The epidemiology of invasive meningococcal disease and the utility of vaccination in Malta
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ORIGINAL ARTICLE
The epidemiology of invasive meningococcal disease and the utility of vaccination in Malta David Pace 1
&
Charmaine Gauci 2 & Christopher Barbara 3
Received: 16 January 2020 / Accepted: 22 April 2020 # Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Invasive meningococcal disease (IMD) is a vaccine-preventable devastating infection that mainly affects infants, children and adolescents. We describe the population epidemiology of IMD in Malta in order to assess the potential utility of a meningococcal vaccination programme. All cases of microbiologically confirmed IMD in the Maltese population from 2000 to 2017 were analysed to quantify the overall and capsular-specific disease burden. Mean overall crude and age-specific meningococcal incidence rates were calculated to identify the target age groups that would benefit from vaccination. Over the 18-year study period, 111 out of the 245 eligible notified cases were confirmed microbiologically of which 70.3% had septicaemia, 21.6% had meningitis, and 6.3% had both. The mean overall crude incidence rate was 1.49/100,000 population with an overall case fatality rate of 12.6%. Meningococcal capsular groups (Men) B followed by C were the most prevalent with W and Y appearing over the last 6 years. Infants had the highest meningococcal incidence rate of 18.9/100,000 followed by 6.1/100,000 in 1–5 year olds and 3.6/100,000 in 11–15 year old adolescents. The introduction of MenACWY and MenB vaccines on the national immunization schedule in Malta would be expected to reduce the disease burden of meningococcal disease in children and adolescents in Malta. Keywords Meningococcus . Epidemiology . Malta . Conjugate vaccination . MenB vaccination
Introduction Invasive meningococcal disease (IMD) manifests predominantly as meningitis and/or septicaemia with most affected individuals having a sudden presentation and rapid deterioration. Although rare, IMD affects all ages, and the brunt of the disease burden is highest in infants, children below 4 years of age and adolescents [1, 2]. Compared with other age groups, there is also a relatively increased incidence of IMD in the elderly who suffer the highest case fatality rates of all [1–3]. Despite advances in medical care, around 10% of individuals with IMD die, and up to 20–36% of survivors sustain
* David Pace [email protected] 1
Department of Paediatrics, Mater Dei Hospital, Tal-Qroqq, Msida MSD2090, Malta
2
Department of Public Health, Superintendence of Public Health, St Luke’s Hospital, Pietà, Malta
3
Department of Pathology, Mater Dei Hospital, Tal-Qroqq, Msida MSD2090, Malta
permanent disabilities such as sensorineural hearing loss, neurodevelopmental problems, seizures and amputations [4–7]. IMD is a worldwide disease, but the epidemiology of the meningococcal capsular groups (Men) is unpredictable and varies by geographical regions and over time. MenB still causes the majority of IMD within Europe, followed by MenC and more recently MenW [1]. In the USA, MenB, MenC and MenY
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