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Published on: November 5, 2019
Invasive meningococcal disease in children in Ireland, 2001-2011
Cilian Ó Maoldomhnaigh1,2, Richard J Drew3,4,5, Patrick Gavin1,2
1Department of Pediatric Infectious Disease and Immunology, Our Lady's Children's Hospital, Crumlin, Ireland.
Background:
In 1999, invasive meningococcal disease was hyperendemic in Ireland at 14.75/100 000 population, with 60% group B and 30% group C diseases. National sepsis guidelines and meningococcal C vaccines were introduced in 2000. Despite a spontaneous decline in group B infection, invasive meningococcal disease remains a leading cause of sepsis. This study characterises the epidemiology of invasive meningococcal disease in children in Ireland since the introduction of meningococcal C vaccine and reviews its clinical presentation, hospital course and outcome in anticipation of meningococcal B vaccine introduction.
Methods:
National surveillance data were obtained from the Health Protection Surveillance Centre. A retrospective study of all meningococcal cases at two tertiary paediatric hospitals was conducted from 2001 to 2011. Records were reviewed using a standardised assessment tool. A study of 407 meningococcal cases published in 2002 provided comparative data.
Results:
Of 1820 cases <19 years of age notified nationally, 382 (21%) cases attended a study hospital; 94% group B, 3% group C, 225 (59%) male, median age 5 years (range 0.1-18). Fever was absent at presentation in 18%. Fifteen patients (3.6%) died. 221 (61%) were admitted to paediatric intensive care units (PICU). Permanent sequelae occurred in 9.4%. Compared with the historical cohort, there were differences in presentation, an increase in PICU interventions, but no significant decline in morbidity or mortality.
Conclusions:
Despite the meningococcal C vaccination campaign, invasive meningococcal disease continues to cause serious morbidity and claim lives. Group B infections remain dominant. As children who die often present with fulminant disease, preventive strategies including use of meningococcal B vaccine are needed to avert death and sequelae.
Insights
Invasive meningococcal disease remains a significant threat in children, with group B infections dominating despite vaccination efforts. New preventive strategies, including meningococcal B vaccines, are crucial to reduce severe illness and fatalities.
Area of Science:
- Pediatric Infectious Diseases
- Epidemiology
- Vaccinology
Background:
- Invasive meningococcal disease (IMD) was hyperendemic in Ireland in 1999, primarily caused by groups B and C.
- National guidelines and meningococcal C vaccines were implemented in 2000.
- Despite a decline in group B infections, IMD remains a leading cause of sepsis in children.
Purpose of the Study:
- To characterize the epidemiology of IMD in Irish children post-meningococcal C vaccine introduction.
- To review clinical presentation, hospital course, and outcomes.
- To inform the anticipated introduction of meningococcal B vaccine.
Main Methods:
- National surveillance data from the Health Protection Surveillance Centre were analyzed.
- A retrospective study of 382 meningococcal cases in children (<19 years) at two tertiary pediatric hospitals (2001-2011).
- Comparison with a 2002 study of 407 meningococcal cases.
Main Results:
- Group B strains predominated (94%) among 382 pediatric IMD cases.
- 18% of patients lacked fever at presentation; 3.6% died, and 9.4% experienced permanent sequelae.
- While PICU admissions increased, there was no significant reduction in morbidity or mortality compared to historical data.
Conclusions:
- Invasive meningococcal disease, particularly group B, continues to cause significant morbidity and mortality in children despite meningococcal C vaccination.
- Preventive strategies, including meningococcal B vaccination, are essential to reduce deaths and long-term complications.
- Fulminant disease presentation in fatal cases highlights the need for timely and effective interventions.
