MENINGOCOCCAL MENINGITIS AND MENINGOCOCCEMIA - EPIDEMIOLOGIC-STUDY, FRANCE (1985-1991)

In France, meningococcal meningitis and meningococcemia occur at an in cidence of 0.8 per 100.000. As about 10 % of cases are fatal, these tw o 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 dea th rate from meningitis and meningococcemia is elevated in young child ren and young adults (with a predominance of serogroup C in the latter ) when meningitis is associated with meningococcemia or extensive purp ura fulminans, and when certain serogroups are present (A and C). For such cases, the use of rifampicin appears to have become normal practi ce since distribution of a circular by the French Ministry of Health ( Department of Health) in February 1990; however, it is necessary to im prove vaccinal practice against meningococci A and C. In addition, ana lysis of the meningococcal strains (1569) addressed to the Centre Nati onal de Reference des Meningocoques et Neisseria apparentees (CNRM) fr om 1989 to 1992 for complementary examination (serotypes, subtypes) re vealed a stronger incidence of serogroup B in extremely heterogeneous antigenic formulae of which the strains B:15:P1.7,16 are encountered m ost 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 DCS and the CNRM revealed elevated death rates a ssociated with serotype 2a and subtype P1.1,2 and a low death rate ass ociated with serotype 4. Improved channels for declaration of cases (m ore exhaustive, more rapid) and research on other antigenic markers ou ght to enhance prevention of secondary cases and allow better monitori ng of epidemic and/or virulent strains.