title: Disease Burden of Invasive Meningococcal Disease in the Netherlands Between June 1999 and June 2011: A Subjective Role for Serogroup and Clonal Complex.
abstract: BACKGROUND
  Several countries consider the implementation of a meningococcal serogroup B vaccine for young children and/or serogroup C or ACWY conjugate vaccine for adolescents. Representative information on clinical course of invasive meningococcal disease (IMD) is useful to evaluate cost-effectiveness of vaccination. Information on the relation between infecting meningococcal clonal complex (CC), disease course and outcome of IMD is scarce.
  
  
  METHODS
  A retrospective study using Dutch surveillance data on IMD from June 1999 to June 2011. Clinical information was retrieved from hospital records. The effect of age, comorbidity, clinical manifestation, serogroup, and CC on disease course and outcome was assessed in multivariable analyses. Meningococcal CCs were assessed by multilocus sequence typing.
  
  
  RESULTS
  Clinical information was retrieved for 879 IMD cases: 48% of patients presented with meningitis, 17% with septic shock, and 22% with septic shock plus meningitis. Development of septic shock was not related to CC or serogroup. Median (interquartile range) duration of hospital admission was 10 (8-13) days. Intensive care unit admittance (38%) was higher for patients aged ≥10 years and patients with septic shock (P-values ≤.001). Case-fatality rate (8%) and development of sequelae (29%) was dependent on age and clinical manifestation (P-values ≤.001) and not affected by comorbidity, CC, or serogroup.
  
  
  CONCLUSIONS
  IMD still coincides with a considerable disease burden and mortality. Disease course and outcome depend mainly on age and clinical manifestation and less on meningococcal CC or serogroup.
authors.affiliation: Centre for Infectious Disease Control (CIb), National Institute for Public Health and the Environment (RIVM), Bilthoven Department of Pediatric Immunology and Infectious Diseases, Wilhelmina Children's Hospital, University Medical Center, Utrecht.
authors.forename: Susanne P
authors.initials: SP
authors.lastname: Stoof
authors.affiliation: Department of Pediatric Immunology and Infectious Diseases, Wilhelmina Children's Hospital, University Medical Center, Utrecht.
authors.forename: Gerwin D
authors.initials: GD
authors.lastname: Rodenburg
authors.affiliation: Centre for Infectious Disease Control (CIb), National Institute for Public Health and the Environment (RIVM), Bilthoven.
authors.forename: Mirjam J
authors.initials: MJ
authors.lastname: Knol
authors.affiliation: Department of Pediatric Immunology and Infectious Diseases, Wilhelmina Children's Hospital, University Medical Center, Utrecht.
authors.forename: Lidewij W
authors.initials: LW
authors.lastname: Rümke
authors.affiliation: Department of Medical Microbiology.
authors.forename: Sandra
authors.initials: S
authors.lastname: Bovenkerk
authors.affiliation: Centre for Infectious Disease Control (CIb), National Institute for Public Health and the Environment (RIVM), Bilthoven.
authors.forename: Guy A M
authors.initials: GA
authors.lastname: Berbers
authors.affiliation: Department of Medical Microbiology Netherlands Reference Laboratory for Bacterial Meningitis, Center for Infection and Immunity Amsterdam, Academic Medical Center, The Netherlands.
authors.forename: Lodewijk
authors.initials: L
authors.lastname: Spanjaard
authors.affiliation: Department of Medical Microbiology Netherlands Reference Laboratory for Bacterial Meningitis, Center for Infection and Immunity Amsterdam, Academic Medical Center, The Netherlands.
authors.forename: Arie
authors.initials: A
authors.lastname: van der Ende
authors.affiliation: Centre for Infectious Disease Control (CIb), National Institute for Public Health and the Environment (RIVM), Bilthoven Department of Pediatric Immunology and Infectious Diseases, Wilhelmina Children's Hospital, University Medical Center, Utrecht.
authors.forename: Elisabeth A M
authors.initials: EA
authors.lastname: Sanders
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D002648:Child; D002675:Child, Preschool; D015897:Comorbidity; D017281:Cost of Illness; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008585:Meningitis, Meningococcal / Q000453:epidemiology* / Q000382:microbiology* / Q000401:mortality; D008589:Meningococcal Infections / Q000453:epidemiology* / Q000382:microbiology* / Q000401:mortality / Q000473:pathology; D022401:Meningococcal Vaccines; D008875:Middle Aged; D058885:Multilocus Sequence Typing; D009345:Neisseria meningitidis / Q000145:classification* / Q000235:genetics / Q000276:immunology; D009426:Netherlands / Q000453:epidemiology; D012189:Retrospective Studies; D065288:Serogroup; D012772:Shock, Septic / Q000382:microbiology*; D013997:Time Factors; D014611:Vaccination / Q000706:statistics & numerical data; D055815:Young Adult
chemical_list: D022401:Meningococcal Vaccines
keywords: case-fatality; clonal complex; invasive meningococcal disease; septic shock; sequelae