title: Public health management of invasive meningococcal disease in Baden-Wuerttemberg, Germany, 2012: adherence to guidance and estimation of resources required as determined in a survey of local health authorities.
abstract: BACKGROUND
  Invasive meningococcal disease (IMD) incidence in Germany is low, but management of contacts to prevent subsequent cases still requires resources. Local public health authorities (LHA) advise antibiotic post-exposure prophylaxis (PEP) and vaccination to close contacts as defined in national guidance. We aimed to audit implementation of recommendations for IMD public health management in the state of Baden-Wuerttemberg, Germany, and to estimate associated costs.
  
  
  METHODS
  We surveyed all 38 LHAs in Baden-Wuerttemberg to evaluate knowledge of national guidance and implementation of IMD contact management using standardized questionnaires. For IMD cases notified in 2012, we requested numbers of household and other contacts ascertained, including advice given regarding PEP and post-exposure vaccination, plus staff time required for their management. We estimated costs for advised antibiotics, LHA staff time and visits to emergency departments according to published sources. The cost of preventing a subsequent case was estimated based on the number of household contacts that received PEP per IMD case and on the previous finding that ~284 household contacts must receive PEP to prevent one subsequent IMD case.
  
  
  RESULTS
  Although LHAs were familiar with national recommendations, they did not advise PEP to 4% of household contacts, while 72% and 100% of school and health provider contacts, respectively, were advised PEP. Only 25% of household contacts of a case with a vaccine-preventable serogroup were advised post-exposure vaccination. A mean of 11.0 contacts/IMD case (range 0-51), of which 3.6 were household contacts, were recommended PEP. Per IMD case, mean costs for LHA staff were estimated at €440.86, for antibiotics at €219.14 and for emergency department visits to obtain PEP at €161.70 - a total of €821.17/IMD case. Preventing a subsequent IMD case would cost ~ €65,000.
  
  
  CONCLUSIONS
  Our results provide insight into costs of IMD public health management in Germany. We identified marked underuse of post-exposure vaccination in household contacts and overuse of PEP in school and health care contacts. In view of an estimated 3-6 quality-adjusted life years lost per case of IMD, our estimated cost of €65,000 for preventing a subsequent case seems justifiable.
authors.affiliation: Baden-Wuerttemberg State Health Office, Stuttgart, Germany. murajda@gmail.com.|European Programme for Intervention Epidemiology Training (EPIET), ECDC, Stockholm, Sweden. murajda@gmail.com.
authors.forename: Lukas
authors.initials: L
authors.lastname: Murajda
authors.affiliation: Baden-Wuerttemberg State Health Office, Stuttgart, Germany. Elisabeth.Aichinger@rps.bwl.de.
authors.forename: Elisabeth
authors.initials: E
authors.lastname: Aichinger
authors.affiliation: Baden-Wuerttemberg State Health Office, Stuttgart, Germany. Guenter.Pfaff@rps.bwl.de.
authors.forename: Guenter
authors.initials: G
authors.lastname: Pfaff
authors.affiliation: Robert Koch Institute, Berlin, Germany. hellenbrandw@rki.de.
authors.forename: Wiebke
authors.initials: W
authors.lastname: Hellenbrand
mesh_terms: D000368:Aged; D000900:Anti-Bacterial Agents / Q000191:economics / Q000627:therapeutic use; D003365:Costs and Cost Analysis; D003430:Cross-Sectional Studies; D005858:Germany / Q000453:epidemiology; D019983:Guideline Adherence / Q000191:economics* / Q000706:statistics & numerical data*; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D015994:Incidence; D008297:Male; D008589:Meningococcal Infections / Q000191:economics* / Q000453:epidemiology / Q000628:therapy*; D022401:Meningococcal Vaccines / Q000008:administration & dosage / Q000191:economics; D056990:Post-Exposure Prophylaxis / Q000191:economics / Q000379:methods; D017410:Practice Guidelines as Topic; D011635:Public Health Administration / Q000191:economics*; D019057:Quality-Adjusted Life Years; D012044:Regression Analysis
chemical_list: D000900:Anti-Bacterial Agents; D022401:Meningococcal Vaccines