Eurosurveillance - Volume 13, Issue 10, 06 March 2008

Invasive meningococcal disease (IMD) is a severe illness primarily affecting children and young adults. It has a high case fatality rate (10%-14%) and 11%-19% of patients who recover experience permanent hearing loss, mental retardation, loss of limbs or other serious sequelae.

The Asian tiger mosquito, Aedes albopictus (Stegomya albopicta) originating from south-east Asia, has spread primarily by the trade of used tyres to the United States, Europe, Latin America and Africa [1]. In Italy, the mosquito species was first detected in Genoa in 1990 and has since spread to several parts of the country, including border areas with Switzerland [2]. In 2000, an active monitoring system was established in southern Switzerland. The first tiger mosquito was detected in the canton of Ticino in 2003 [3]. Monitoring was gradually intensified due to growing mosquito densities in northern Italy. As the long-distance migration of Ae. albopictus depends on passive transport, the monitoring system consisted of strategically positioned oviposition traps along main traffic axes, including parking lots within industrial complexes, border crossings and shopping centres. In 2007, this monitoring system consisted of over 70 checkpoints with a total of 300 traps. Bi-weekly control visits to all traps were conducted between April and November 2007. As soon as eggs were detected, the surrounding vegetation within a perimeter of about 100 metres was sprayed with permethrin against adult mosquitoes. Stagnant water was treated with Bacillus thuringiensis and in some cases with diflubenzuron to control the larval stages.

Individual surveillance reports on meningococcal disease in Poland from 2003-2006 were screened for information on cluster detection and chemoprophylaxis administration, and a questionnaire was distributed to the country's regional health departments in order to summarize cluster investigation. The number of primary cases of meningococcal disease reported in 2003-2006 was 635, including 292 cases of meningitis, 185 cases of septicaemia, and 158 cases of meningitis with septicaemia. Chemoprophylaxis was administered to close contacts on average in 33.2% cases, the proportion increasing from 3.9% in 2003 to 43.8% in 2006. Between 2003 and 2006, there were five household clusters reported, involving a total of 10 cases. In one cluster, only co-primary cases were identified, and in the other four clusters, secondary cases were detected. Four of the five clusters were microbiologically confirmed, and the serogroup was established in two clusters (one C, one B). Chemoprophylaxis was correctly administered to household members in one cluster, after the diagnosis of the primary case, and a further case was recorded 42 days after the onset of disease in the primary case. Vaccination of contacts was not performed during the studied period. No deaths or serious disease sequelae were observed in the course of described household clusters. .

In 2007, a European survey was conducted to compare national policies on public health management of cases of meningococcal disease and their contacts. An electronic questionnaire was sent to 27 national public health institutes; 22 countries responded (response rate 81%). The results of the survey revealed differences in definitions of close contacts and prophylactic regimens between countries. These differences can be attributed to a lack of evidence on optimal prevention and treatment strategies. The development of guidance for best practice in priority areas, based on evidence or consensus, is therefore recommended.

We strongly agree with the authors conclusion that the correct application of droplet precautions, including the use of surgical masks, should always be observed when caring for a suspected case of meningitis. When oxygen supplementation is needed, further precaution measures, such as the use of standard low flow oxygen or placement of bacterial/viral filters should be considered.

Fusco et al. raise some very interesting points regarding the spread of respiratory secretions in the form of aerosols caused by oxygen therapy. We believe this does indeed warrant further investigation, and a review of the guidelines regarding the chemoprophylaxis of staff involved in airway management.

The European Centre for Disease Prevention and Control invites applications for several positions.

The Royal College of Physicians is organising a conference on 'Global Health: Current Issues, Future Trends and Foreign Policy' on 29 April 2008 at the Royal College of Physicians, London.

A Siedler was included in the authors list of the article "Measles in south-west Germany imported from Switzerland - a preliminary outbreak description".