Meningococcal disease in children in Merseyside, England: a 31 year descriptive study.
Meningococcal disease (MCD) is the leading infectious cause of death in early childhood in the United Kingdom, making it a public health priority. MCD most commonly presents as meningococcal meningitis (MM), septicaemia (MS), or as a combination of the two syndromes (MM/MS). We describe the changing epidemiology and clinical presentation of MCD, and explore associations with socioeconomic status and other risk factors. A hospital-based study of children admitted to a tertiary children's centre, Alder Hey Children's Foundation Trust, with MCD, was undertaken between 1977 to 2007 (n = 1157). Demographics, clinical presentations, microbiological confirmation and measures of deprivation were described. The majority of cases occurred in the 1-4 year age group and there was a dramatic fall in serogroup C cases observed with the introduction of the meningococcal C conjugate (MCC) vaccine. The proportion of MS cases increased over the study period, from 11% in the first quarter to 35% in the final quarter. Presentation with MS (compared to MM) and serogroup C disease (compared to serogroup B) were demonstrated to be independent risk factors for mortality, with odds ratios of 3.5 (95% CI 1.18 to 10.08) and 2.18 (95% CI 1.26 to 3.80) respectively. Cases admitted to Alder Hey were from a relatively more deprived population (mean Townsend score 1.25, 95% CI 1.09 to 1.41) than the Merseyside reference population. Our findings represent one of the largest single-centre studies of MCD. The presentation of MS is confirmed to be a risk factor of mortality from MCD. Our study supports the association between social deprivation and MCD.
Lancaster Medical School, Faculty of Health and Medicine, Lancaster University, Lancaster, United Kingdom. m.stanton@lancaster.ac.uk
Michelle C
MC
Stanton
David
D
Taylor-Robinson
David
D
Harris
Fauzia
F
Paize
Nick
N
Makwana
Scott J
SJ
Hackett
Paul B
PB
Baines
F Andrew I
FA
Riordan
Omnia
O
Marzouk
Alistair P J
AP
Thomson
Peter J
PJ
Diggle
C Anthony
CA
Hart
Enitan D
ED
Carrol
D000293:Adolescent; D017677:Age Distribution; D002648:Child; D002675:Child, Preschool; D004739:England / Q000453:epidemiology; D005260:Female; D006761:Hospitals / Q000706:statistics & numerical data; D006801:Humans; D007223:Infant; D016015:Logistic Models; D008297:Male; D008589:Meningococcal Infections / Q000175:diagnosis / Q000453:epidemiology* / Q000401:mortality; D012959:Socioeconomic Factors