Abstract
Study objective: To review the epidemiology of meningococcal disease in Malta over the period 1994–1998, and to identify factors at presentation and in the management of meningococcal disease which may influence mortality. Design: All admissions with meningococcal disease to a national hospital in a population-based study over the period 1994–1998 were studied retrospectively. Main results: Fifty-six cases were diagnosed over 1994–1998, the incidence rising from 0.8/100,000 to 7.2/100,000 total population (p < 0.0001). The median time interval from arrival at hospital to administration of parenteral antibiotic decreased over the 5-year period from 4.4 to 1.2 hours (p = 0.025), with no significant change in the case-fatality rate. There was no association between the time interval from arrival at hospital to parenteral antibiotic administration, and mortality. The following features at presentation were associated with increased mortality: older age (p = 0.03), meningococcaemia compared with meningitis (p = 0.05), shock (p < 0.0001), disseminated intravascular coagulation (p = 0.0001), a normal/low white blood cell count (p = 0.0003), a low platelet count (p = 0.0001) and a high serum creatinine (p = 0.003). Conclusions: The upsurge of cases in the population was accompanied by a decrease in intervention time in the general hospital, probably due to increased awareness of the disease. This study did not show a positive relationship between early in-hospital administration of antibiotics and improved survival, probably because antibiotics were given earlier to those with fulminant disease and, with therefore, an inherently worse outcome. Stratification of cases by severity on admission is recommended in future studies.
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References
Connolly M, Noah N. Surveillance of Bacterial Meningitis in Europe 1996. King's European Meningitis Surveillance Unit. London (1997) p. 6.
WHO publication (Dec 1998) factsheet No. 105.
Havens PL, Garland JS, Brook MM, Dewitz BA, Stremski ES, Troshynski TJ. Trends in mortality in children hospitalised with meningococcal infections, 1957–1987. Paediatric Infec Dis J 1989; 8: 8–11.
Cartwright K, Reilly S, White D, Stuart J. Early treatment with parenteral penicillin in meningococcal disease. Br Med J 1992; 305: 143–147.
Strang J, Pugh E. Meningococcal infections: Reducing the case fatality rate by giving penicillin before admission to hospital. Br Med J 1992; 305: 141–143.
Gossain S, Constantine CE, Webberly JM. Early parenteral penicillin in meningococcal disease. Br Med J 1992; 305: 523–524.
Cartwright C, Strang J, Gossain S, Begg N. Early treatment of meningococcal disease. Br Med J 1992; 305: 774.
Sorensen HT, Nielsen GL, Schonheyder HC, et al. Outcome of pre-hospital antibiotic treatment of meningococcal disease. J Clin Epidemiol 1998; 51(9): 717–721.
Schildkamp R, Lodder M, Bijlmer H, Dankert J, Scholten R. Clinical manifestations and course of meningococcal disease in 562 patients. Scand J Infec Dis 1996; 28: 47–51.
Lancaster T. Early parenteral penicillin in meningococcal disease. Br Med J 1992; 305: 420.
Dawson L. Early parenteral penicillin in meningococcal disease. Br Med J 1992; 305: 420.
Peltola H. Early meningococcal disease: Advising the public and the profession. Lancet 1993; 342: 509–510.
Pollard AJ, Britto J, Nadel S, DeMunter C, Habibi P, Levin M. Emergency management of meningococcal disease. Arch Dis Childhood 1999; 80: 290–296.
Kornelisse RF, Hazelzet JA, Hop WC, Suur MH, van der Voort E, de Groot R. Meningococcal septic shock in children: Clinical and laboratory features, outcome, and development of a prognostic score. Clin Infec Dis 1997; 25(3): 640–646.
Flaegstad T, Kaaresen PI, Stokland T, Gutteberg T. Factors associated with fatal outcome in childhood meningococcal discase. Acta Paediatrica 1995; 84(10): 1137–1142.
Algren JT, Lai S, Cutliff SA, Richmen BJ. Predictors of outcome in acute meningococcal infection in children. Crit Care Med 1993; 21(3): 447–452.
Leclerc F, Chenaud M, Delepoulle F, Diependaele JF, Martinot A, Hue V. Prognostic value of C-reactive protein in severe infectious purpura: A comparison with eight other scores. Crit Care Med 1991; 19(3): 430–432.
Savona Ventura C. An outbreak of cerebrospinal fever in a 19th century British Mediterranean naval base. J Roy Army Med Corps 1994; 140: 155–158.
Demographic review for the Maltese Islands. Central Office of Statistics, Malta, 1997.
Cartwright K. Meningococcal disease. England: John Wiley & Sons, 1995, pp 147–151.
Carnall D. Steep rise reported in meningococcal infections. Br Med J 1996; 312: 202.
Riordan FAI, Thomson APJ, Sills JA, Hart CA. Prospective study of door to needle time in meningococcal disease. J Acci Emer Med 1998; 15: 249–251.
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Piscopo, T., Mallia-Azzopordi, C., Grech, V. et al. Epidemiology and prognostic factors in meningococcal disease in a small island population: Malta 1994–1998. Eur J Epidemiol 16, 1051–1056 (2000). https://doi.org/10.1023/A:1010865315425
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DOI: https://doi.org/10.1023/A:1010865315425