Abstract
Pediatric cases of invasive meningococcal disease (IMD) during the 1998 to 2001, hyperendemic
period in Switzerland, were investigated. Retrospective analysis of confirmed and
probable cases of IMD, in patients <16 years of age, identified at the University
of Bern Children's Hospital, during a 5-year period beginning on February 1, 1997,
was done. Sixty-two cases were identified (22% of nationally reported cases of pediatric
IMD). Thirty-eight cases (61%) were culture confirmed. Probable cases were clinically
indistinguishable, but significantly more likely to be secondary referrals and to
have received pre-admission antibiotics (OR 5.4; 95%CI 1.8–16.4). The proportion of
confirmed cases was significantly smaller than among all cases reported to the Swiss
Federal Office of Public Health (83%; OR 0.32, 95%CI 0.19–0.57). The distance between
the patients' place of residence and the tertiary care center did not correlate with
the delay from onset of IMD to treatment and admission. The presence of petechiae
(n = 38) was associated with a significantly shorter median delay from onset of IMD
to admission (18 vs. 25 hours, P = 0.016). Case fatality rate was 5%. In conclusion, secondary referrals of IMD patients,
having received pre-admission antibiotics, reduce the number of culture-confirmed
cases. The large proportion of culture-negative (i.e., probable) IMD cases in comparison
with national data indicates that probable cases are incompletely reported to the
federal authorities. Additional efforts (e.g., meningococcal polymerase chain reaction)
are needed to improve the surveillance of pediatric IMD in Switzerland.
Keywords
Neisseria meningitides
- serogroup C - child - epidemiology - meningococcal conjugate vaccine
