title: Paediatric meningococcaemia in northwestern Ontario, Canada: a case for publicly funded meningococcal B vaccination.
abstract: BACKGROUND
  Neisseria meningitidisserogroup B is an important infectious agent in developed countries, including Canada. Infants are particularly susceptible to infection with serogroup B because of immature immune systems, pathogen virulence factors and changing serogroup dynamics in the post-vaccination era. Currently, the Ontario provincial government does not include serogroup B in its routine publicly funded meningococcal vaccination program.
  
  
  METHODS
  A formerly well 14-month-old male presented to a tertiary hospital emergency department with fever, minor respiratory problems, diffuse purpuric rash, distended abdomen, tachycardia, and history of one episode of vomiting and melena each. Meningococcaemia was immediately suspected, and he was treated with ceftriaxone, cefotaxime and vancomycin before transfer to a different acute care facility within 12 h.N. meningitidisserogroup B, sensitive to ceftriaxone and penicillin, was identified in his blood. The patient developed gangrene of the lower legs and underwent bilateral below-knee amputation 8 days post-admission.
  
  
  CONCLUSIONS
  This instance of meningococcaemia with extensive sequelae is an example of the various serious outcomes of meningococcal infection. It provides persuasive reason for routine publicly funded vaccination againstN. meningitidisserogroup B in Ontario.
authors.affiliation: Northern Ontario School of Medicine , Thunder Bay, Ontario , Canada.
authors.forename: Vic
authors.initials: V
authors.lastname: Eton
authors.affiliation: Vaccine Preventable Bacterial Diseases, National Microbiology Laboratory , Winnipeg, Manitoba , Canada.
authors.forename: Raymond S W
authors.initials: RS
authors.lastname: Tsang
authors.affiliation: Northern Ontario School of Medicine, Thunder Bay, Ontario, Canada; Lakehead University, Thunder Bay, Ontario, Canada.
authors.forename: Marina
authors.initials: M
authors.lastname: Ulanova
keywords: Canada; Neisseria meningitidis; Ontario; amputation; cefotaxime; ceftriaxone; meningococcaemia; purpura fulminans; serogroup B; vancomycin