Meningococcal Disease in Europe: Surveillance and Support
By Dr Daphne Holt

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Slide 1 - Title Slide The juxtaposition of disease surveillance and victim support within the same lecture may seems strange, however Non Government Organisations (NGOs) such as the Meningitis Trust need to understand disease distribution and incidence in order to develop their core activities. NGOs wish to offer the best possible services to the public where ever they are and the public can be reasured that they will benefit from such an expanded knowledge pool.

Slide 2 Knowledge of disease surveillance data is important at many levels. It throws light on the general health of the global population, It informs governments on health economic issues and provides strategic information for NGOs. The principles and methodologies of data collection are very clearly explained on the website of the World Health Organisation, which is also a valuable source of data on disease incidence. Information on global surveillance systems, including a slide show on Principals of Surveillance, can be found at URL http://www.who.int/emc/surveill/index.html A list of Ministries of Health and national surveillance institutes around the world can be found at URL http://www.who.int/emc/surveill/mohglobal.html

Slide 3 In 1998 the European Parliament came to the decision that the building of a centralised facility for the collection and analysis of disease surveillance data was not justified. As in the United Kingdom, many diseases are required by law to be reported, and many countries have their own epidemiology units where case numbers are reported. A recent article in the British Medical Journal (MacLehose et al. BMJ 2001;323,861-3) has now looked more closely at this decision, examining how a decentralised network could function in the event of an international disease outbreak.

Slide 4 Meningococcal disease was used by the authors as a case study in their analysis. While the overall picture showed that intra-country networks have a large part to play in data collection, some critical points were raised which showed that Pan-European coordination is essential. The two major points which concern us here are failures in case identification and reporting and difficulties in the transfer of information. When data on the incidence of meningococcal disease is assessed it must be remembered that it could be incomplete and therefore it is best used to interpret trends rather than as an indicator of true incidence.

Slide 5 Coordination of collected data is an important function and four prominant organisations have taken up the challenge. The European Commission funds the surveillance of meningococcal disease in European Union Countries. In order to make best use of reporting systems and to avoid collection errors, these data also enter the database of the European Bacterial Meningitis Surveillance Project coordinated by the United Kingdom Public Health Laboratory Service. Both the United States Centre for Disease Control and the World Health Organisation collect global statistics. There is also a European Advisory Board, which held its first annual meeting in Austria in October 2000 (Meeting report, Vaccine 2001;19:4347-4356) In order to produce a snapshot of the epidemiology of meningococcal disease across Europe, data from the European Bacterial Meningitis Surveillance Project is used here. The report, which was published in 2001, covers 1999-2000. The Meningitis Trust were pleased to support the development of the database used in this project. The Authors of the 2001 report are Norman Noah and Brian Henderson and it can be found at URL http://www.phls.co.uk . The authors have kindly given their permission for the data to be used here.

Slide 6 The crude incidence of meningococcal disease across 25 countries of Europe during the reporting period was 1.8/100,000 population (range 0.05-13.0). It should be pointed out here once again that this is reported incidence. The difficulties of reporting across the countries of Europe have been indicated in slide 4. The figures include data collected in the United Kingdom before the introduction of the conjugate vaccine for Meningococcal Group C disease in November 1999.

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