title: Bacterial meningitis in children in Iceland, 1975-2010: a nationwide epidemiological study.
abstract: BACKGROUND
  Bacterial meningitis is a serious and potentially rapid life-threatening disease. Therefore, to ensure appropriate treatment, early recognition of signs and symptoms is imperative, along with knowledge of the epidemiology and microbiology of the disease.
  
  
  METHODS
  A long-term, nationwide epidemiological study of bacterial causes of meningitis in children (≤ 18 y) in Iceland during the period 1975-2010 was carried out. A detailed chart review was performed of all cases diagnosed in 1995-2010.
  
  
  RESULTS
  A total of 477 children were diagnosed with bacterial meningitis during the period 1975-2010. Of these, 67% were aged under 5 y. The most common pathogens were Neisseria meningitidis (n = 265), Haemophilus influenzae (n = 132), Streptococcus pneumoniae (n = 47), and Streptococcus agalactiae (n = 19); their incidences varied according to age. The age-specific incidence (cases/100,000/y) dropped from 26 in 1975 to 1 in 2010 (p < 0.001). The most common symptoms during the period 1995-2010 were fever (92%), vomiting (67%), nuchal rigidity (60%), and rashes/petechiae (51%). H. influenzae type b disappeared following implementation of Hib vaccination in 1989, and, likewise, the incidence of meningococcal meningitis fell significantly after vaccination against meningococcus serogroup C was initiated in 2002 (p < 0.001). The overall 30-day case fatality rate of bacterial meningitis was 4.4% and remained unchanged during the study period.
  
  
  CONCLUSIONS
  The incidence of childhood bacterial meningitis has been reduced significantly by successful vaccinations against H. influenzae type b and N. meningitidis serogroup C. Nevertheless, the case fatality rate has remained unchanged and thus the disease is still a serious threat to childhood health. Further prevention by novel vaccines and improved management of childhood meningitis is an exciting challenge.
authors: From the University of Iceland Faculty of Medicine.
authors: Kolfinna
authors: K
authors: Snaebjarnardóttir
authors: Helga
authors: H
authors: Erlendsdóttir
authors: Ingi Karl
authors: IK
authors: Reynisson
authors: Karl
authors: K
authors: Kristinsson
authors: Sandra
authors: S
authors: Halldórsdóttir
authors: Hjördís
authors: H
authors: Hardardóttir
authors: Thórólfur
authors: T
authors: Gudnason
authors: Magnús
authors: M
authors: Gottfredsson
authors: Ásgeir
authors: Á
authors: Haraldsson
mesh_terms: D000293:Adolescent; D001419:Bacteria / Q000145:classification* / Q000302:isolation & purification*; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007055:Iceland / Q000453:epidemiology; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D016920:Meningitis, Bacterial / Q000453:epidemiology* / Q000382:microbiology*; D009026:Mortality; D014611:Vaccination / Q000706:statistics & numerical data