An attempt at an epidemiological explanation - Epib.nl

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CHAPTER 6SECONDARY CASES OF MENINGOCOCCAL DISEASEIN THE NETHERLANDS, 1989-1990A reappraisal of chemoprophylaxisRJPM Scholten, HA Bijlmer, J Dankert, HA ValkenburgNed Tijdschr Geneeskd; accepted for publication (in Dutch)
Chapter 6ABSTRACfObjectives: To assess the secondary attack rate (SAR) of meningococcal disease(MD) among tbe household contacts of primary patients with MD and to describe theuse of chemopropbylaxis in tbe Netherlands.Design: Descriptive, nation-wide survey.Patients and methods: Patients with MD, reported between 1st April 1989 and 30thApril 1990, and their household contacts. A bousebold contact suffering from MDbetween 24 hours and 1 month after hospital admission of the primary case, wasconsidered to be a secondary case. Chemopropbylaxis was considered appropriate ifrifampicin or rninocycline had been prescribed to all household contacts within amaximum of one day after admission of the primary patient.Results: The SAR was 0.3 %. Chemoprophylaxis was prescribed to 627 of 1130household contacts (55%). In 46% of tbose, the prophylaxis was considered appropriate.Of the 5 secondary cases, 2 were not given any prophylaxis, 2 received penicillinand 1 rifampicin. Of the primary patients, 6% was given prophylaxis during tbeir stayin the hospital. All meningococci, isolated from pairs of primary and secondarypatients, were rifampicin-sensitive.Conclusions: The SAR of MD in the Netherlands is similar to that in other countries.Although the prescription of chemoprophylaxis is not recommended by tbe government,it is prescribed to 55% of tbe bousehold contacts, and in ahoost balf of tbeseinstances it was considered to be appropriate. Chemopropbylaxis is rarely prescribedto primary patients. Recommendations concerning chemoprophylaxis in the Netherlands,compared with standards elsewhere, are inappropriate and are ill need ofreappraisal. Based on results from this study and the literature, the prescription ofchemoprophylaxis to the household contacts of a patient with MD, as well as to theprimary patient, is recommended.76
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An attempt at an epidemiological ex
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VRIJE UNIVERSITEITTHE INCREASED INC
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CONTENTSChapter 1 General introduct
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Chapter 1Meningococcal disease (MD)
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Chapter 1Antigenic variation in the
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Chapter 1by electrophoretic typing.
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Chapter 1is assumed to be the main
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CluJpter 1Study objectives and cont
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Chapter 125 Crowe BA. Wall RA. Kuse
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Chapter 170 Brandtzacg P, Kicrulf P
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Chapler 2ABSTRACfIn order to explai
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Chapter 2MATERIALS AND METHODSBacte
Page 25 and 26: Chapter 2Table 2. An nual number of
Page 27 and 28: Chapter 2the age-distribution to ol
Page 29 and 30: Chapter 2of serotype 4 strains vari
Page 31 and 32: Chapter 2Table 6. Relative distribu
Page 33 and 34: Chapter 2endemicity in the Netherla
Page 35 and 36: Chapter 2REFERENCESde Marie S. Epid
Page 37 and 38: CHAPTER 3PHENOTYPIC AND GENOTYPIC C
Page 39 and 40: Evolution of meningococcal cionesIN
Page 41 and 42: Evolution of meningococcal clonesme
Page 43 and 44: Evolution of meningococcal clonesTa
Page 45 and 46: Evolution of meningococcal clonesli
Page 47 and 48: CHAPTER 4LIPOOLIGOSACCHARIDE IMMUNO
Page 49 and 50: LOS immunotyping of N. meningitidis
Page 57 and 58: LOS immunolyping of N. meningilidis
Page 59 and 60: LOS immunolyping of N. meningilidis
Page 65 and 66: Chapter 5ABSTRACfThe aim of this pr
Page 67 and 68: Chapter 5tive lung disease, chronic
Page 69 and 70: Chapter 5distribution of the clinic
Page 71 and 72: Chapter 5The striking difference in
Page 73 and 74: Chapter 510-19 and ~50 years, in wh
Page 75: Chapter 5REFERENCES1 Andersen BM. M
Page 79 and 80: Chapter 6PATIENTS AND METHODSThis s
Page 81 and 82: Chapler 6case. In 28 household cont
Page 83 and 84: Chapter 6rifampicin witb oral contr
Page 85 and 86: CHAPTER 7GENERAL DISCUSSION ANDRECO
Page 87 and 88: General discussionexample of the ab
Page 89 and 90: General discussionPossible changes
Page 91 and 92: General discussionBrazilian study,
Page 93 and 94: General discussionIt is very diffic
Page 95 and 96: General discussionREFERENCES1 Pelto
Page 97 and 98: SUMMARY
Page 99 and 100: Summaryemergence of a meningococcal
Page 101 and 102: Summaryexplains part of the rise. T
Page 103 and 104: SamenvattingMeningokokkenziekte (me
Page 105 and 106: Samenvatting57 isolaten was bet imm
Page 107 and 108: AFFILIATIONS OF CO-AUTHORSHenk A. B
Page 109 and 110: DaJl /..:woordVele" hebben meegewer
Page 111: DanklVoordMijD ouders dank ik voor
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