Incidence and case-fatality rate of meningococcal meningitis and meningococcal septicaemia in the Gaza Strip, occupied Palestinian territory, during 2011

Abstract

Background Meningococcal disease is a life-threatening bacterial infection that presents as meningococcal septicaemia or meningococcal meningitis. Meningococcal septicaemia, despite treatment and improvement of the associated case-fatality rate (CFR), is rapidly progressive and can be fatal, whereas meningococcal meningitis usually has a good outcome and is more common than is meningococcal septicaemia (47% vs 43%). Meningococcal disease is endemic in the Gaza Strip, whereas it is sporadic in the West Bank, occupied Palestinian territory (oPt). We describe the subtypes of meningococcal disease in the Gaza Strip with respect to age, sex, serotype, and CFR during 1 calendar year (2011). Methods The five main hospitals providing paediatric services in the Gaza Strip notified the Ministry of Health about all cases of meningococcal disease on diagnosis during 2011. The hospitals used a standard pro forma to provide the ministry with the patients' personal, clinical, and laboratory data. The staff at the Ministry of Health visited these hospitals to gather data and follow up the cases of meningococcal disease by use of questionnaires and by visiting the patient's home to give prophylactic treatment and educational information to all the patient's contacts. We used SPSS (version 13.0) for statistical analysis (descriptive statistics, frequencies, cross tabulations, χ 2 , t test, one-way ANOVA, SD, and p values). Findings 151 cases (mean age of 149 cases 4·4 years [SD 3·2], and two cases aged 50 years and 59 years) of confirmed meningococcal disease were reported during 2011: 117 (77%) meningococcal septicaemia and 34 (23%) meningococcal meningitis. Diagnostic tests used were CSF culture (n=26), Gram staining of CSF (n=17), skin smear (n=101), or blood culture (n=6); a diagnostic test was not done for one case, which was diagnosed on the basis of clinical presentation, skin rash, and rapid progression to death. With a population of 1 588 691, the overall incidence was 9·50 per 100 000 population (9·35–9·65) in the Gaza Strip. 92 (61%) patients were boys. 117 (77%) cases of meningococcal septicaemia were diagnosed by use of Gram stain. Only Neisseria meningitidis serotype B (no available vaccine) was identified in 22 of 32 culture-positive cases—17 meningococcal meningitis and five meningococcal septicaemia. Children who had received antibiotics (28 [19%]) before admission and those who had not received antibiotics (123 [81%]) did not differ in terms of the culture results or CFRs. 25 (17%) children with meningococcal septicaemia died (16 boys; CFR 23%). CFR was highest in infants (six [24%]). Interpretation Despite the use of identical diagnostic criteria, the incidence of meningococcal disease was much higher in the Gaza Strip than in the West Bank, oPt (9·50 cases per 100 000 population vs 0·04 per 100 000 population, respectively). The higher population density and humidity in the Gaza Strip might contribute to the higher incidence of the disease. Most of the CSF or blood cultures from the confirmed cases in the Gaza Strip were negative, suggesting a laboratory error. The results suggest the need for reassessment of quality-control measures in the laboratories in this region and the introduction of other laboratory technologies such as latex agglutination and PCR. Funding None.