title: Pneumococcal meningitis in Jamaican children.
abstract: OBJECTIVE
  To describe the clinical features and outcome of pneumococcal meningitis in Jamaican children.
  
  
  METHODS
  All patients admitted to the Bustamante Hospital for Children, during the period 1995-1999, who had pneumococcus isolated from cerebrospinal fluid (CSF) or pleocytosis in association with a blood culture isolate of pneumococcus were selected. Demographic, clinical and laboratory data were collected.
  
  
  RESULTS
  Twenty-five (23%) of 111 patients with pneumococcal infections satisfied criteria for meningitis. The median age was 8 months (range 0.5-60 months). There were 4 (16%) cases of sickle cell disease, 2 (50%) of whom were first diagnosed during the current illness. This represents a 53-fold increased risk of pneumoccocal meningitis in patients with Sickle-cell disease based on population prevalence rates. Oxacillin resistance occurred in 3 (12%) patients, one of whom died. Mortality rate was 12% (3) with all deaths occurring in infants < 1 year. Poor outcome occurred in 36% (9) of the patients. Of the (35%) 8 survivors who had follow-up evaluation, (38%) 3 had documented hearing loss.
  
  
  CONCLUSIONS
  Meningitis is a common clinical syndrome of invasive pneumococcal disease, occurring in 23% of cases resulting in mortality and high morbidity among Jamaican children. Local seroepidemiological studies are urgently needed to inform national vaccine decisions. As an interim plan, policymakers should consider a risk-based strategy to vaccine prophylaxis that will ensure that high risk groups such as children with sickle cell disease are offered currently available conjugate pneumococcal vaccines.
authors.affiliation: Department of Obstetrics, Gynaecology and Child Health, The University of the West Indies, Kingston 7, Jamaica. helen.trotmanedwards@uwimona.edu.jm
authors.forename: H
authors.initials: H
authors.lastname: Trotman
authors.forename: O
authors.initials: O
authors.lastname: Olugbuyi
authors.forename: M
authors.initials: M
authors.lastname: Barton
authors.forename: D
authors.initials: D
authors.lastname: McGregor
authors.forename: S
authors.initials: S
authors.lastname: Thomas
mesh_terms: D000755:Anemia, Sickle Cell / Q000150:complications / Q000453:epidemiology; D002675:Child, Preschool; D005260:Female; D034381:Hearing Loss / Q000453:epidemiology / Q000209:etiology / Q000382:microbiology; D006776:Hospitals, Pediatric / Q000706:statistics & numerical data; D006801:Humans; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D007563:Jamaica / Q000453:epidemiology; D008297:Male; D008586:Meningitis, Pneumococcal / Q000150:complications / Q000401:mortality*