Meningococcal infections in children from Arkansas

Background. Infections with Neisseria meningitidis are an important cause of morbidity and mortality in children of all ages. With widespread use of the heptavalent pneumococcal conjugate vaccine, this organism might become the prominent pathogen for invasive disease in children. Methods. Retrospective reviews of medical and microbiologic records from Arkansas Children's Hospital were done to identify patients with invasive N. meningitidis infections from January, 1988, through December, 2000. Basic demographic and clinical data were gathered and reviewed. Data on invasive meningococcal infections were obtained from the Arkansas Department of Health. Results. Three hundred ninety-four cases of invasive meningococcal infection were reported to the Arkansas Department of Health during the study period. Two hundred ninety-six cases were in patients <21 years of age. The estimated annual incidence of meningococcal disease for the State of Arkansas was calculated to be 1.2-cases/100 000 population during the study period. The annual incidence of meningococcal disease in patients <21 years of age was estimated at 2.9 and 21.7 cases/100 000 population for children <1 year of age. One hundred fifty patients (51%) <21 years of age with 151 episodes of invasive meningococcal infections were treated at our institution. Eighty percent of the patients were Caucasian, 55% were male, 31% live in a rural area and the median age at presentation was 30 months (range, 2 weeks to 21 years). The most common signs and symptoms at admission included fever (95%), petechial/purpuric rash (62%), nuchal rigidity (41%) and hypotension (41%). Thirty-eight patients (26%) required both inotropic support and mechanical ventilation during hospitalization, 15 patients died and 18 patients had long term sequelae. Eighty-three of the isolates were serogrouped and included the following: A (2); B (38); C (33); and Y (10). Eighty-four of the index cases were treated with parenteral cephalosporin therapy alone and did not receive additional chemoprophylaxis. Conclusions. Many infections in the general pediatric population are a result of N. meningitidis. Although most patients do well and recover without sequelae, there are a significant number who experience major morbidity and mortality as a result of this infection.