September 21, 2001

Meningitis Vaccination: Quebec
The minister of State at Santé et Services sociaux kicked off the meningitis vaccination campaign at the Rosemont CLSC. Along with the president of the Association des CLSC-CHSLD du Québec, the assistant deputy minister of public health and the chair of the immunization committee, the minister announced that this campaign would start on September 24 and continue on an intensive basis until the end of December. The campaign will be conducted with the cooperation of CLSCs, public health branches of every region and the Institut national de santé publique du Québec. By the end of 2001, approximately 1.7 million youth between the ages of 2 months and 20 years will be vaccinated for type C meningitis. The new conjugate vaccine (licensed just over a few months ago) will be used; it is more effective than the vaccine that has been available thus far. The minister said that the last major meningitis vaccination campaign dates back to 1992-1993. It proved to be very effective since the number of reported cases plummeted in the years that followed. However, the old vaccine offered protection for just 5 years. According to medical experts, the new vaccine will be effective for a much longer period, namely 15 years. Primary or secondary school students- even college-level students-will be vaccinated at their school. Secondary school students, who are the most vulnerable, will be the first to be vaccinated, followed by those at the CÉGEP and primary levels. As for pre-school children and young adults, the conditions and schedule for their vaccination will be determined according to region. CLSCs will head the school vaccination campaign in their own areas. In several regions, private clinic physicians will help vaccinate very young children and young adults who are not in school. An information campaign will be launched over the next several days to raise the population's awareness of the importance of vaccination and give it a general overview of the operation.
Source: Press release, Government of Quebec, September 14, 2001.

Syphilis: France
The incidence of syphilis is increasing in France in the context of a general resurgence in sexually transmitted infections (STIs), including gonorrhoea. After several years in which syphilis was considered a rare disease, a study coordinated by the Institut de Veille Sanitaire (InVS) has shown a worrying reversal in this trend. In November 2000, the STI centre at the Tarnier hospital in Paris alerted the InVS about the unusually high number of cases of syphilis diagnosed during the preceding 6 weeks. A study was undertaken to describe these and other cases in detail and to determine the extent of the increase in syphilis in France. Between January 1 and May 31, 2001, 78 syphilis cases (of which 77 were men) were notified to the InVS by clinicians (32 of these cases had been diagnosed in 2000 and 46 cases in the first 5 months of 2001). Sixty-eight (87%) of the reported cases were diagnosed in Paris. The median age of the cases was 36.4 years. Fifty-eight (75%) of the male cases were homosexual. Overall, 21 cases (27%) had no previous history of STIs, and 41 (53%) were coinfected with HIV. Seven patients discovered their HIV infection status during the episode when syphilis was diagnosed. Secondary syphilis was diagnosed in 49 cases (63%). A similar resurgence of syphilis has been observed in other European countries, such as Belgium, Ireland, the Netherlands, and the United Kingdom. This outbreak of syphilis in France is consistent with the increase in other STIs and in risky sexual behaviour, especially among homosexual men. A national network for syphilis surveillance has been established in France as part of the response to the situation.
Source: Eurosurveillance Weekly, Issue 37, September 13, 2001.

Aseptic Viral Meningitis: Germany
Between August 11-17, 2001, the health office of Kassel, a city in the German state of Hesse, received notifications from two hospitals in northern Hesse of an increased number of cases of aseptic meningitis. Fifteen children and 10 adults had been admitted with symptoms including severe headache, fever, neck stiffness, and vomiting. All were discharged after two to four days. The health office of Kassel initiated an outbreak investigation to identify the causative agent, describe the extent and severity of the outbreak, and identify and exclude potential risk factors. Active case finding among resident general practitioners and in hospitals in the city resulted in the identification of 68 patients with aseptic viral meningitis from the Kassel and neighbouring districts. Cerebrospinal fluid (CSF) from all 68 patients was analysed for suspected bacterial meningitis. This diagnosis was ruled out because of an absence of bacterial strains and an only moderately raised cell count of lymphocytes in the CSF. The first notified patient had been admitted on July 15. On July 31, more than two patients with aseptic meningitis were admitted in one day for the first time. The number of admissions peaked between August 4 and August 19, 2001. The youngest patient was aged 3 years, the oldest 50. Sixty per cent (41/68) of patients were aged between 5 and 14 years. Forty patients (59%) were male. Twenty-seven (40%) were from Kassel county district, 22 (32%) from Kassel city, and 11 (16%) from the neighbouring Schwalm-Eder district. Two to three patients each lived in several adjacent districts. A case-control study is currently being conducted to identify potential risk factors. Seven CSF specimens from two hospitals were analysed at the National Reference Centre for Polio and Enteroviruses, where polymerase chain reaction for enteroviruses was positive for six specimens. Echovirus 30 was cultured from four samples. The outbreak continues.
Source: Eurosurveillance Weekly, Issue 37, September 13, 2001

The details given are for information only and may be very provisional. Where incidents are considered of national importance and are ongoing, the initial report will be updated as new information becomes available.

[Infectious Diseases News Brief]