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A prospective investigation of the long-term auditory-neurological sequelae associated with bacterial meningitis: a
1Lenakel Hospital, Tanna, Vanuatu.
Abstract:
During the period August 1988-July 1991 all cases of bacterial meningitis admitted to Lenakel Hospital on the island of Tanna in Vanuatu were followed. During this period there were 83 cases of purulent meningitis giving an annual incidence of 134 per 100,000 population. There were 13 deaths during the acute illness phase (CFR = 15.7%). Of the 70 survivors 65 (93%) were successfully followed for a mean duration of 17.5 months. When grouped by severity of illness there was no significant difference in the mean age, duration of symptoms or sex of the patients. At the time of discharge 31.5% had auditory-neurological abnormalities. During follow-up 35% of the survivors were found to have one or more auditory-neurological sequelae. Hearing loss was the most frequent abnormality occurring in 32.2% of the study group. Of those with auditory-neurological sequelae 39% were judged to have severe disabilities likely to impair their ability to live independently. A statistically significant association was found between the severity of the illness at presentation and the risk of auditory-neurological sequelae. Meningitis caused by Streptococcus pneumoniae was associated with the highest incidence of sequelae and that caused by Hemophilus influenzae type b with the lowest. There was no association with sex or age group. Strategies to reduce the mortality and morbidity from bacterial meningitis in developing countries are briefly discussed.
Insights
Bacterial meningitis in Vanuatu caused significant auditory-neurological sequelae, particularly hearing loss, in 35% of survivors. Severe illness increased sequelae risk, with Streptococcus pneumoniae posing the greatest threat.
Area of Science:
- Epidemiology
- Neurology
- Infectious Diseases
Background:
- Bacterial meningitis poses a significant public health challenge, especially in developing countries.
- Understanding the incidence and long-term consequences of meningitis is crucial for effective public health strategies.
- Lenakel Hospital on Tanna Island, Vanuatu, serves as a key site for studying infectious diseases in the region.
Purpose of the Study:
- To determine the incidence and mortality of bacterial meningitis in Vanuatu.
- To assess the prevalence and nature of auditory-neurological sequelae following bacterial meningitis.
- To identify risk factors associated with these sequelae.
Main Methods:
- A prospective follow-up study of all bacterial meningitis cases admitted to Lenakel Hospital from August 1988 to July 1991.
- Data collection included patient demographics, clinical presentation, treatment, and outcomes during acute illness and follow-up.
- Auditory-neurological assessments were performed on survivors during follow-up.
Main Results:
- An annual incidence of 134 per 100,000 population was observed, with a case fatality rate of 15.7%.
- Of the survivors, 35% developed auditory-neurological sequelae, most commonly hearing loss (32.2%).
- Severe illness at presentation was significantly associated with a higher risk of sequelae, and Streptococcus pneumoniae caused more sequelae than Hemophilus influenzae type b.
Conclusions:
- Bacterial meningitis results in substantial long-term auditory-neurological morbidity in the studied population.
- Severity of illness and specific bacterial pathogens influence the risk and type of sequelae.
- Targeted interventions are needed to reduce mortality and long-term disability from meningitis in developing nations.