactic use of rifampicin and minocycline on
rates of carriage of Neisseria meningitidis in army recruits in Finland. J
Infect Dis 1978;137:238-44.
Competing interests: No competing interests