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首页> 外文期刊>BMC Public Health >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
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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

机译：德国巴登-符腾堡州，侵袭性脑膜炎球菌疾病的公共卫生管理，2012年：遵守对地方卫生当局的调查所确定的指导和所需资源的估算

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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.
机译：背景技术德国的侵袭性脑膜炎球菌病（IMD）发病率较低，但是为预防随后的病例而进行的接触管理仍需要资源。地方公共卫生当局（LHA）建议根据国家指南中的规定，对抗生素的暴露后预防（PEP）和疫苗接种进行密切接触。我们旨在审核德国巴登-符腾堡州IMD公共卫生管理建议的实施情况，并估算相关费用。方法我们对巴登-符腾堡州的所有38个LHA进行了调查，以使用标准化调查表评估有关国家指导和IMD联系人管理实施的知识。对于2012年通知的IMD病例，我们要求确定家庭和其他联系人的数量，包括有关PEP和暴露后疫苗接种的建议，以及管理人员所需的时间。根据公开的资料，我们估计了建议的抗生素，LHA工作人员的时间以及去急诊室的费用。预防后续病例的成本是根据每个IMD病例接受PEP的家庭联系人的数量以及先前的发现（约284个家庭联系人必须接受PEP才能预防随后的IMD病例）估算的。结果尽管LHA熟悉国家的建议，但他们并未建议对4％的家庭接触者进行PEP建议，而分别为72％和100％的学校和卫生服务提供者接触被建议为PEP。建议只有25％的可预防疫苗血清组病例的家庭接触者在接触后接种疫苗。建议PEP平均11.0个接触者/ IMD病例（范围0-51），其中3.6个是家庭接触者。对于每个IMD案例，LHA工作人员的平均成本估计为440.86欧元，抗生素的平均成本为219.14欧元，急诊就诊以获得PEP的平均成本为161.70欧元-每个IMD案例总计821.17欧元。防止随后发生的IMD案件的费用约为65,000欧元。结论我们的结果提供了对德国IMD公共卫生管理成本的见解。我们发现在家庭接触者中暴露后疫苗的使用明显不足，在学校和卫生保健接触者中过度使用了PEP。鉴于每例IMD估计会损失3–6个质量调整生命年，因此我们为预防随后的病例而估计花费的65,000欧元似乎是合理的。

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