Academic journal article Journal of Health Population and Nutrition

Estimating Costs Associated with a Community Outbreak of Meningococcal Disease in a Colombian Caribbean City

Academic journal article Journal of Health Population and Nutrition

Estimating Costs Associated with a Community Outbreak of Meningococcal Disease in a Colombian Caribbean City

Article excerpt

INTRODUCTION

Invasive meningococcal disease is a potentially life-threatening infection (1). About 500,000 cases of the disease occur worldwide each year (2), of which approximately 800-1,500 cases occur annually in the United States, resulting in a rate of 0.3-0.5/100,000 population (3,4). In developing countries, meningococcal disease causes 330,000 cases annually and results in 35,000 annual deaths. The estimated total numbers of deaths reported range from 350,000 to 600,000 annually, especially in infants below one year of age (5,6).

Meningococcal disease can result in outbreaks and epidemics (2). N. meningitidis can be classified into 13 serogroups based on their capsular polysaccharides. Serogroup B causes over 50% of cases in infants (<1 year of age) while serogroups C, Y, and W135 combined cause 75% of meningococcal disease in children aged 11 years and older (7). Vaccines for serogroup A, C, Y, and W135 are available but nowadays no vaccine is available for serogroup B.

We describe the outbreak of meningococcal disease in a Colombian Caribbean city with 1 month of active surveillance follow-up. In this outbreak, a total of 6 cases were detected, of which 3 resulted in deaths. While infants are most commonly affected by meningococcal disease, adolescents have the highest rates of mortality (1,2). Invasive meningococcal disease is caused by Neisseria meningitidis (NM). Serogroups B and C are the main causes of meningococcal disease in the Americas and in Europe. The meningococcus can be transmitted from human to human through direct contact with droplet of respiratory secretions (8). N. meningitidis causes a number of clinical conditions, including meningitis and bacteraemia (or meningococcaemia), which are the most severe manifestation of meningococcal infection; and much less common localized infection, such as pneumonia, pericarditis, endocarditis, supraglottitis, conjunctivitis, urethritis, and otitis media (3,9-15). The disease is fatal in 9-12% of cases, with a death rate of up to 40% in patients with meningococcaemia (16,17).

The costs associated with management of cases and outbreaks of meningococcal disease in Latin America and the Caribbean region are underreported and underestimated in the literature. The studies that estimate the costs of meningococcal disease are limited and provide information from Europe and other parts of the world (18).

We estimated the costs associated with an outbreak of serogroup B meningococcal disease in Colombia.

MATERIALS AND METHODS

We describe an outbreak of serogroup B meningococcal disease (six cases) in the city of Cartagena de Indias in Colombia. Cartagena de Indias, located on the shores of the Caribbean Sea, is one of the most important tourist destinations in Latin America, with a population of nearly one million inhabitants.

The outbreak occurred from 21 February through 17 March 2012 and involved 6 children who lived in a low-income neighbourhood in the southeast of the city. The outbreak was investigated by the Napoleon Franco Pareja Children's Hospital (CH) and the District Health Department (DADIS, Spanish acronym for Departamento Administrativo Distrital de Salud). The CH is a tertiary academic hospital and is the largest paediatric hospital in the Colombian Caribbean region whereas the DADIS is a governmental agency that regulates and monitors disease outbreaks.

The costs were split in two phases: the disease response phase that includes costs associated with management of the disease and the disease surveillance phase cost that corresponds to monitoring of disease cases.

Characteristics of patients

Twenty close contacts were found, and they were admitted to hospital (CH) for medical check-up. Close contacts were defined as patients who have meningococcal disease and may include: (i) household members (including dormitory room, barracks); (ii) childcare centre contacts, and (iii) persons directly exposed to the patient's oral secretions (e. …

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