Quebec's $100-million campaign targets meningococcal disease

Susan Pinker

Quebec has launched a mass vaccination program against meningococcal disease that will cost at least $100 million. Under the campaign, 1.7 million Quebecers aged 2 months to 20 years are being offered a new vaccine that provides longer protection against group C meningococcal infection.

The vaccination program is one of the most expensive in Canadian medical history; Ontario's universal influenza vaccination program will cost $44 million this year.

Quebec has had 2 meningococcal disease scares in the past 10 years. In 1992/93, 181 youngsters were infected, 25 died and 27 were left with permanent disabilities. An outbreak in Quebec City during the winter of 2001 resulted in 44 confirmed cases of group C meningococcal disease and 8 deaths. “Looking at what happened in the Quebec City region, which had a significant outbreak this [past] winter, there was a feeling that we were entering a time of increased incidence,” says Dr. John Carsley, head of the Infectious Disease Unit of the Montreal Regional Public Health Department. The department is responsible for immunizing 420 000 Montrealers before the end of December.

“The epidemiology of group C disease has a very regional behaviour,” he said, adding that a virulent new strain has been identified and is being targeted during the current campaign.

A recently developed vaccine (Menjugate) was licensed by Health Canada in June after having been fast-tracked through the approval process at the urging of Quebec and British Columbia. It is not yet licensed in the US. Merck Frosst, the producer, is selling it to Quebec for $50 a dose, said Carsley, whose office is providing the vaccine free to the province's community clinics and doctors' offices. Alberta, BC, London, Ont., and Winnipeg have launched regionalized vaccination campaigns.

Dr. Philippe De Wals, a professor of medicine at University of Sherbrooke and head of Quebec's immunization committee, said epidemiologists and policy officials tried to estimate the impact of meningococcal disease with and without a vaccination program. “We had a very bad experience in '92/'93 and what we saw last winter was a repetition of that era. The opinion of the experts was that we were in the ascending phase of another epidemic.”

De Wals says no one knows exactly how much this campaign will cost, but public opinion is strongly behind it. “It's unacceptable today to see healthy children and adolescents dying of a completely preventable disease,” he said. The advantages of mass vaccination with the new vaccine include a high level of protection for children as young as 2 months of age and greater long-term efficacy. Although there are no data yet on the new vaccine's duration of immunogenicity, De Wals says it exceeds the 5-year limit of the vaccine used in 1992/93 and may extend for as long as 15 years.

The new campaign targets high school and college-age students as well as younger children. In Quebec, anyone 14 years or over has the right to withhold consent for medical procedures such as vaccinations; in elementary schools, a parent's consent is required.

But nurses have noted little opposition to this campaign. “This is one of the few areas where there was consensus about a decision,” says De Wals, citing agreement between public health officials, citizens' groups and health care practitioners.

“The social consensus is that it's a frightening, unpredictable disease. No one knows who will be the next target. All the groups in society were in favour of doing something.”

More information about the campaign is available from the Quebec Ministry of Health and Social Services Web site, www.msss.gouv.qc.ca/meningite, and the Montreal Department of Public Health Web site, www.santepub-mtl.qc.ca.