Tuesday, May 30, 2023
|
Variable |
Total no. (missing data) |
No. (%) cases/y |
Average incidence, cases/100,000 population/y |
|---|---|---|---|
| Age, y | 319 (0) | ||
| <1 y | 118 (37.0) | 31.5 | |
| 1–4 | 120 (37.6) | 8.2 | |
| 5–9 | 46 (14.4) | 2.6 | |
| 10–14 | 35 (11.0) | 2.0 | |
| Sex | 319 (0) | ||
| F | 125 (39.2) | 4.8 | |
| M | 194 (60.8) | 7.0 | |
| Ethnicity, prioritized | 319 (0) | ||
| Māori | 114 (35.7) | 11.6 | |
| Pacific | 140 (43.9) | 13.4 | |
| Non-Māori, non-Pacific | 65 (20.4) | 1.9 | |
| New Zealand Index of Deprivation Quintile† | 317‡ | ||
| 1 | 11 (3.5) | NA | |
| 2 | 21 (6.6) | NA | |
| 3 | 42 (13.2) | NA | |
| 4 | 54 (17.0) | NA | |
| 5 | 189 (59.6) | NA | |
| Clinical manifestations | 319 (0) | ||
| Bacteremia only | 108 (33.9) | NA | |
| Meningitis only | 63 (19.7) | NA | |
| Meningitis with bacteremia | 138 (42.3) | NA | |
| Septic arthritis only | 5 (1.6) | NA | |
| Septic arthritis with bacteremia | 2 (0.6) | NA | |
| Meningitis and septic arthritis with bacteremia | 3 (0.9) | NA | |
| Vital signs on first presentation | |||
| Temperature >38·5°C or <36°C | 314 (5) | 150 (47.7) | NA |
| Systolic hypotension for age | 218 (101) | 84 (38.5) | NA |
| Impaired level of consciousness | 291 (28) | 99 (34.0) | NA |
| Clinical signs at first presentation | |||
| Rash in cases with bacteremia | 248 (3) | 213 (85.9) | NA |
| Includes purpura | 213 (3) | 108 (50.7) | NA |
| Includes petechiae without purpura | 213 (3) | 86 (40.4) | NA |
| Blanching only | 213 (3) | 19 (8.9) | NA |
| Meningism in cases with meningitis | 184 (20) | 111 (60.3) | NA |
| Bulging fontanelle in infants with meningitis | 43 (39) | 19 (44.2) | NA |
| Arthritis during admission | 314 (5) | 19 (6.1) | NA |
| Arthralgia during admission | 314 (5) | 23 (7.3) | NA |
Table 1. Demographic and clinical factors of 319 confirmed cases of invasive meningococcal disease in children <15 years of age, Auckland, New Zealand, 2004–2020*
*NA, not applicable.
†Each NZDep quintile contains ≈20% of the population. 1 = least deprived; 5 = most deprived.
‡Two overseas cases were excluded.
| Outcome |
No. cases/total no. (%) |
|---|---|
| Died | 13/319 (4.1) |
| Cure, complete outcome data | 258/306 (84.3) |
| Cure, incomplete outcome data | 48/306 (15.6) |
| Cure without sequelae | 197/258 (76.4) |
| Cure with sequelae | 61/258 (23.6) |
| Sequelae | |
| Neurodevelopmental | 35/258 (13.6) |
| Sensorineural hearing loss | 32/258 (12.4) |
| Skin scarring | 16/258 (6.2) |
| Loss of limbs or digits | 7/258 (2.7) |
| Chronic kidney disease | 1/258 (0.4) |
| Other sequelae* | 5/258 (1.9) |
| Neurodevelopmental sequelae | |
| Delayed development | 20/258 (7.8) |
| Cerebral ischemia | 13/258 (5) |
| Epilepsy | 8/258 (3.1) |
| Learning, concentration, behavior, psychological | 8/258 (3.1) |
| Other† | 10/258 (3.9) |
Table 2. Outcomes of 319 confirmed cases of invasive meningococcal disease in children <15 years of age, Auckland, New Zealand, 2004–2020
*Other: bone growth arrest 2/258 (0.8%); cardiomyopathy 1/258 (0.4%); gastrointestinal hemorrhage 1/258 (0.4%); panniculitis 1/258 (0.4%). †Other neurodevelopmental: chronic hydrocephalus 2/258 (0.8%); autism spectrum disorder 1/258 (0.4%); ataxia 1/258 (0.4%); carotid artery narrowing 1/258 (0.4%); chronic headache 1/258 (0·4%); cranial nerve palsy 1/258 (0.4%); encephalomalacia 1/258 (0.4%); hypertonia 1/258 (0.4%); syringomyelia 1/258 (0.4%).
