The incidence of meningococcal disease, comprising meningitis and septicaemia, in the Republic is almost five times the European average and is continuing to rise, an all-Ireland health conference was told yesterday.
Dr Darina O'Flanagan, director of the National Disease Surveillance Unit, said between 1991 and 1998 there were 7.61 laboratory confirmed cases of the disease per 100,000 people in the Republic compared to a rate of 2.86 in the North and a European standardised rate of 1.58.
Moreover, the latest figures from the Department of Health show there were 401 cases of bacterial meningitis in the first eight months of this year, an increase of 8 per cent on the same period last year, and more than three times the total number of cases in 1990.
Most alarming, said Dr O'Flanagan, was a shift in the profile of the disease from the preventable group C strain to group B, for which a vaccine has yet to be developed. In the first six months of this year, group B accounted for 70 per cent of cases in the Republic, compared to 57 per cent in 1995.
Dr O'Flanagan was speaking at the Meningitis Research Foundation conference, "Management of Meningococcal Disease into the Millennium", at Dublin Castle.
She said there were a number of reasons the disease was found to be "hyper-endemic" in the Republic. First, the dominant strains of the disease were currently in the early stages of their cycle and thus levels of immunity in the population were low.
Second, improved detection methods and data have impacted on statistics. In particular, new tests by the Meningococcal Reference Laboratory in the Children's Hospital, Temple Street, Dublin, have led to greater certainty about health board figures. Some 85 per cent of notified cases were laboratory-confirmed in the first six months of this year compared to 55 per cent in 1996.
Third, said Ms O'Flanagan, an increase in population mixing, with emigration and more people taking foreign holidays, could contribute to an increase in the spread of infectious diseases. She said this factor was particularly relevant for peripheral, island countries, noting that Iceland, Malta, the Faroe Islands and New Zealand were among the other countries which had recently experienced a surge in meningococcal disease.
While the incidence of the disease had increased here, she said, the mortality rate had not and there were indications it was beginning to fall from an average of 20-25 deaths per year.
However, she stressed there were other groups which needed to be targeted, such as students. "They tend not to seek medical attention but rather think they can sleep a fever off".
Opening the conference, the Minister for Health, Mr Cowen, said the newly-developed conjugate vaccine to protect against group C meningococcal disease should be available here early next year. Planning was under way for the incorporation of the vaccine into the Primary Childhood Immunisation Programme and for it to be given to older children and young people in a "catch-up" programme "eventually involving the vaccine being administered to about a third of the population".
However, he noted it could only be introduced when the statutory licensing authority, the Irish Medicines Board, had granted the necessary authorisation.
Dr O'Flanagan said trials on a group B vaccine were at an early stage and it would be at least five years before one was developed. "In the meantime, we are very much dependent on the alertness and vigilance of parents and the public at large."
Last year group C accounted for 124 cases of meningococcal disease here, a decrease of 14 cases on 1997. In comparison, group B accounted for 223 cases last year, an increase of 41 on 1997.
Both strains can develop either as meningitis, the inflammation of tissues which cover the brain and spinal cord, or septicaemia, a type of blood poisoning whereby bacteria damage blood vessels, causing blood to leak under the skin.
