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Slide 7 This table, compiled from data given in the report, shows that meningococcal disease remains rare across the majority of mainland Europe with the exception of Spain and The Netherlands. The European islands however have a relatively high incidence. The explanation for the relatively high incidence in the islands remains elusive. It may be speculated that in such communities there is circulation of, and thus immunity to, only a limited number of indigenous strains. Therefore when a new strain is introduced to which the population is not immune, an epidemic occurs (personal communication, Professor Norman Noah).

Slide 8 In order to assess changes in disease epidemiology over time and to assess the reliability of the reporting system, a core data set of 16 countries was defined, with a crude incidence of 2.4/100,000. The authors considered that this was possibly closer to the true European incidence.

Slide 9 The age standardised core data set indicated that the major risk group in Europe are children under five years of age. A further group at risk are young people of 14-18 years. Age standardisation removes any biase caused by countries which may have small differences in age distribution and allows comparison of data. This graph also shows that the incidence of meningococcal disease rose progressively over the period 1997-2000.

Slide 10 The overall case fatality rate (CFR) was around 7%, however outcome data was not recorded in all the cases reported by some countries. In those 12 countries where outcome of all reported cases was known the CFR was closer to 10%. Those cases in the older age groups were more likely to die but the incidence in these groups in very low. The authors of the report note that the CFR should be interpreted with care. Countries with very low incidence of disease but with a high fatality rate may indicate reporting only of the most severe cases, while the reverse may indicate a situation where deaths are occuring after the disease is notified. The disease is seasonal across Europe, with the highest number of cases reported in the first and last quarters of the year (October – March).

Slide 11 The distribution of the major meningococcal serogroup is similar over all the reporting countries; with around 65% of cases due to Meningococcus Group B, 33% to Group C, and 2% to ‘others’ (Groups A, W135 and Y) .

Slide 12 However this pooling of data masks some striking differences in a minority of countries. These four countries (Romania, Slovenia, Israel and Switzerland) show serogroup patterns different from each other and from the rest of Europe. In Romania almost 30% of cases are not assigned to a particular meningococcal Group (NGA), while a further 18% of cases of disease are caused by Group A. Group A disease is rarely seen in European countries but is prevalent in Asia and China, as well as in Sub Saharan Africa. Slovenia and Israel report more cases caused by Group B than Group C, as is the European norm, however Group W135 is reported in around 29% of cases in Slovenia and Group Y is seen in 20% of cases in Israel. The appearance of Group W135 has been linked to the return of pilgrims from the Hajj and Group Y is more often seen in North America. It should be pointed out here that these three countries (Romania, Slovenia, Israel) report very small numbers of cases overall. Switzerland differs from the European norm in that more cases due to Group C than Group B are reported.

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