Invasive Meningococcal Disease: The Need for Immunization in Childhood
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 %) . 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 . 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 .
Interestingly the clinical audit demonstrated a significant decrease in association of a non- blanching rash with IMD: 11 % (study by Wells et al.)  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 . 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].