title: Meningitis in children in Fiji: etiology, epidemiology, and neurological sequelae.
abstract: OBJECTIVE
  To describe the etiology, epidemiology, neurological sequelae, and quality of life of children aged 1 month to less than 5 years admitted with meningitis to the Colonial War Memorial Hospital (CWMH), Suva, Fiji.
  
  
  METHODS
  Over a 3-year period, all eligible children with suspected meningitis admitted to CWMH had blood drawn for culture. Of these children, those for whom is was possible were tested for a four-fold rise in antibody titers to Haemophilus influenzae type b (Hib) and pneumococcal surface adhesin A (PsaA). Cerebrospinal fluid (CSF) was taken for bacteriological culture and antigen testing. CSF was also tested by PCR for Streptococcus species, Neisseria meningitidis, Hib, Mycobacterium tuberculosis, and enterovirus. Pneumococcal isolates were serotyped using multiplex-PCR reverse-line blot hybridization. Following discharge, cases underwent a neurological assessment, audiometry, and quality of life assessment (Pediatric Quality of Life Inventory (PedsQL) tool).
  
  
  RESULTS
  There were 70 meningitis cases. Meningitis was more common in indigenous Fijian than Indo-Fijian children. Enterovirus was the most common etiological agent and appeared to be outbreak-associated. Streptococcus pneumoniae was the most common bacterial cause of meningitis with an annual incidence of 9.9 per 100 000 under 5 years old (95% confidence interval 4.9-17.7) and a case fatality rate of 36%. With the exception of deafness, neurological sequelae were more frequent in cases of bacterial meningitis than in viral meningitis (18.5% vs. 0%, p=0.04). Quality of life at follow-up was significantly lower in patients with bacterial meningitis than in those with viral meningitis (p=0.003) or meningitis of unknown etiology (p=0.004).
  
  
  CONCLUSIONS
  During the study period an outbreak of enterovirus occurred making it the most common etiological agent identified. However in the absence of this outbreak, S. pneumoniae was the most common cause of childhood meningitis in Fiji. Bacterial meningitis is associated with serious sequelae and a reduced quality of life.
authors.affiliation: Department of Public Health and Primary Care, Fiji School of Medicine, College of Medicine Nursing and Health Sciences, Fiji National University, Private Mail Bag, Suva, Fiji. viema.biaukula@fnu.ac.fj
authors.forename: Viema Lewagalu
authors.initials: VL
authors.lastname: Biaukula
authors.forename: Lisi
authors.initials: L
authors.lastname: Tikoduadua
authors.forename: Kristy
authors.initials: K
authors.lastname: Azzopardi
authors.forename: Anna
authors.initials: A
authors.lastname: Seduadua
authors.forename: Beth
authors.initials: B
authors.lastname: Temple
authors.forename: Peter
authors.initials: P
authors.lastname: Richmond
authors.forename: Roy
authors.initials: R
authors.lastname: Robins-Browne
authors.forename: Edward Kim
authors.initials: EK
authors.lastname: Mulholland
authors.forename: Fiona Mary
authors.initials: FM
authors.lastname: Russell
mesh_terms: D002675:Child, Preschool; D005260:Female; D005367:Fiji / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D007223:Infant; D008297:Male; D008586:Meningitis, Pneumococcal / Q000134:cerebrospinal fluid / Q000150:complications / Q000453:epidemiology*; D008587:Meningitis, Viral / Q000134:cerebrospinal fluid / Q000150:complications / Q000453:epidemiology*; D011446:Prospective Studies; D012640:Seizures / Q000453:epidemiology* / Q000382:microbiology