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Long-term outcomes of pneumococcal meningitis in childhood and adolescence

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Abstract

A vaccine to prevent pneumococcal meningitis (PM) has recently been introduced. However, contemporary data to inform cost-effectiveness analysis and justify its routine use are sparse. We examined the cognitive, educational, psychological and social outcomes of PM in childhood. We completed a population-based case–control study in two regions of the UK. Children and young people currently between 3 and 20 years of age that had been diagnosed with PM ≤14 years of age were identified from active regional surveillance. Controls were siblings or neighbours of similar age. Standardised questionnaires and neuropsychological testing was administered to assess IQ, educational attainments, memory, psychological distress, quality of life and hearing impairment. Data were available on 97 patients and 93 controls. Eighty-four patients had a sibling/neighbour-matched control. Both matched and unmatched analyses were completed, and results of the 84 matched comparisons were highly similar to the unmatched. For the total sample, controls were similar in age, ethnicity and socioeconomic status. Median age at meningitis was 11 months. Median time between meningitis and assessment was 6.0 years. In the matched analysis, partial or profound hearing impairment was reported in 14% of patients and 1% of controls. Patients had significantly lower mean full-scale IQ (p = 0.05), verbal IQ (p = 0.0008), numeracy (p = 0.02), total quality of life (p = 0.04), school functioning (p = 0.005), psychosocial functioning (p = 0.001) and psychological difficulties (p = 0.01). Parents of patients reported greater functional disability (p = 0.008), impairment in all aspects of quality of life (p = 0.001) and psychological difficulties (p < 0.0006). Findings for IQ were not materially different when analyses were repeated only in those without hearing impairment. In multivariate regression analysis that included both case–control status and hearing status, both being a patient (p = 0.001) and having profound hearing impairment (p = 0.001) were independently associated with lower full-scale IQ. Conclusions Pneumococcal meningitis is associated with major sequelae. Our findings strongly support the introduction of pneumococcal conjugate vaccine as part of routine childhood vaccination programmes internationally.

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Abbreviations

PM:

Pneumococcal meningitis

UK:

United Kingdom

FSIQ:

Full-scale IQ

VIQ:

Verbal IQ

PIQ:

Performance IQ

CSF:

Cerebrospinal fluid

MFQ:

Moods and Feelings Questionnaire

SDQ:

Strengths and Difficulties Questionnaire

QOL:

Quality of life

WPPSI-R:

Weschler Preschool and Primary Scale of Intelligence—Revised

WASI:

Weschler Abbreviated Scale of Intelligence

WORD:

Wechsler Objective Reading Dimension

WOND:

Wechsler Objective Numerical Dimension

FDI:

Functional Disability Inventory

PedsQoL:

Pediatric Quality of Life

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Acknowledgements

We are extremely grateful to all the families that participated in this study; the research team Claire Arnold, Gemma Woodley and Jacki Rumble who conducted all the interviews and assessments; Richard Moxon who provided research advice and expertise; Derek Crook who contributed to study design and subject identification. KK is supported by the NIHR Biomedical Research Centre, Oxford, UK.

Financial disclosures and conflict of interest

None

Funding

The study was funded by a research grant from the Meningitis Research Foundation. The funding body had no role in the decision to publish or the content of this article.

Ethical approval

The study was approved by the Multicentre Research Ethics Committee, North London.

Author information

Authors and Affiliations

  1. General and Adolescent Paediatrics Unit, UCL Institute of Child Health, London, UK

    Deborah Christie & Russell M. Viner

  2. Oxford Vaccine Group, Department of Paediatrics, University of Oxford, Oxford, UK

    Kyle Knox

  3. Department of Microbiology and Infectious Disease, Oxford Radcliffe Hospitals NHS Trust, Oxford, UK

    Kyle Knox

  4. Centre for Child Health, Barts and the London School of Medicine and Dentistry, Queen Mary, University of London, London, UK

    Pietro G. Coen, Haitham El Bashir & Robert Booy

  5. Health Economics Research Centre, Department of Public Health, University of Oxford, Oxford, UK

    Rosa Legood

  6. Department of Microbiology and HPA Collaborating Laboratory, North West London Hospitals NHS Trust, Harrow, UK

    Bharat C. Patel

  7. National Centre for Immunization Research and Surveillance, Children’s Hospital at Westmead, University of Sydney, Sydney, Australia

    Han Wang & Robert Booy

Authors
  1. Deborah Christie
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  2. Russell M. Viner
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  3. Kyle Knox
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  4. Pietro G. Coen
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  7. Rosa Legood
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  9. Robert Booy
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Corresponding author

Correspondence to Deborah Christie.

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Christie, D., Viner, R.M., Knox, K. et al. Long-term outcomes of pneumococcal meningitis in childhood and adolescence. Eur J Pediatr 170, 997–1006 (2011). https://doi.org/10.1007/s00431-010-1390-5

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  • DOI: https://doi.org/10.1007/s00431-010-1390-5

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