| Variable |
No. cases (%) |
OR (95% CI) |
p value |
|---|---|---|---|
| Ethnicity, compared with non-Māori, non-Pacific population | |||
| Pacific | 38/118 (32.2) | 2.91 (1.31–7.18) | 0.0128 |
| Māori | 28/96 (29.2) | 2.52 (1.10–6.35) | 0.0366 |
| Reduced penicillin susceptibility | 12/64 (18.8) | 0.548 (0.25–1.14) | 0.117 |
| NZDep quintile† | 271 | 1.21 (0.95–1.58) | 0.142 |
| Age, mo† | 271 | 0.996 (0.99–1.00) | 0.157 |
| Serogroup, compared with MenB | |||
| MenC | 7/18 (38.9) | 1.80 (0.64–4.82) | 0.247 |
| MenW | 6/25 (24.0) | 0.89 (0.31–2.24) | 0.822 |
| MenY | 3/8 (37.5) | 1.70 (0.34–7.16) | 0.478 |
| Male sex, compared with female | 50/168 (29.8) | 1.39 (0.80–2.48) | 0.248 |
| Season, compared with autumn | |||
| Spring | 23/76 (30.3) | 1.47 (0.64–3.60) | 0.374 |
| Summer | 11/35 (31.4) | 1.56 (0.57–4.31) | 0.386 |
| Winter | 30/116 (25.9) | 1.19 (0.54–2.79) | 0.683 |
| MeNZB vaccination, compared with fully vaccinated | |||
| Unvaccinated | 43/166 (25.9) | 0.76 (0.39–1.51) | 0.425 |
| Partially vaccinated | 12/41 (29.3) | 0.90 (0.37–2.17) | 0.817 |
| Prehospital parenteral antibiotic treatment | 10/44 (22.7) | 0.79 (0.35–1.64) | 0.537 |
| Sepsis criteria | 39/145 (26.9) | 1.14 (0.51–2.77) | 0.751 |
Table 3. Univariate logistic regression for combined outcome of death or sequelae in 271 confirmed cases of invasive meningococcal disease in children <15 years of age, Auckland, New Zealand, 2004–2020*
*Men, Neisseria meningitidis serogroup; OR, odds ratio; NZDep, New Zealand Index of Deprivation
†Continuous variable; OR represents increase in odds for each unit increase in variable.
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We conducted a retrospective, observational study in Auckland. Eligible cases were those in children <15 years of age who contracted IMD while residing within the Auckland region during January 1, 2004–December 31, 2020. We included cases where N. meningitidis was identified by culture or PCR from a normally sterile site (i.e., blood, cerebrospinal fluid [CSF], synovial fluid).
All persons who test positive for N. meningitidis in New Zealand are actively notified as part of public health surveillance; isolates and DNA extracted from sterile site specimens are forwarded to the Meningococcal Reference Laboratory at the Institute of Environmental Science and Research[3]. The institute provided all cases confirmed by N. meningitidis culture or PCR. We collected data by using National Health Index numbers (a unique identifier for medical care for all persons residing in New Zealand)[19] from clinical and laboratory records and the National Immunization Register (an electronic record of vaccination events for New Zealand children)[20].
We categorized clinical manifestations according to the presence of bacteremia, meningitis, and septic arthritis. We defined bacteremia as a positive N. meningitidis culture or PCR from blood. We defined meningitis as a positive N. meningitidis culture or PCR from CSF or an alternative sterile site positive for N. meningitidis with a CSF leukocytosis or with clinical signs of meningitis if CSF was not obtained. We defined septic arthritis as a positive N. meningitidis culture or PCR from synovial fluid or an alternative sterile site positive for N. meningitidis with clinical signs of septic arthritis. We defined sepsis by Pediatric Sepsis Consensus Congress criteria[21]. We calculated CFR as the number of children who died divided by the total number of cases. For survivors, we classified outcomes as cure, cure with sequelae, and unknown. We used a composite outcome of death and cure with sequelae in our outcome analysis.
We obtained population denominators from Statistics New Zealand[22] and recorded prioritized ethnicity using New Zealand ethnicity data protocols[23]. We measured socioeconomic deprivation using the New Zealand Index of Deprivation (NZDep) quintiles for 2013 and 2018[24]. NZDep stratifies small geographic areas into equal-sized groups based on multiple measures of socioeconomic deprivation. We identified serogroup by serological means or by PCR. DNA sequence analysis of the porA gene determined the subtype. We defined the epidemic strain as MenB with the P1.7–2,4 subtype and defined vaccine subtype IMD as any serogroup with the P1.7–2,4 subtype. We determined MICs by using Etest (bioMérieux). We categorized isolates with penicillin MICs of >0.06 mg/L as having reduced penicillin susceptibility and interpreted ceftriaxone, ciprofloxacin, and rifampin MICs according to standardized breakpoints[25]. We defined MeNZB vaccination status as fully vaccinated (received all approved doses for age), partially vaccinated (received less than approved doses for age), unvaccinated (received no doses), or ineligible (born outside of the MeNZB program period). We obtained approval for the study from the Health and Disability Ethics Committees (18/NTA/86/AM02).
We performed calculations using R (The R Foundation for Statistical Computing, https://www.r-project.org) and OpenEpi (Open Source Epidemiologic Statistics for Public Health, https://www.openepi.com). We included only cases with available data in the analysis of each variable. We employed a 2-tailed test to determine p values, using a significance level of 0.05, and used a Poisson model to investigate temporal trends in IMD and the epidemic strain. We used univariate logistic regression to investigate factors associated with an increased risk of death or sequelae and χ2 test to compare rates and calculate 95% CIs. We compared MeNZB vaccination status with timing of IMD illness by using analysis of variance and independent samples t-tests.
