Abstract
Meningococcal disease (MCD) is the leading infectious cause of death in early childhood in the United Kingdom, making it a public health priority. MCD most commonly presents as meningococcal meningitis (MM), septicaemia (MS), or as a combination of the two syndromes (MM/MS). We describe the changing epidemiology and clinical presentation of MCD, and explore associations with socioeconomic status and other risk factors. A hospital-based study of children admitted to a tertiary children's centre, Alder Hey Children's Foundation Trust, with MCD, was undertaken between 1977 to 2007 (n = 1157). Demographics, clinical presentations, microbiological confirmation and measures of deprivation were described. The majority of cases occurred in the 1–4 year age group and there was a dramatic fall in serogroup C cases observed with the introduction of the meningococcal C conjugate (MCC) vaccine. The proportion of MS cases increased over the study period, from 11% in the first quarter to 35% in the final quarter. Presentation with MS (compared to MM) and serogroup C disease (compared to serogroup B) were demonstrated to be independent risk factors for mortality, with odds ratios of 3.5 (95% CI 1.18 to 10.08) and 2.18 (95% CI 1.26 to 3.80) respectively. Cases admitted to Alder Hey were from a relatively more deprived population (mean Townsend score 1.25, 95% CI 1.09 to 1.41) than the Merseyside reference population. Our findings represent one of the largest single-centre studies of MCD. The presentation of MS is confirmed to be a risk factor of mortality from MCD. Our study supports the association between social deprivation and MCD.
Highlights
Meningococcal disease (MCD) is seen predominantly in infancy and early childhood, with a higher incidence in males [1]
Merseyside has a higher incidence of MCD than the rest of the North West of England, and England and Wales as a whole
Data from the Health Protection Agency indicate that the incidence of MCD in England and Wales for 2008 and 2009 was 2.26/100,000 and 1.88/100,000 respectively
Summary
Meningococcal disease (MCD) is seen predominantly in infancy and early childhood, with a higher incidence in males [1]. As early as 1919, Rolleston [2] stated that "half the total cases occur in first five years of life", a statement that still applies today [3]. The case fatality rates are high in under fives, low in school age children, and highest in those aged 25 years or more [4,5]. The overall European picture has been similar to that in the United Kingdom, with overall case-fatality rates falling and the incidence of serogroup C disease falling [9,10,11]
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