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Meningococcal disease in Belgium. Secondary attack rate among household, day-care nursery and pre-elementary school contacts

During a recrudescence of meningococcal disease mainly due to serogroup B, 1913 notified cases were investigated in Belgium from 1971 to 1976. From 1971 to 1973, 76 secondary cases were reported out of a total of 1455 cases (5.2 per cent); and from 1974 to 1976, nine secondary cases were reported of a total of 458 cases (2.0 per cent). Seventy per cent of the secondary cases occurred within seven days after the Index case. The 4.7 per cent fatality rate among secondary cases was lower than the 9.8 per cent fatality rate among primary cases. The estimated secondary attack rate was 685 per 100 000 among household contacts, 404 per 100 000 among day-care nursery contacts and 77 per 100 000 among pre-elementary school contacts. These attack rates were significantly higher (P less than 0.001) than the incidence rates in the corresponding age-groups in the general community, indicating the need for prophylaxis in these contacts.

Association between lepromatous leprosy and Australia antigen.

Abstract Australia antigen is more common in patients with lepromatous leprosy than in patients with tuberculoid leprosy or in non-leprosy controls. In the combined populations, the frequency is, in general, higher in males than in females, and in younger people than in older people. Australia antigen has now been found to be associated with lepromatous leprosy, leukaemia, and hepatitis, and to cluster in families. It is suggested that individuals with Australia antigen have an inadequate immune response and are especially susceptible to various illnesses, including lepromatous leprosy.

Longitudinal study of asymptomatic meningococcal carriage in two Belgian populations of schoolchildren

In Brussels, a 15-month longitudinal survey was conducted in two primary schools, from March 1975 to May 1976, in order to analyse the dynamic of asymptomatic meningococcal carriage, during an epidemic mainly caused by serogroup B, serotype 2 Neisseria meningitidis. In the first school, which is situated in a suburban area with upper-middle socio-economic status of residents, a mean prevalence of carriers of 10 per cent, an acquisition rate of eight per 1000 months, and a mean duration of carriage of 12.4 months were observed among 158 schoolchildren aged six to 11 years old. In the second school, which is situated in a densely populated area with low socio-economic status of residents, a mean prevalence of carriers of 33 per cent, an acquisition rate of 28 per 1000 months, and a mean duration of carriage of 11.7 months were observed among 203 schoolchildren aged three to 14 years old. For both schools, the median duration of carriage was estimated at 9.4 months. The differences of prevalence and incidence of acquisition between the two schools cannot be explained by age, sex or ethnic factors and are probably related to socio familial variables. The theoretical relationship between prevalence, incidence and duration of meningococcal carriage was for the first time demonstrated in this study. The results also suggest that populations of low socio-economic status and living in densely populated areas constitute a target population for meningococcal disease prevention.

Information Systems and Needs Assessment in Natural Disasters: An Approach for Better Disaster Relief Management

The paper addresses the issue of information in disasters relief. It begins by establishing the need for planning and systematic organization in disaster action, in order to produce a long term effect on the vulnerability levels of communities. Information is introduced as a key element in any phase of disaster management. The different informational needs are described by phases; information types and possible sources are briefly described. The organizational network of information collection is presented and the immediate need for research in this field is emphasized.

Mortality in meningococcal disease in Belgium

A survey of children admitted with meningococcal disease to 53 paediatric units in Belgium between 1975 and 1979 was made in order to assess the case mortality rate (CMR) and to identify risk factors associated with death. A total of 309 cases (226 bacteriologically confirmed and 83 unconfirmed) was recorded. The overall CMR was 6.1 per cent. It was 4.4 for bacteriologically confirmed cases and 10.8 for unconfirmed cases. The CMR was higher for septicaemia without meningitis (22.2 per cent) than for meningitis with or without signs of septicaemia (3.4 per cent). The risk of death was not related to the sex or nationality of the patients. Age was a major determinant of the CMR, independently of the clinical picture. The highest risk of death was in children under one year of age. Poor socio-economic conditions were a significant risk factor. Failure to recognise the severity of the disease by some poorly educated mothers, and the admission of the patient to a hospital lacking adequate facilities for managing severely affected children, were the two significant causes of delay of adequate treatment.

Decreased survival of HTLV-I carriers in leprosy patients from the Democratic Republic of the Congo: a historical prospective study.

