title: Clinically based surveillance of invasive meningococcal disease in young children admitted to selected US hospitals between January 2000 and June 2009: a retrospective cohort study.
abstract: Invasive meningococcal disease (IMD) is under-reported in countries that do not employ polymerase-chain reaction for surveillance because culture-negative cases are omitted. To evaluate a clinically based, case-finding method, we developed case definitions for "probable," "compatible with," and "possible, but unlikely" IMD, respectively, based on supportive documentation (e.g., discharge diagnosis of meningococcal infection, culture-negative bacterial meningitis, petechiae/purpura, Gram-negative diplococci on Gram stain) and weight of clinical evidence, which we then applied to electronic health records for all children aged ≤5 y who were admitted to approximately 100 US hospitals between January 2000 and June 2009. Among 47,863 qualifying admissions, 16 children had culture-positive IMD, 5 had "probable" IMD, and 5 had illness "compatible with" IMD. Five additional children had disease considered "possible but unlikely" IMD. Our case-finding methods suggest that culture-based ascertainment may underestimate the number of IMD cases by 31-63%, supporting findings in other nations that culture-based reporting provides incomplete information on disease incidence and therefore underestimates the potential benefits of routine vaccination of young children against meningococcal disease.
authors.affiliation: Policy Analysis Inc., Brookline, MA, USA.
authors.forename: Ariel
authors.initials: A
authors.lastname: Berger
authors.forename: Stephen I
authors.initials: SI
authors.lastname: Pelton
authors.forename: Jerome O
authors.initials: JO
authors.lastname: Klein
authors.forename: Jeffrey J
authors.initials: JJ
authors.lastname: Stoddard
authors.forename: John
authors.initials: J
authors.lastname: Edelsberg
authors.forename: Gerry
authors.initials: G
authors.lastname: Oster
mesh_terms: D002675:Child, Preschool; D015331:Cohort Studies; D005260:Female; D006760:Hospitalization; D006801:Humans; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D016920:Meningitis, Bacterial / Q000453:epidemiology*; D008589:Meningococcal Infections / Q000453:epidemiology*; D012189:Retrospective Studies; D018805:Sepsis / Q000453:epidemiology*; D014481:United States / Q000453:epidemiology