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Volume 10, Number 9—September 2004

Research

Space-Time Cluster Analysis of Invasive Meningococcal Disease

Christian J.P.A. Hoebe*Comments to Author , Hester de Melker†, Lodewijk Spanjaard‡, Jacob Dankert‡1, and Nico Nagelkerke†
Author affiliations: *Eastern South Limburg Municipal Public Health Service, Heerlen, the Netherlands; †National Institute of Public Health and the Environment, Bilthoven, the Netherlands; ‡Netherlands Reference Laboratory for Bacterial Meningitis, Amsterdam, the Netherlands; 1Deceased 24 January 2004.

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Table 1

Overview of meningococcal disease cases and serogroup profile of cases included for analysis, 1993–2001

Characteristic 1993 1994 1995 1996 1997 1998 1999a 2000 2001b Total
Reported cases 
(per 100,000 population) 563 (3.7) 422 (2.7) 460 (3.0) 482 (3.1) 491 (3.2) 505 (3.2) 531 (3.4) 516 (3.3) 770 (4.8) 4,740 (3.4)
Case-ascertainment 
(per 100,000 population) 753 (4.9) 571 (3.7) 689 (4.5) 659 (4.3) 658 (4.2) 704 (4.5) 597 (3.7) 532 (3.4) 396 (5.9) 5,559 (4.3)
Nonconfirmed casesc 115 91 88 94 103 86 44 1 41 663
Meningococcal cases included for analysis 638 480 601 565 555 619 553 531 354 4,896
Serogroup profiled
  A 3 2 0 0 2 0 0 0 0 7
  B (%) 524
(82) 399 
(83) 527 
(88) 498 
(88) 458 
(83) 536
(87) 455
(82) 413
(78) 229
(65) 4,039 (82)
  C (%) 101
(16) 65
(12) 57
(11) 57
(11) 81
(15) 72
13) 79
(15) 103
(19) 114
(21) 729
(15)
  W135 (%) 4 (1) 5 (1) 7 (1) 3 (1) 6 (1) 4 (1) 12 (2) 12 (2) 7 (2) 60 (1)
  X 1 0 0 1 2 1 1 1 0 7
  Y 4 5 7 5 6 2 5 2 3 39
  Z 0 0 1 0 0 0 0 0 2 3
  29E 0 2 0 1 0 1 0 0 0 4
  Not serogroupable 1 2 2 0 0 2 1 0 0 8

aCase-ascertainment (number of cases after linking procedure) was hampered due to lack of identifying variables from April 1, 1999, when the new Dutch Communicable Disease Act was introduced.
bLaboratory data included from January 1993 to May 2001; during the year 2001, the surveillance was more active because of the increase in serogroup C cases.
cAfter linking the reported cases with the laboratory cases, no strain was available for these cases.
dOf 4,896 confirmed cases, 9 could not be used in the analysis because of recording errors: 2 serogroup A cases, 4 serogroup B cases, 1 serogroup C, 1 serogroup W135, and 1 serogroup Y.

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