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Eurosurveillance, Volume 7, Issue 30, 24 July 2003
Articles

Citation style for this article: de Greeff S, Ruijs H, Timen A, van Deuren M, de Melker H, Spanjaard L, Dankert J. First effects of meningococcal C vaccination campaign in the Netherlands. Euro Surveill. 2003;7(30):pii=2264. Available online: http://www.eurosurveillance.org/ViewArticle.aspx?ArticleId=2264

First effects of meningococcal C vaccination campaign in the Netherlands

Sabine de Greeff 1(Sabine.de.Greeff@rivm.nl), Helma Ruijs2, Aura Timen3, Marcel van Deuren4, Martin de Vries5, Hester de Melker1, Lodewijk Spanjaard6, and Jaap Dankert6

1Department of Infectious Diseases Epidemiology, National Institute of Public Health and the Environment, the Netherlands. 2Municipal Health Service, Rivierenland, the Netherlands. 3National Coordination for Communicable Diseases Control, the Netherlands. 4University Medical Centre, Nijmegen, the Netherlands. 5National Association of Municipal Health Services, the Netherlands. 6Netherlands Reference Laboratory for Bacterial Meningitis, the Netherlands.

In response to the increasing incidence of meningococcal C disease in the Netherlands since 2000, routine conjugated meningococcal C vaccination for children aged 14 months and a catch up campaign for all 1-18 year olds was implemented (coverage ±90%) in June-November 2002 (1, 2). The age groups with the highest incidence of meningococcal C disease, those aged 1-5 and 15-18 years, were vaccinated in June-July 2002. For logistic reasons those aged 6-14 years were vaccinated later, in Sept-Nov 2002.

Figure: Incidence (per 100 000 inhabitants) of meningococcal disease in the Netherlands from 2000 onwards.

Data are based on Neisseria meningitidis isolates, from patients with meningococcal disease, sent to NRBM.

Incidence of meningococcal C disease decreased soon after the vaccination campaign was carried out. The highest incidence of serogroup C disease had been reported in January-March 2002 (3.1, 2.8, 2.2/100 000). In the same months in 2003 the incidence had decreased to 0.4/100 000 (figure). The number of patients in the first three months after the campaign (November 2002-January 2003) was almost 90% lower than during the same period of the previous year (97 versus 11). Since the introduction of meningococcal C conjugate vaccine, no cases of meningococcal C disease have been reported in children previously vaccinated (3).

Incidence of meningococcal disease also decreased in non-vaccinated age groups in the first three months after the campaign. The number of patients decreased from 48 in November 2001-January 2002 to 9 in the same period the next year. This might be a first indication of a herd immunity effect. (3). However, since in 2001 the number of meningococcal C cases increased over the year and no seasonal trend was visible, re-occurence of the seasonal influence in 2002 could have interfered with the decrease after the vaccination campaign.

The National Institute of Public Health (RIVM) together with the Community Health Services (CHS) and the Netherlands Reference Laboratory for Bacterial Meningitis (NRBM) began enhanced surveillance in January 2003. This will enable monitoring of the incidence and disease burden of meningococcal C disease, provide estimates of vaccine efficacy, and identify vaccine failures. CHS report their notifications in accordance with infectious disease law. These notifications with an additional questionnaire are recorded in an electronic database and combined with typing results from NRBM by RIVM. This surveillance is used to monitor the remaining incidence of meningococcal disease. An additional aim of the enhanced surveillance is to gain insight into the role of early recognition and treatment in reducing disease severity.

Despite the successful vaccination campaign, the number of patients with meningococcal disease has returned to the same levels as before the increase of serogroup C. Most cases are caused by meningococci of serogroup B. Disease rates are being monitored carefully, as the introduction of a vaccine against this serogroup is not expected before 2008 (4, 5).

Acknowledgements
The authors thank all the MHS and the NRBM for their contributions and collaboration on the intensified meningococcal surveillance.

References:
  1. Esveld, M. Advice on universal vaccination of infants against both group C meningococci and pneumococci in the Netherlands. Eurosurveillance Weekly 2002; 6: 020503. (http://www.eurosurveillance.org/ew/2002/020503.asp)
  2. Neppelenbroek S, de Greeff S, de Vries M. National meningococcal C vaccination campaign in the Netherlands: process evaluation. Eur J Public Health 2002; 146: 1562-3.
  3. De Greeff S.C, de Melker H.E., Spanjaard L, van den Hof S, Dankert J. Eerste effect van landelijke vaccinatiecampagne tegen meningokokken-C-ziekte: snelle en sterke afname van het aantal patiënten [in Dutch]. (First impact of national vaccination campaign against meningococcal C disease: rapid and large decrease in the number of cases). Ned Tijdschr Geneesk 2003; 147: 1132-6
  4. Van Alphen L, Berbers G. Microbiologie van meningokokken en vaccins tegen meningokokkenziekten voor het Rijksvaccinatieprogramma [in Dutch]. (Microbiology of meningococci and vaccines against meningococcal disease for the national immunisation programme). Infectieziekten Bulletin 2001; 12: 257-63
  5. Houweling H. Advice on universal vaccination of infants against both group C meningococci and pneumococci in the Netherlands. Eurosurveillance Weekly 2002; 6 (5): 020131 (http://www.eurosurveillance.org/ew/2002/020131.asp)

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