The Health Burden of Invasive Meningococcal Disease: A Systematic Review.
Although relatively rare, invasive meningococcal disease continues to be a health concern, especially in young children. This systematic review clearly delineates both the near- and long-term morbidities that can occur after, and persist beyond, the period of acute illness.


BACKGROUND
Although rare, invasive meningococcal disease (IMD) continues to be a health concern in high-income countries because of its severe morbidity and relatively high case fatality rate, especially in young children. However, studies measuring sequelae of IMD across the spectrum of invasive syndromes have not been systematically reviewed. We conducted a systematic review of sequelae attributable to IMD and quality of life (QoL) in IMD survivors in high-income countries.


METHODS
We searched Medline, Embase, and HealthSTAR for primary studies that assessed sequelae or QoL in individuals of any age with and without IMD. Two independent reviewers screened articles, abstracted data, and performed quality appraisal. The findings were summarized qualitatively.


RESULTS
Of 1884 citations screened, 17 studies were included. The most commonly assessed sequelae were hearing impairment, cognitive impairment, and psychological problems. In general, children with IMD had a greater incidence of hearing loss and psychological disorders, including attention-deficit/hyperactivity disorder. However, its effects on intelligence in children remain unclear. No statistical differences in overall cognitive function in adults were reported. The odds of death were significantly increased with IMD at hospital discharge and up to 30 years after disease. Lower overall QoL was observed in those who had IMD versus controls.


CONCLUSIONS
The results of this systematic review delineate both the short- and long-term morbidities that can occur after, and persist beyond, the period of acute illness. A better understanding of the full spectrum of IMD sequelae is critical for assessing the burden of IMD and supporting healthcare planning and decision making in light of new vaccines.
Knowledge Translation Program, St. Michael's Hospital.|Institute of Health Policy, Management and Evaluation, University of Toronto.
Lisa
L
Strifler
Division of Infectious Diseases, Hospital for Sick Children.|Department of Paediatrics, University of Toronto.
Shaun K
SK
Morris
Public Health Ontario.
Vica
V
Dang
Institute of Health Policy, Management and Evaluation, University of Toronto.
Hong Anh T
HA
Tu
Inner City Health Program, St. Michael's Hospital.
Ripudaman S
RS
Minhas
Public Health Ontario.|Department of Laboratory Medicine and Pathobiology.
Frances B
FB
Jamieson
Public Health Ontario.|Dalla Lana School of Public Health, University of Toronto.
Shelley L
SL
Deeks
Public Health Ontario.|Dalla Lana School of Public Health, University of Toronto.
Natasha S
NS
Crowcroft
Institute of Health Policy, Management and Evaluation, University of Toronto.|Public Health Ontario.|Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada.
Beate
B
Sander
D002648:Child; D002675:Child, Preschool; D019049:Developed Countries; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008589:Meningococcal Infections / Q000150:complications* / Q000453:epidemiology*; D011788:Quality of Life; D017741:Survivors
Neisseria meningitidis; quality of life; sequelae