 |
|
||||||
What we know
|
|
|||||
| What we know | ||||||
| Many infectious agents can cause acute meningitis either viral or bacterial. Viral meningitis is usually a mild illness. The most common cause is an enterovirus infection due to either coxsackie or echovirus. Bacterial meningitis is a medical emergency and can be caused by a variety of bacteria including Streptococcus pneumoniae, Haemophilus influenzae type B (Hib) and most commonly Nesseria meningitis which can also present as septicaemia with or without meningitis. |
||||||
| What information do we have about the Eastern Board area? | ||||||
| Bacterial meningitis particularly Meningococcal disease continues to be a major public health concern. The absence of a vaccine for all serogroups, the sudden onset and potential severity of the disease causes significant public anxiety. Most cases occur sporadically, however clusters are documented from time to time. The disease has a seasonal trend and the majority of cases are notified during the winter months. The age group most commonly affected are children, particularly the under fives. Within the EHSSB
area, cases of viral meningitis are under notified, and it is usually
only those cases admitted to hospital that are reported. In recent
years the numbers of notified cases have fluctuated. In 2003 a total
of four cases of viral meningitis were formally notified. |
||||||
| What is the result of this on our health locally? | ||||||
| The epidemiology of bacterial meningitis in the EHSSB as indeed elsewhere in the UK has changed significantly with the introduction of both the Hib and Men C vaccines. Hib meningitis was in the past an important cause of morbidity and mortality, especially in the very young. Following the introduction of the HIB vaccine in 1992 there was a significant reduction in the incidence of Hib infection and in the four-year period between 1995-1998 there were no reported cases of Hib infection in the EHSSB or elsewere in Northern Ireland. However in 2002 there was a marked increase in the number of cases, with a total of eighteen cases in Northern Ireland and eight of those cases were EHSSB residents This trend was also mirrored in other parts of the UK. National and local surveillance identified the problem and action was taken. The increase was believed to have been due a combination of factors including accelerated scheduling and the efficacy of a vaccine with a tendence to mix ineffectively. Response to this was rapid and in 2003 the decision was taken nationally to offer an extra dose of Hib vaccine to all children aged between 6 months and four years. Vaccine uptake and disease incidence continue to be closely monitored. In 1999 the Meningococcal Group C conjugate vaccine was incorporated into the routine childhood immunisation schedule. This was associated with a fall in the number of reported cases of confirmed Group C disease and a reduction in the number of deaths due to this serogroup. However there is as yet no vaccine available
to protect against serogroup B that is now responsible for the largest
number of cases of meningococcal disease in the EHSSB
(see graph). |
||||||
| Policies | ||||||
|
In 2002 new guidance was issued on the public health management of Meningococcal Disease in the UK . This guidance was issued to all relevant public health staff within the EHSSB and recommendations endorsed. Further guidance was issued "Preventing meningococcal disease in health care workers'. This was also endorsed by the EHSSB and circulated to all relevant health care staff. |
||||||
| What is happening in the Eastern Board area? | ||||||
| In 1999 the EHSSB, along with the other Health Boards, were asked to contribute to Regional and UK Enhanced Surveillance for Meningococcal disease. All notified cases of meningococcal disease are reported weekly to the Health Protection Agency were they are validated and collated. While much progress has been made with the reduction of Men C cases, it has not been eliminated and meningococcal Group B remains a major public health concern. Within the EHSSB education of both the public and health professionals is given a high priority. When a case of meningococcal disease occurs in a child attending school, the school is contacted and visited. This is followed up with a letter from the Consultant in Communicable Disease Control and information leaflet to all parents of children attending the school. Household members and close contacts of all cases notified are contacted and given information about the disease and at the same time offered chemoprophylaxis in an effort to prevent further spread of the organism. Streptococcus pneumoniae ('pneumoccoccus') is the commonest cause of community-acquired pneumonaie and a common cause of meningitis. Within the EHSSB the incidence of pneumococcal meningitis varies from year to year (see graph). Although the incidence of pneumococcal meningitis is highest in young children, its relative importance is greater in the middle-aged and elderly population. Within the EHSSB, General Practioners are encouraged to offer pneumococcal vaccine to all patients over the age of 65 years and to those individuals identified who are within the under 65 "At Risk" group as identified by national guidance.
|
||||||
|
For further information on this topic please contact us at publichealth@ehssb.n-i.nhs.uk Eastern Health and Social Services Board Champion
House, 12-22 Linenhall Street, Belfast BT2 8BS Telephone: (028)
9032 1313 Fax: (028) 9055 3681 Text Phone:(028) 9032 4980 Website:
www.ehssb.org
E-mail: pr@ehssb.n-i.nhs.uk |
||||||
