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Increased incidence of childhood bacterial meningitis. A 25-year study in a defined population in Sweden
Insights
Bacterial meningitis incidence, particularly Haemophilus influenzae, increased significantly in Swedish children. However, mortality rates decreased substantially due to improved hospital care, though hearing impairment remained a common sequel.
Area of Science:
- Pediatric Infectious Diseases
- Epidemiology
- Bacteriology
Background:
- Bacterial meningitis poses a significant threat to child health.
- Understanding trends in causative agents, incidence, and outcomes is crucial for public health strategies.
- Long-term data is essential for evaluating interventions and identifying persistent challenges.
Purpose of the Study:
- To analyze trends in the etiology, incidence, mortality, and sequelae of bacterial meningitis in children.
- To investigate the impact of treatment timelines on patient outcomes, specifically hearing impairment.
- To assess changes in bacterial meningitis epidemiology over a 25-year period in Orebro, Sweden.
Main Methods:
- Retrospective analysis of 201 pediatric bacterial meningitis cases from 1956-1980 in Orebro, Sweden.
- Data collection included etiological agents (Haemophilus influenzae, Neisseria meningitidis, Streptococcus pneumoniae), incidence rates, mortality, and long-term sequelae.
- Statistical analysis was performed to identify significant trends and correlations, including admission time and outcomes.
Main Results:
- A significant increase in Haemophilus influenzae meningitis incidence was observed, rising from 5.6 to 13.0 per 100,000 children annually (p < 0.01).
- Overall mortality decreased from 19% to 4%, primarily attributed to reduced in-hospital mortality after 12 hours of admission.
- Hearing impairment was the most frequent sequel (10%), with no change in frequency over the study period; it was significantly more common with late hospital admission (>48 hours, p < 0.001).
Conclusions:
- Despite an increasing incidence of Haemophilus influenzae meningitis, significant reductions in mortality were achieved, likely due to improved medical care.
- Timely hospital admission is critical for reducing the risk of severe sequelae like hearing impairment.
- Continued surveillance and research are necessary to address persistent challenges, such as the prevalence of hearing impairment.
Abstract:
In a retrospective study in Orebro, Sweden 1956-1980, 201 cases of bacterial meningitis in children over the age of 1 month were analysed. The aetiology was Haemophilus influenzae in 123 cases, Neisseria meningitidis in 55 cases and Streptococcus pneumoniae in 19 cases. We registered a significant increase in incidence of H. influenzae meningitis from 5.6 (1956-1965) to 13.0 (1971-1980) per 100,000 children and year (p less than 0.01). The mortality decreased from 19% to 4% during the period studied. This decrease was primarily due to a reduced mortality in hospital later than 12 h after admission. Hearing impairment was the most frequent sequel (10%) and no change in frequency was observed during the 25 years studied. Hearing impairment was registered significantly more often in cases with a late admission to hospital (greater than 48 h) as compared to cases with an earlier admission (p less than 0.001).