Meningococcal disease in South African goldmines - Epidemiology and strategies for control

Objectives. To describe the epidemiology of meningococcal disease in South African goldmines and to suggest strategies for the prevention and control of further outbreaks. Design. We prospectively investigated a meningococcal outbreak that occurre d in 1996 and describe the control measures that were implemented. in addit ion, we conducted a retrospective analysis of routinely collected data on m eningococcal disease in these mines from 1972 to 1996. Setting. Four goldmines in Gauteng, employing 30 000 workers who live in ho stels. Subjects. All cases of meningococcal disease at the mine hospital. Results. Between 1972 and 1976, 588 cases were diagnosed, with peaks in 197 2 (203 cases, 727/100 000) and 1975 (147 cases, 564/100 000). Since 1978 le ss than 5 cases have been reported in most years, but smaller outbreaks occ urred in 1990 (30 casts, 89/100 000) and 1996 (14 cases, 50/100 000). The 1 996 outbreak (group A, clone I-1) was part of a larger outbreak in Gauteng that originated in Mozambique and began in one mine in July 1996, after whi ch a mass vaccination campaign was implemented, This was followed by a smal ler outbreak among non-vaccinated workers at an adjacent mine. Five patient s were new recruits. Conclusions. Despite a dramatic reduction in meningococcal disease over the last 25 years due mainly to changes in the work force, there are still out breaks in this community. Those most at risk are young men who are new to t he industry. Suggestions for prevention include effective surveillance, rou tine vaccination of new recruits and a rapid response to outbreaks, with ma ss vaccination and provision of chemoprophylaxis to close contacts.