title: Outcomes of invasive meningococcal disease in adults and children in Canada between 2002 and 2011: a prospective cohort study.
abstract: BACKGROUND
  Neisseria meningitidis causes 500 000 cases of septicemia and meningitis worldwide annually, with approximately 200 cases in Canada each year. Previous studies describe a case-fatality rate of 5%-15% and up to 20% of survivors suffering from long-term disability.
  
  
  METHODS
  This study was performed in Canada between 2002 and 2011; the study area included >50% of the country's population. We identified risk factors associated with death and the development of complications in children and adults admitted to hospital with confirmed invasive meningococcal disease (IMD). Clinical information was obtained from hospital records. Risk factors for death and complications were analyzed by univariate and multivariable analyses.
  
  
  RESULTS
  Of 868 individuals hospitalized with IMD, there were 73 deaths (8.4%) and 157 (18%) developed complications. The most common complications were hearing loss (5.4%), skin scarring (5.4%), amputation (3.4%), renal dysfunction (2.6%), and seizures (2.5%). Mortality was independently associated with shock (adjusted odds ratio [aOR], 23.30; P<.0001), age (aOR, 1.02 per 1-year increased age; P<.0001), symptom onset within 24 hours of admission (aOR, 1.80; P=.0471), and admission to the intensive care unit (aOR, 0.41; P=.0196). Development of complications was independently associated with seizures (aOR, 4.55; P<.0001), shock (aOR, 3.10; P<.0001), abnormal platelet count (aOR, 2.14; P=.0002), bruising (aOR, 3.17; P=.0059), abnormal white blood cell count (aOR, 0.52; P=.0100), and prior antibiotic exposure (aOR, 0.27; P=.0273).
  
  
  CONCLUSIONS
  Outcomes following IMD remain poor in this resource-rich setting in the 21st century. These data identify priorities for clinical management of adults and children with IMD, and provide prognostic information for affected patients and their families and cost-effectiveness analyses for meningococcal vaccine programs.
authors.affiliation: Vaccine Evaluation Center, Division of Infectious and Immunological Diseases, Department of Pediatrics, BC Children's Hospital and the University of British Columbia, Vancouver, Canada Department of Paediatrics, University of Oxford, United Kingdom.
authors.forename: Manish
authors.initials: M
authors.lastname: Sadarangani
authors.affiliation: Vaccine Evaluation Center, Division of Infectious and Immunological Diseases, Department of Pediatrics, BC Children's Hospital and the University of British Columbia, Vancouver, Canada.
authors.forename: David W
authors.initials: DW
authors.lastname: Scheifele
authors.affiliation: Canadian Center for Vaccinology, IWK Health Centre and Dalhousie University, Halifax, Nova Scotia.
authors.forename: Scott A
authors.initials: SA
authors.lastname: Halperin
authors.affiliation: Division of Infectious Diseases, Department of Pediatrics, Stollery Children's Hospital and University of Alberta, Edmonton.
authors.forename: Wendy
authors.initials: W
authors.lastname: Vaudry
authors.affiliation: Division of Infectious Disease, Children's Hospital of Eastern Ontario, Ottawa.
authors.forename: Nicole
authors.initials: N
authors.lastname: Le Saux
authors.affiliation: Vaccine Preventable Bacterial Diseases, National Microbiology Laboratory, Winnipeg, Manitoba, Canada.
authors.forename: Raymond
authors.initials: R
authors.lastname: Tsang
authors.affiliation: Vaccine Evaluation Center, Division of Infectious and Immunological Diseases, Department of Pediatrics, BC Children's Hospital and the University of British Columbia, Vancouver, Canada.
authors.forename: Julie A
authors.initials: JA
authors.lastname: Bettinger
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002170:Canada / Q000453:epidemiology; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008607:Intellectual Disability; D008297:Male; D008585:Meningitis, Meningococcal / Q000150:complications / Q000453:epidemiology* / Q000401:mortality; D008875:Middle Aged; D009026:Mortality; D009345:Neisseria meningitidis; D011446:Prospective Studies; D012307:Risk Factors; D018805:Sepsis / Q000150:complications / Q000453:epidemiology* / Q000401:mortality; D016896:Treatment Outcome; D055815:Young Adult
keywords: Neisseria meningitidis; death; meningitis; morbidity; septicemia