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Risk of Invasive Meningococcal Disease in Preterm Infants
Anna Calvert1,2,3, Helen Campbell3, Paul T Heath1,2
1Centre for Neonatal and Paediatric Infection and Vaccine Institute, St George's, University of London, London, UK.
Insights
Preterm infants face a higher risk of invasive meningococcal disease (IMD) and its complications. This study highlights increased IMD incidence and sequelae in premature infants, especially those born before 32 weeks gestation.
Area of Science:
- Pediatrics
- Infectious Diseases
- Vaccinology
Background:
- Invasive meningococcal disease (IMD) disproportionately affects infants.
- Preterm infants may experience higher IMD risk and severity compared to term infants.
- The study investigates IMD in preterm vs. term infants post-national 4CMenB vaccine introduction in England.
Purpose of the Study:
- To compare the incidence, clinical presentation, and outcomes of IMD in preterm versus term infants.
- To assess the impact of prematurity on IMD risk and severity following the 4CMenB vaccine rollout.
- To identify specific gestational age thresholds associated with increased IMD risk.
Main Methods:
- Utilized enhanced national IMD surveillance data from the UK Health Security Agency.
- Included infants under 1 year with confirmed IMD between September 2015 and August 2020.
- Compared IMD incidence, demographics, clinical features, and outcomes between preterm (<37 weeks) and term infants.
Main Results:
- Overall infant IMD incidence was 12.4/100,000 live births.
- Preterm infants showed significantly higher IMD incidence (18.3/100,000) than term infants (10.9/100,000).
- Infants born <32 weeks gestation had the highest IMD incidence (32.9/100,000) and a higher likelihood of sequelae (35.9% vs 19.0%).
Conclusions:
- Preterm infants exhibit a greater incidence of IMD compared to term infants.
- The highest IMD incidence is observed in infants born before 32 weeks gestation.
- Preterm infants face an elevated risk of IMD-related sequelae.
Background:
Invasive meningococcal disease (IMD) is most common in the first year of life. We hypothesized that preterm infants may have a higher risk of IMD and more severe disease than term infants. We compared the incidence, demographics, clinical presentation, and outcomes of IMD in preterm compared with term infants during the first 5 years after implementation of a national meningococcal group B vaccine (4CMenB) for infants in England.
Methods:
The UK Health Security Agency conducts enhanced national IMD surveillance with detailed follow-up of all confirmed cases in England. Infants aged <1 year (uncorrected for gestational age) with IMD confirmed between 1 September 2015 and 31 August 2020 were included.
Results:
There were 393 infant IMD cases (incidence, 12.4/100 000 live births). Among 363 (92.4%) of the infants with known gestational age, the IMD incidence was higher in preterm (<37 weeks' gestation) than in term infants (18.3/100 000 vs 10.9/100 000; incidence rate ratio [IRR], 1.68 [95% confidence interval, 1.23-2.29]; P = .001). The IMD incidence was highest in those born at <32 weeks' gestation (32.9/100 000; incidence rate ratio for <32 weeks' gestation vs term, 3.01 [95% confidence interval, 1.73-5.24]; P ≤ .001). There were no differences in demographics, clinical presentation, rate of intensive care admission, or case-fatality rate, but preterm infants were more likely than term infants to have ≥1 reported sequela (14 of 39 [35.9%] vs 51 of 268 [19.0%]; P = .02).
Conclusions:
Preterm infants had a higher incidence of IMD than term infants and the IMD incidence was highest in infants born at <32 weeks' gestation. Preterm infants also had a higher risk of IMD sequelae.
