Meningococcal disease in South African goldmines--epidemiology and strategies for control.
OBJECTIVE
To describe the epidemiology of meningococcal disease in South African goldmines and to suggest strategies for the prevention and control of further outbreaks.


METHODS
We prospectively investigated a meningococcal outbreak that occurred in 1996 and describe the control measures that were implemented. In addition, we conducted a retrospective analysis of routinely collected data on meningococcal disease in these mines from 1972 to 1996.


METHODS
Four goldmines in Gauteng, employing 30,000 workers who live in hostels.


METHODS
All cases of meningococcal disease at the mine hospital.


RESULTS
Between 1972 and 1976, 588 cases were diagnosed, with peaks in 1972 (203 cases, 727/100,000) and 1975 (147 cases, 564/100,000). Since 1978 less than 5 cases have been reported in most years, but smaller outbreaks occurred in 1990 (30 cases, 89/100,000) and 1996 (14 cases, 50/100,000). The 1996 outbreak (group A, clone I-1) was part of a larger outbreak in Gauteng that originated in Mozambique and began in one mine in July 1996, after which a mass vaccination campaign was implemented. This was followed by a smaller outbreak among non-vaccinated workers at an adjacent mine. Five patients were new recruits.


CONCLUSIONS
Despite a dramatic reduction in meningococcal disease over the last 25 years due mainly to changes in the work force, there are still outbreaks in this community. Those most at risk are young men who are new to the industry. Suggestions for prevention include effective surveillance, routine vaccination of new recruits and a rapid response to outbreaks, with mass vaccination and provision of chemoprophylaxis to close contacts.
Sonnenberg
P
P
Department of Community Health, University of the Witwatersrand.
Silber
E
E
Ho
K C
KC
Koornhof
H J
HJ
D000293:Adolescent; D000328:Adult; D018890:Chemoprevention; D004196:Disease Outbreaks; D006046:Gold; D006801:Humans; D008297:Male; D008589:Meningococcal Infections / Q000453:epidemiology* / Q000517:prevention & control; D008906:Mining; D011446:Prospective Studies; D012189:Retrospective Studies; D013019:South Africa / Q000453:epidemiology; D014611:Vaccination
D006046:Gold