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. 2024 Jan 2;7(1):e2352402.
doi: 10.1001/jamanetworkopen.2023.52402.

Increased Risk of Long-Term Disabilities Following Childhood Bacterial Meningitis in Sweden

Salini Mohanty  1 , Urban Johansson Kostenniemi  2 , Sven Arne Silfverdal  3 , Stina Salomonsson  4 , Federico Iovino  5 , Eric M Sarpong  6 , Goran Bencina  7 , Gustaf Bruze  8
Affiliations

Increased Risk of Long-Term Disabilities Following Childhood Bacterial Meningitis in Sweden

Salini Mohanty et al. JAMA Netw Open. .

Abstract

Importance: Few studies have examined the incidence of long-term disabilities due to bacterial meningitis in childhood with extended follow-up time and a nationwide cohort.

Objective: To describe the long-term risks of disabilities following a childhood diagnosis of bacterial meningitis in Sweden.

Design, setting, and participants: This nationwide retrospective registry-based cohort study included individuals diagnosed with bacterial meningitis (younger than 18 years) and general population controls matched (1:9) by age, sex, and place of residence. Data were retrieved from the Swedish National Patient Register from January 1, 1987, to December 31, 2021. Data were analyzed from July 13, 2022, to November 30, 2023.

Exposure: A diagnosis of bacterial meningitis in childhood recorded in the National Patient Register between 1987 and 2021.

Main outcomes and measures: Cumulative incidence of 7 disabilities (cognitive disabilities, seizures, hearing loss, motor function disorders, visual disturbances, behavioral and emotional disorders, and intracranial structural injuries) after bacterial meningitis in childhood.

Results: The cohort included 3623 individuals diagnosed with bacterial meningitis during childhood and 32 607 controls from the general population (median age at diagnosis, 1.5 [IQR, 0.4-6.2] years; 44.2% female and 55.8% male, median follow-up time, 23.7 [IQR, 12.2-30.4] years). Individuals diagnosed with bacterial meningitis had higher cumulative incidence of all 7 disabilities, and 1052 (29.0%) had at least 1 disability. The highest absolute risk of disabilities was found for behavioral and emotional disorders, hearing loss, and visual disturbances. The estimated adjusted hazard ratios (HRs) showed a significant increased relative risk for cases compared with controls for all 7 disabilities, with the largest adjusted HRs for intracranial structural injuries (26.04 [95% CI, 15.50-43.74]), hearing loss (7.90 [95% CI, 6.68-9.33]), and motor function disorders (4.65 [95% CI, 3.72-5.80]). The adjusted HRs for cognitive disabilities, seizures, hearing loss, and motor function disorders were significantly higher for Streptococcus pneumoniae infection (eg, 7.89 [95% CI, 5.18-12.02] for seizure) compared with Haemophilus influenzae infection (2.46 [95% CI, 1.63-3.70]) or Neisseria meningitidis infection (1.38 [95% CI, 0.65-2.93]). The adjusted HRs for cognitive disabilities, seizures, behavioral and emotional disorders, and intracranial structural injuries were significantly higher for children diagnosed with bacterial meningitis at an age below the median.

Conclusions and relevance: The findings of this cohort study of individuals diagnosed with bacterial meningitis during childhood suggest that exposed individuals may have had an increased risk for long-term disabilities (particularly when diagnosed with pneumococcal meningitis or when diagnosed at a young age), highlighting the need to detect disabilities among surviving children.

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Conflict of interest statement

Conflict of Interest Disclosures: Dr Mohanty reported owning stock or stock options from Merck & Co Inc during the conduct of the study. Dr Johansson Kostenniemi reported receiving funding to his institution from Merck Sharp & Dohme LLC during the conduct of the study and serving on the advisory board for pneumococcal vaccines from Merck Sharp & Dohme LLC outside the submitted work. Dr Silfverdal reported receiving grant funding to his institution from Merck Sharp & Dohme LLC during the conduct of the study and serving on the advisory board for pediatric vaccines from Merck Sharp & Dohme LLC and advisory boards of Pfizer Inc, GlaxoSmithKline, Janssen Pharmaceuticals, and Sanofi Pasteur outside the submitted work. Dr Salomonsson reported owning stock or stock options from Merck Sharp & Dohme LLC during the conduct of the study. Dr Iovino reported receiving grant funding from Merck Sharp & Dohme LLC to his institution during the conduct of the study. Dr Sarpong reported owning stock or stock options from Merck & Co Inc during the conduct of the study. Dr Bencina reported owning stock or stock options from Merck Sharp & Dohme LLC during the conduct of the study. Dr Bruze reported receiving grant funding from Merck Sharp & Dohme LLC during the conduct of the study. No other disclosures were reported.

Figures

Figure.
Figure.. Cumulative Incidence of Disabilities by Type of Disability
Shading represents 95% CIs.
See this image and copyright information in PMC

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