The Indian Journal of Pediatrics

, Volume 81, Issue 2, pp 203–204

Invasive Meningococcal Disease: The Need for Immunization in Childhood


  • Sarah Sian Thandi Hicks
    • Department of PediatricsGreat Western Hospital
    • Department of PediatricsGreat Western Hospital
  • Stanley Tamuka Zengeya
    • Department of PediatricsGreat Western Hospital
  • Georgina M. G. Williams
    • Department of PediatricsGreat Western Hospital

DOI: 10.1007/s12098-013-0997-8

Cite this article as:
Hicks, S.S.T., Paul, S.P., Zengeya, S.T. et al. Indian J Pediatr (2014) 81: 203. doi:10.1007/s12098-013-0997-8

To the Editor: We read with interest the paper by Dass Hazarika et al. describing analysis of 110 cases of invasive meningococcal disease (IMD) in North-Eastern India; purpura and rashes were noted in a quarter of cases (23.6 %) [1]. Wells et al. highlighted that only 11 % cases of non-blanching rash were associated with IMD; other conditions e.g., tonsillitis, Henoch Schönlein Purpura (HSP), were more frequent in clinical practice [2]. Meningococcal-C vaccine was introduced in the UK in 1999 and is likely to have further reduced the overall incidence of IMD. A recent Joint Committee on Vaccination and Immunisation (JCVI) report confirmed a 95 % fall in incidence of IMD caused by serogroup C Meningococcus in the UK [3].

A retrospective clinical audit (August’2010 to June’2012) was done to review all children admitted to pediatric ward with a non-blanching rash; our clinical management showed full compliance with the NICE guidelines [4]. Ninety-nine children were identified and computerized patient records reviewed; outcome is highlighted in Fig. 1. Two children were diagnosed with IMD and treated for 10 d with intravenous ceftriaxone; serogroup B Neisseria meningitides were detected in blood culture and PCR testing in both children.
Fig. 1

Outcome of the patients in the clinical audit

Interestingly the clinical audit demonstrated a significant decrease in association of a non- blanching rash with IMD: 11 % (study by Wells et al.) [2] to 2 % (our study). Our findings are concordant with the JCVI report: 88 % of IMD in the UK is now caused by serogroup B Neisseria meningitides [3]. This calls for a change in practice in managing afebrile, fully immunized, well children with a non-blanching rash: there is a need to rationalize invasive investigations. However, if a clinical suspicion about IMD arises, blood tests and antibiotics are necessary. The child with IMD is more likely to be febrile and clinically unwell [1, 2].

This clinical audit is a pilot study highlighting the need for a bigger study to confirm that IMD with non-blanching rash is less likely in post meningococcal-C immunization era in the UK. This decrease in incidence of IMD further shows the beneficial effect of herd immunity [2, 4]. There is a need for introduction of conjugate meningococcal vaccine in developing countries like India; this will decrease the incidence and outbreaks of IMD which not only causes high mortality and morbidity but also puts constraints on health service [1, 2].

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© Dr. K C Chaudhuri Foundation 2013