Meningococcal Diseases: Post Men C Vaccination Era

 B Ramly1,2

  1. Paediatric Registrar, Letterkenny University Hospital, Donegal
  2. Paediatric Registrar, University Hospital Waterford, Waterford

Sir,

After the introduction of Men C vaccination in the year 2000, the incidence of meningococcal disease caused by Neisseria meningitidis Serotype C has significantly reduced, from a crude incidence rate of 4/ 100 000 population in the year 1999 to almost none in 2015. Interesting enough the incidence of those caused by Serotype B has also reduced which is most probably due to cross protection given by Men C vaccination from a crude incidence of 14.5/100 000 population in the year 1999 to approximately 4/100 000 population in 20151.

We did a retrospective study of thirty children whom lumbar puncture was performed with the preliminary diagnosis of meningococcal disease/ meningitis excluding neonates, those with non-infectious diagnosis and failed lumbar puncture. Investigations results that were taken into account for this study were Cerebrospinal fluid(CSF) culture, CSF Polymerase Chain Reaction (PCR) analysis for meningococcal , Blood PCR analysis for meningococcal, Peripheral blood culture (Blood C&S), C-Reactive Protein (CRP) of more than 10 and Total white cell count(WCC) of >15 or <4.

From our cohort twenty-one children (70%) received the Men C vaccination and nine (30%) did not. Five children (16.6%) were proven to have meningococcal disease. Three (60%) of them had a positive result for Meningococcal Serotype B, and these children received Men C vaccination. The other two children (40%) who did not receive any Men C vaccination had Serotype W135 in the culture/PCR. None of these children had N.Menigitidis Serotype C. This supports the efficiency of the vaccine.

Out of 1820 cases <19 years of age notified nationally, 382 (21%) cases attended a study hospital; the presence of Men C serotype was only 3%2.

The main aim is to ensure the uptake of Men C vaccination remains high to ensure the protective effect of it.

Corresponding Author
Dr Bazlin Ramly,
Paediatric Registrar,
Paediatric Department,
University Hospital Waterford.
Tel: +35351842359
Email: mrcpch2016@gmail.com


References

1) Health Protection Surveillance Centre (2012). Guidelines for the early clinical and public health management of bacterial meningitis (including meningococcal disease) www.hpsc.ie/hpsc/AboutHPSC/ScientificCommittees/Publications/File,12977,en.pdf
2) Cilian Ó MaoldomhnaighRichard J Drew,Patrick Gavin, Mary Cafferkey, Karina M Butler, Invasive meningococcal disease in children in Ireland, 2001–2011. Arch Dis Child doi:10.1136/archdischild-2015-310215

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