In this historical prospective study using sera stored for 22 years, we investigated the effect of HTLV-I infection on survival in a population of leprosy patients in the Democratic Republic of the Congo (formerly Zaire). We also determined the distribution of HTLV-I by subpopulation, age, and gender. Stored sera taken from a population of leprosy patients and controls in 1969 were tested for HTLV-I. Follow-up survival data on these patients were obtained in 1991. The sera collected in 1969 from 520 individuals was used to determine the prevalence of HTLV-I. Included in this number were 328 patients resident in the sanatorium. Survival and other data were available for 327 of these. A multivariate survival analysis using a logistic regression model was performed to evaluate the influence of HTLV-I status, age, type of leprosy, gender, duration of hospitalization, and ethnic group on survival. The overall prevalence of HTLV-I among the 520 individuals in the prevalence study was 34%, with 37.4% in the leprosy group and 25.2% in the control group (p < 0.01). Multivariate analysis using logistic regression showed that females of the Mongo and Ngombe ethnic group taken together were significantly more likely to be infected than the other groups (OR = 3.67, 95% CI: 2.14 to 6.30). A comparison of the death rates directly standardized for age and sex showed that the rate was significantly higher for HTLV-I positive (5.5/100 person-years of observation) compared with HTLV-I negative (3.6/100 person-years of observation). A survival analysis using the Cox model showed a risk ratio of 1.4 (CI: 1.04 to 1.89) for those infected with HTLV-I. An increase in the death rate was associated with HTLV-I infection in leprosy inpatients. The decreased survival associated with HTLV-I infection may result from an increased susceptibility to a variety of diseases.

Validity of the recording of meningococcal disease according to various sources of information

A study was made in Belgium in order to assess the completeness and specificity of the recording of meningococcal disease by routine sources of information. Ninety-three cases identified in a hospital survey were linked with those recorded in mortality statistics, in the notification of communicable diseases, and by the National Reference Laboratory for meningococci. Statistics based on mortality data appeared to be of low validity. The overall completeness of recording was 44% for the notification of communicable disease, and 40% for the reference laboratory. When these two sources were used for surveillance, the completeness of case-finding increased to 56%. When the analysis was restricted to bacteriologically-confirmed cases, the completeness of recording was 62% for the notification system, 70% for the laboratory, and 84% for both sources. The surveillance of communicable diseases should rely on various sources of information. Laboratory data should be systematically used in order to improve both the completeness of recording and the specificity of case-ascertainment.

Incidence of congenital rubella syndrome in 19 regions of Europe in 1980-1986.

Twenty-five cases of congenital rubella syndrome were recorded in 1,458,126 live births in 19 EUROCAT birth defects registries from 1980 to 1986. During the study period, the incidence declined steadily from 3.50 to 0.41 per 100,000 births. Rubella infection occurred in 12 multiparous women indicating failure in immunization programme.

Quality of perinatal death registration

The quality of national perinatal mortality statistics was evaluated from a survey in nine maternity hospitals in Hainaut, Belgium (total births: 7862). The overall completeness of perinatal death registration was 86%. Under-registration was especially frequent in low birth weight babies. In 69% of cases, the birth weight value reported on death certificates was in exact agreement with the value in hospital records. Using detailed categories of causes, there was, in 37% of cases, agreement between the underlying cause on death certificates and the main cause identified in hospital records. Using gross categories of causes, the level of agreement was 56%. Disagreement was mostly due to the lack of specificity of the underlying cause on death certificates. The authors suggest ways to improve the quality of registration.

The Impact of Natural Disasters: A Brief Analysis of Characteristics and Trends

Most natural disasters that occur frequently may be classified into four main categories: floods, earthquakes, cyclones and famine. Other catastrophic events, such as land slides, avalanches, snow storms, fires occur at rarer occasions and threaten smaller proportions of the populated world. The destructive agents in the above categories are wind, water (a lack or excess thereof) and tectonic force. While all of these cause structural damage, their mortality and morbidity effects are varied both between them and over time. The disaster cycle can be differentiated into five main phases, extending from one disaster to the next. The phases are: the warning phase indicating the possible occurrence of a catastrophe and the threat period during which the disaster is pending; the impact phase when the disaster strikes; the emergency phase when rescue, treatment and salvage activities commence; the rehabilitation phase when essential services are provided on a temporary basis; the reconstruction phase when a permanent return to normality is achieved. The disaster-induced mortality and morbidity differ between these phases and are also a function of the prevailing health and socioeconomic conditions of the affected community. As a result of this, global statistics on disasters seem to indicate a significantly higher frequency of natural disasters in the developing countries than in the industrialized world.