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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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    Associate Director, Accreditation and Compliance, Medscape, LLC


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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, MDFaculty and Disclosures

CME / ABIM MOC Released: 3/16/2023

Valid for credit through: 3/16/2024



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