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Table 1.  


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.

Table 2.  


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)
   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%).

Table 3.  


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.


A New Study Highlights the Need for the Meningitis B Vaccine for Children in New Zealand

  • Authors: Cameron Burton, MBChB; Emma Best, MBChB; Matthew Broom, MBChB; Helen Heffernan, BSc (Hons 1); Simon Briggs, MBChB; Rachel Webb, MD
  • CME / ABIM MOC Released: 3/16/2023
  • Valid for credit through: 3/16/2024
Start Activity

  • Credits Available

    Physicians - maximum of 1.00 AMA PRA Category 1 Credit(s)™

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    You Are Eligible For

    • Letter of Completion
    • ABIM MOC points

Target Audience and Goal Statement

This activity is intended for primary care physicians, pediatricians, infectious disease specialists, and other clinicians who treat and manage children at risk for infection with Neisseria meningitidis.

The goal of this activity is for learners to be better able to evaluate the epidemiology, clinical features, and outcomes of pediatric invasive meningococcal disease.

Upon completion of this activity, participants will:

  • Assess the global epidemiology of invasive meningococcal disease
  • Analyze the epidemiology of invasive meningococcal disease among children in Aotearoa New Zealand
  • Evaluate clinical features of invasive meningococcal disease in the current study
  • Distinguish outcomes of invasive meningococcal disease in the current study


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  • Cameron Burton, MBChB

    Te Whatu Ora Counties Manukau
    University of Auckland 
    Auckland, New Zealand

  • Emma Best, MBChB

    Te Whatu Ora Te Toka Tumai Auckland
    University of Auckland
    Auckland, New Zealand

  • Matthew Broom, MBChB

    Te Whatu Ora Te Toka Tumai Auckland
    University of Auckland
    Auckland, New Zealand

  • Helen Heffernan, BSc (Hons 1)

    Institute of Environmental Science and Research
    Wellington, New Zealand

  • Simon Briggs, MBChB

    Te Whatu Ora Te Toka Tumai Auckland
    University of Auckland
    Auckland, New Zealand

  • Rachel Webb, MD

    Te Whatu Ora Te Toka Tumai Auckland
    University of Auckland
    Auckland, New Zealand

CME Author

  • Charles P. Vega, MD

    Health Sciences Clinical Professor of Family Medicine
    University of California, Irvine School of Medicine
    Irvine, California


    Charles P. Vega, MD, has the following relevant financial relationships:
    Consultant or advisor for: GlaxoSmithKline; Johnson & Johnson Pharmaceutical Research & Development, L.L.C.


  • Cheryl Salerno, BA

    Emerging Infectious Diseases


    Cheryl Salerno, BA, has no relevant financial relationships.

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  • Yaisanet Oyola, MD

    Associate Director, Accreditation and Compliance, Medscape, LLC


    Yaisanet Oyola, MD, has no relevant financial relationships.

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A New Study Highlights the Need for the Meningitis B Vaccine for Children in New Zealand: Methods



Study Design and Collection of Data

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].

Case Definitions and Variables

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).

Statistical Methods

We performed calculations using R (The R Foundation for Statistical Computing, and OpenEpi (Open Source Epidemiologic Statistics for Public Health, 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.