Meningococcal disease in children in Merseyside, England: a 31 year descriptive study

Abstract

Meningococcal disease (MCD) is the leading infectious cause of death in early childhood in the United Kingdom, making it a public health priority. MCD most commonly presents as meningococcal meningitis (MM), septicaemia (MS), or as a combination of the two syndromes (MM/MS). We describe the changing epidemiology and clinical presentation of MCD, and explore associations with socioeconomic status and other risk factors. A hospital-based study of children admitted to a tertiary children's centre, Alder Hey Children's Foundation Trust, with MCD, was undertaken between 1977 to 2007 (n = 1157). Demographics, clinical presentations, microbiological confirmation and measures of deprivation were described. The majority of cases occurred in the 1-4 year age group and there was a dramatic fall in serogroup C cases observed with the introduction of the meningococcal C conjugate (MCC) vaccine. The proportion of MS cases increased over the study period, from 11% in the first quarter to 35% in the final quarter. Presentation with MS (compared to MM) and serogroup C disease (compared to serogroup B) were demonstrated to be independent risk factors for mortality, with odds ratios of 3.5 (95% CI 1.18 to 10.08) and 2.18 (95% CI 1.26 to 3.80) respectively. Cases admitted to Alder Hey were from a relatively more deprived population (mean Townsend score 1.25, 95% CI 1.09 to 1.41) than the Merseyside reference population. Our findings represent one of the largest single-centre studies of MCD. The presentation of MS is confirmed to be a risk factor of mortality from MCD. Our study supports the association between social deprivation and MCD.

Figure 1. Location of MCD cases admitted to Alder Hey 1977–2007.

Maps are of the UK, and of Merseyside only. The location of Alder Hey is clearly highlighted.

Figure 2. Histograms of numbers of cases by year group of admission.

Cases are stratified by serogroup (A), age group (B), disease type (C) and outcome (D).

Figure 3. Smoothed density plot of Townsend scores for the reference population of Merseyside and MCD cases.

The reference population is plotted for 1981 (dashed line), 1991 (dotted line), 2001 (dashed-dotted line). Townsend scores for the cases are represented by a solid line.