Long-term outcomes of pneumococcal meningitis in childhood and adolescence
Christie D., Viner RM., Knox K., Coen PG., Wang H., El Bashir H., Legood R., Patel BC., Booy R.
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. © 2011 Springer-Verlag.