The incidence of meningococcal illness in the East Anglian Regional Health Authority: 1990-1991.

The rate at which notifications of meningococcal meningitis were reported by districts of the East Anglian Regional Health Authority to the Office of Population Censuses and Surveys (OPCS) varied between 6.8 and 28.0 cases per million resident population per year between 1987 and 1991. A study was conducted to find out whether this variation represented differences in incidence, completeness of notification, or reporting practices. One hundred and one cases of meningococcal illness with onset between 1 January 1990 and 31 December 1991 were identified retrospectively in residents of the East Anglian region (population 2.06 million). The ascertained incidence of meningococcal illness was 24.5 cases/million/year with a range between districts of 13.1 to 35.7 cases/million/year, similar to that expected from national data. Most of the variation in the rates of reporting to OPCS was explained by the practices of two consultants in communicable disease control (CCDCs), who reported all cases of which they were aware, irrespective of statutory notification. The study showed that communication to CCDCs was sometimes inadequate, and that control measures were not instituted in a small proportion of cases. The recommendations resulting from this study are, firstly, that OPCS should produce clear guidelines for notification and reporting. In the meantime proper officers should make their reporting practice explicit. Secondly, a sensitive case definition for meningococcal illness is needed for local monitoring of prophylactic coverage. Thirdly, CCDCs, microbiologists, clinicians, and environmental health officers should review arrangements for data exchange.