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.
Physicians - maximum of 1.00 AMA PRA Category 1 Credit(s)™
ABIM Diplomates - maximum of 1.00 ABIM MOC points
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:
Medscape, LLC requires every individual in a position to control educational content to disclose all financial relationships with ineligible companies that have occurred within the past 24 months. Ineligible companies are organizations whose primary business is producing, marketing, selling, re-selling, or distributing healthcare products used by or on patients.
All relevant financial relationships for anyone with the ability to control the content of this educational activity are listed below and have been mitigated. Others involved in the planning of this activity have no relevant financial relationships.
Medscape, LLC designates this Journal-based CME activity for a maximum of 1.0 AMA PRA Category 1 Credit(s)™ . Physicians should claim only the credit commensurate with the extent of their participation in the activity.
Successful completion of this CME activity, which includes participation in the evaluation component, enables the participant to earn up to 1.0 MOC points in the American Board of Internal Medicine’s (ABIM) Maintenance of Certification (MOC) program. Participants will earn MOC points equivalent to the amount of CME credits claimed for the activity. It is the CME activity provider’s responsibility to submit participant completion information to ACCME for the purpose of granting ABIM MOC credit.
For questions regarding the content of this activity, contact the accredited provider for this CME/CE activity noted above. For technical assistance, contact [email protected]
There are no fees for participating in or receiving credit for this online educational activity. For information on applicability
and acceptance of continuing education credit for this activity, please consult your professional licensing board.
This activity is designed to be completed within the time designated on the title page; physicians should claim only those
credits that reflect the time actually spent in the activity. To successfully earn credit, participants must complete the
activity online during the valid credit period that is noted on the title page. To receive AMA PRA Category 1 Credit™, you must receive a minimum score of 70% on the post-test.
Follow these steps to earn CME/CE credit*:
You may now view or print the certificate from your CME/CE Tracker. You may print the certificate, but you cannot alter it.
Credits will be tallied in your CME/CE Tracker and archived for 6 years; at any point within this time period, you can print
out the tally as well as the certificates from the CME/CE Tracker.
*The credit that you receive is based on your user profile.
CME / ABIM MOC Released: 3/16/2023
Valid for credit through: 3/16/2024
processing....
| « Return to: A New Study Highlights the Need for the Meningitis B Vaccine for Children in New Zealand |
