Prithvi Raj Sendi, MD
Nicklaus Children's Hospital
Miami, Florida
Disclosure information not submitted.
Paul Martinez, MD
Assistant Professor
Nicklaus Children's Hospital, United States
Disclosure information not submitted.
Balagangadhar Totapally, MBBS, MD, DCH, MRCP, FAAP, FCCP, FCCM
Chief, Division of Critical Care Medicine. Program Director, Critical Care Fellowship Program
Nicklaus Children's Hospital, United States
Disclosure information not submitted.
Title: Temporal Trends of meningococcal disease and mortality in children from 1997 to 2016
Introduction: The prevalence of meningococcal disease has decreased over time, but the changing prevalence and associated case fatality rate have not been described at a national level. The aim of this study was to evaluate the trends in prevalence and mortality associated with meningococcal disease in the US between the years 1997 and 2016.
Methods: A retrospective analysis of the Healthcare Cost and Utilization Project’s Kids’ Inpatient Database from the years 1997 to 2016 was performed. Patients, 29 days to 20 years, with meningococcal disease were selected using respective ICD 9 and ICD 10 codes. Mid-year population for the age group was obtained from US Census Bureau to calculate hospitalization rates per 100,000 population. Trend analyses (StatCalc, CDC) were performed to evaluate hospitalization rate, prevalence, and case fatality rate of meningococcal disease from 1997-2016.
Results: The meningococcal disease hospitalization rate in the general population decreased from 0.25/100,000 individuals in 1997 to 0.02/100,000 individuals in 2016 (p < 0.001). Among those who were hospitalized, the prevalence decreased from 6.8/10,000 discharges in 1997 to 0.8/10,000 discharges in 2016 (p < 0.001) The overall prevalence during the study period was 2.7/10,000 discharges. The majority of the discharges with meningococcal disease were male (57%) and in white (48.1%)). The median age of patients with meningococcal disease was 5 years (IQR:1-14) and the length of stay was 6 days (IQR:3-8). The median length of stay for survivors of meningococcal disease was 6 days (IQR: 4-9), but for those who died it was 1 day (IQR: 0-2). The case fatality rate for meningococcal disease was 5.5%. Age-specific mortality was highest in late-adolescents (8.1%) and lowest in infants (4.8%). Mortality was higher when associated with hemodialysis 29.6% (OR:7.5, 95% CI: 3.4-16.7) and mechanical ventilation 22.1% (OR:10.3, 95% CI: 7.3-14.6). Amputation was performed in 1.4% of patients. There was no change in the case fatality rate of meningococcal disease during the study period (p=0.09).
Conclusion: From 1997 to 2016, the prevalence of meningococcal disease declined while the case fatality rate was unchanged. The reasons for unchanged case fatality rate with meningococcal disease in the era of the Surviving Sepsis Campaign should be explored.