Philippe De Wals

Complications and Sequelae of Meningococcal Disease in Quebec, Canada, 1990–1994

To study complications and sequelae of serogroup B and C meningococcal disease, a retrospective survey examined the outcome of all culture-proven cases reported in the province of Quebec, Canada, from January 1990 through December 1994 (serogroup B, 167 cases; serogroup C, 304 cases). Data were collected from medical files, postal questionnaires, and telephone interviews. Age groups having the most cases were the 10-19-year age group for serogroup C and the < 1-year age group for serogroup B. Fatality rates were 7% for serogroup B and 14% for serogroup C disease. Only 3% of survivors of serogroup B disease had physical sequelae, compared with 15% of survivors of serogroup C disease (skin scars, 12%; amputations, 5%; hearing loss, 2%; renal problems, 1%; and other sequelae, 4%). These results confirm the gravity of disease caused by serogroup C, serotype 2a Neisseria meningitidis and justify liberal use of vaccination for outbreak control.

In the heart of darkness: sleeping sickness in Zaire

n Human African trypanosomiasis (HAT) control programs existed during the colonial era in the Belgian Congo. HAT cases peaked in 1930 at 33,562. They declined gradually to about 1000 cases in 1959. The civil war that erupted after Zaires independence in 1960 crippled the public health system. During 1960-1967, no active case finding was conducted and notification of HAT cases fell greatly. Mismanagement and corruption maintained a severe social and economic crisis after the civil war. At the end of the 1980s, the number of new HAT cases began to increase from the relatively stable numbers of 4000-6000 during 1969-1981 to almost 10,000. Socioeconomic conditions deteriorated quickly in the 1990s. The withdrawal of foreign aid in 1991 devastated many governmental health facilities that had been dependent on these funds. In much of Zaire, Catholic and Protestant missions were the only health care providers. The breakdown of the health system contributed to epidemics of Ebola fever, dysentery, the plague, and cholera. The specialized mobile teams providing trypanocidal drugs to HAT patients could no longer operate, resulting in drug shortages and thousands of deaths. The teams were somewhat remobilized during 1993-1994, when some foreign aid was again available. A return to neglected areas in 1994 found the HAT prevalence to be 15.4/1000 in the Equator region. In Kimbanzi, Bandundu region, it was 718/1000 among 241 persons examined. Had the teams not arrived when they did, the entire village of Kimbanzi could have disappeared within 1-2 years. The high prevalence rates in neglected areas were the highest rates recorded this century. The neglect brought about an increase in the number of infectious people, an increase in transmission, and a higher cost and toxicity of treatment due to an increase in late-stage HAT cases. The estimated true total incidence of HAT in Zaire in 1994 was about 34,400 new cases. The number of HAT deaths in 1994 was probably at least 80 times higher than that of Ebola deaths in 1995. Proper HAT control methods need to be fully funded and implemented to control this curable disease.n

A Prospective Evaluation of the Charlson Comorbidity Index for Use in Long-Term Care Patients

Longitudinal cohort study.

Complications of Meningococcal Disease in College Students

A retrospective study was conducted to provide a description of the risk, complications, fatality, and sequelae associated with invasive meningococcal disease in college students admitted in the Allegheny county (Pennsylvania) hospital system from January 1990 to May 1999.

Vaccinating first-year college students living in dormitories for Meningococcal disease: an economic analysis.

BACKGROUNDnSurveillance of meningococcal disease among U.S. college students found an elevated rate of this disease among first-year students living in dormitories.nnnOBJECTIVEnThis study examines the economics of routinely vaccinating a cohort of 591,587 incoming first-year students who will live in dormitories for > or =1 years.nnnMETHODSnA cost-benefit model (societal perspective) was constructed to measure the net present value (NPV) of various vaccination scenarios, as well as the cost/case and cost/death averted. Input values included hospitalization costs from

Epidemiological evidence for immunity following Trypanosoma brucei gambiense sleeping sickness

10,924 to

Economic analysis of the 1992-1993 mass immunization campaign against serogroup C meningococcal disease in Quebec.

24,030 per hospitalization; immunization costs (vaccine plus administration costs) from

Relationship between Regulatory Status, Quality of Care, and Three-Year Mortality in Canadian Residential Care Facilities: A Longitudinal Study

54 to

Burden of Chickenpox on Families: A Study in Quebec

88 per vaccine; 30 nonfatal, vaccine-preventable cases over a 4-year period (includes 3 with sequelae); 3 premature deaths; value of human life from

Influenza and Pneumococcal Vaccination in Long Term Care Facilities in Two Regions of Quebec

1.2 million to