An attempt at an epidemiological explanation - Epib.nl

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Chapter 7Concluding remarksDespite the fact that numerically speaking MD constitutes a relatively minor problem- in tbe Netherlands 300-500 cases per year - the bigb case-fatality and sequelae ratesresulting from this disease continue to be a subject of considerable concern. Notwithstandingthe scientific progress that bas been made in the past era regarding ourknowledge of N. meningitidis, it still remains obscure wby tbe majority of individualswho acquire meningococci become carriers, and only a minority develop a Ijfethreateningdisease. The improvements in clinical care that have been made in thepast four decades bave not influenced the case-fatality rate of MD." The only meansto circumvent the problems caused by this serious disease is to prevent its occurrenceby vaccination. All efforts sbould be directed towards the further development of aserogroup B meningococcal vaccine and the improvement of tile existing serogroupNe vaccine. Therefore, careful monitoring of tbe various epidemiological markers ofmeningococci must continue, with the aim of eventually achieving the development ofa vaccin e which will give optimal protection against meningococcal disease.94
General discussionREFERENCES1 Peltola H. Meningococcal disease: still with us. Rev Infect Dis 1983~:71-91.2 Severin WP, Ruys AC. Bijkerk H, el al. The epidemiology of meningococcal meningitis in theNetherlands in recent years, with special reference to the epidemic of 1966. Zbl Bakt [OrigJ1%9;210:364-70.3 Evans AS, Brachman PhS, eds. Bacterial infections of humans. Epidemiology and control. NewYork: Plenum Medical Book Company, 1991.4 de Mane S. Epidemiology of meningococcal disease in the Netherlands (thesiS]. Amsterdam, theNetherlands: University of Amsterdam, 1985. 132 pp.5 Spanjaard L, Bol P, Ekker W, Zanen HC. The incidence of bacterial meningitis in the Netberland'i:a comparison of three registration systems, 1977·1982. J Infect 1985;11:259-68.6 de Marie S, Poolman JT, Hoeijmakers nu. Bol P, Spanjaard L, Zanen HC. Meningococcal diseasein "The Nethcrlands, 1959-1981: thc occurrence of serogroups and serotypes 2a and 2b of Neisseriamellillgitidis. J Infcct 1986;12:133-43.7 Abdillabi H, Poolman IT. Neisseria meningilidis group B scrosubtyping using monoclonal antibodiesin whole-ceD ELISA. Microb Pathog 1988;4:27-32.8 Caugant DA, B~vre I
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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
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Chapter 2Table 2. An nual number of
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Chapter 2the age-distribution to ol
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Chapter 2of serotype 4 strains vari
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Chapter 2Table 6. Relative distribu
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Chapter 2endemicity in the Netherla
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Chapter 2REFERENCESde Marie S. Epid
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CHAPTER 3PHENOTYPIC AND GENOTYPIC C
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Evolution of meningococcal cionesIN
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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 and 76: Chapter 5REFERENCES1 Andersen BM. M
Page 77 and 78: Chapter 6ABSTRACfObjectives: To ass
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: General discussionIt is very diffic
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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