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Slide 13 Although it is important to coordinate data collation across Europe, access to the data from within individual countries also remains important for a number of reasons.

Slide 14 In order to obtain snap shots within individual countries, it is sometimes necessary to gather data from a variety of sources. This is a composite graph showing the incidence of meningococcal disease in Hungary. It show that the incidence of the disease, although very low, has fluctuated across the years. Although a 40%increase in cases was seen 1999-2000, the number of cases reported in 2000-2001 has now fallen back close to that reported in previous years. It is speculated that the fall in numbers of cases reported in 2000-2001 was due to the lack of an influenza epidemic after the introduction of an effective influenza vaccination campaign (Andras Lakos M.D – personal communication). A recent prior infection with influenza is a known risk factor for meningococcal disease (Cartwright K. Meningococcal Carriage and Disease. In: Cartwright K, ed; Meningococcal Disease, 1995; Wiley, England) Data used to construct the graph came from the following sources: Incidence and some characteristics of purulent meningitis in Hungary, 1983 through 1987. Nyerges G, Mesner Zs. Orv. Hentil. 1989;130:2615-2620 Changes in epidemic features of IMC disease in Hungary between 1999 and 2000. Krisztalovics K et al. European Monitoring Group for Meningococci (EMGM) 2001, Orebro, Sweden Garbor Metzler – personal communication; data distilled from publications of the National Epidemiology Center, Budapest, and published in Hungarian

Slide 15 Although the incidence in Hungary is very low, this graph illustrates that even in low incidence countries it is still the children who are most at risk. Data from 1999-2000 indicated that around 30% of cases were due to serogroup B and 45% to serogroup C; the remaining 25% being made up of those cases which were diagnosed clinically, had unknown serogroups or were caused by other serogroups (Changes in epidemic features of IMC disease in Hungary between 1999 and 2000. Krisztalovics K et al. European Monitoring Group for Meningococci (EMGM) 2001, Orebro, Sweden) Data from 2000-2001, which may still be incomplete, indicates 70% of cases were caused by serogroup B and 30% by serogroup C (Garbor Metzler – personal communication)

Slide 16 The incidence of meningococcal disease in France caused by Group C has also changed with time. According to data reported in Eurosurveillance weekly archive: 2002; Vol6, issue 43 (www.eurosurveillance.org/ew/2002/021024.asp#4), a 60% increase in the number of cases over the previous year was reported in 2001. In the first nine months of 2002 the incidence of Meningococcal C disease in the South West of the country rose ten fold.

Slide 17 The departments affected are all in the South West corner of the country. The incidence in neighbouring departments are not unusually high, however the two with the highest incidence border with Spain which has a relatively high incidence (4/100,000) A vaccination campaign for for children and young people commenced in these departments on 21st October 2002

Slide 18 In summary: it is important to collect an overall picture in Europe there are high and low incidence countries children are more at risk everywhere High incidence countries are an obvious target for NGOs involved in the support of victims of the disease and their families, however, it could be argued that low incidence countries are even more in need of education and awareness-raising measures.

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