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Bacterial meningitis in children under five years of age in Western Australia
1University of Western Australia, Department of Medicine, Queen Elizabeth II Medical Centre, Nedlands.
Insights
Bacterial meningitis caused 16 deaths and serious neurological issues in Western Australian children. Haemophilus influenzae type b was the primary cause, particularly in Aboriginal children, highlighting the need for effective vaccination strategies.
Area of Science:
- Pediatric Infectious Diseases
- Epidemiology
- Vaccinology
Background:
- Bacterial meningitis poses a significant threat to children under five.
- Neurological sequelae and mortality are serious concerns.
- Haemophilus influenzae type b (Hib) is a major pathogen in childhood meningitis.
Purpose of the Study:
- To determine the epidemiology of bacterial meningitis in young children in Western Australia.
- To assess mortality and neurological sequelae associated with bacterial meningitis.
- To evaluate the potential impact of Haemophilus influenzae type b vaccination.
Main Methods:
- Retrospective survey utilizing multiple case ascertainment sources.
- Study population included children aged one month to five years in Western Australia (1984-1988).
- Outcomes measured included meningitis episodes, deaths, sensorineural deafness, and cerebral palsy.
Main Results:
- 270 episodes of bacterial meningitis were identified, with 70 in Aboriginal children and 200 in non-Aboriginal children.
- The case fatality rate was 5.9% (16 deaths), with 7 cases of profound sensorineural deafness and 7 of cerebral palsy.
- Haemophilus influenzae type b accounted for nearly 70% of cases, with significantly higher incidence and earlier onset in Aboriginal children.
Conclusions:
- Conjugate Haemophilus influenzae type b vaccines are expected to be effective in non-Aboriginal children vaccinated within six months.
- Highly immunogenic vaccines, such as PRP-OMP, are likely necessary for effective vaccination of Aboriginal infants.
- Targeted vaccination strategies are crucial to reduce the burden of Haemophilus influenzae type b meningitis in vulnerable populations.
Objectives:
To describe the epidemiology and the associated mortality and serious neurological sequelae of bacterial meningitis in children under five years of age in Western Australia, and to consider the potential impact of a Haemophilus influenzae type b vaccine on this group of children.
Design:
A retrospective survey, using multiple sources of case ascertainment.
Patients:
All children in Western Australia from one month to five years of age who developed bacterial meningitis, over a five-year period (from 1984 to 1988 inclusive).
Main Outcome Measures:
Episodes of bacterial meningitis, deaths associated with bacterial meningitis, and sensorineural deafness (requiring hearing aids) and cerebral palsy following bacterial meningitis.
Results:
Two hundred and seventy episodes of bacterial meningitis were identified; 200 occurred in non-Aboriginal children and 70 in Aboriginal children. There were 16 meningitis-associated deaths (case fatality rate, 5.9%), 7 children developed profound sensorineural deafness and a further 7 children developed cerebral palsy after bacterial meningitis. H. influenzae type b caused nearly 70% of the cases of childhood bacterial meningitis. The annual incidence rate of H. influenzae meningitis was significantly greater in Aboriginal children (150 episodes per 100,000 children under five years of age per year) than in non-Aboriginal children (27 episodes per 100,000), and the mean age of onset of H. influenzae meningitis was significantly lower in Aboriginal children (6.8 months) than in non-Aboriginal children (19.8 months).
Conclusions:
Any conjugate H. influenzae type b vaccine should be effective when administered to non-Aboriginal children in the first six months of life, but only the most immunogenic vaccines (for example, the vaccine known as PRP-OMP) are likely to be effective in Aboriginal infants.