ArticlesOutcomes of invasive meningococcal serogroup B disease in children and adolescents (MOSAIC): a case-control study
Introduction
Every year, 500 000 cases of invasive meningococcal disease causing 50 000 deaths are reported worldwide.1, 2 In countries using serogroup C meningococcal polysaccharide-protein conjugate vaccines, about 90% of invasive meningococcal disease is now caused by serogroup B Neisseria meningitidis.1, 2 The incidence of invasive meningococcal disease is now 0·35 per 100 000 in the USA, is 2·0 per 100 000 in the UK, and ranges from 0·30 to 8·90 cases per 100 000 population in most of Europe and the Americas.1, 2
Serogroup B meningococcal disease is now the commonest cause of life-threatening septicaemia and meningitis in children in many high-income and middle-income countries. It largely affects children younger than 5 years, with a case-fatality rate of about 5%.3 Effective vaccines for serogroup B meningococcal infection have proved difficult to develop. New vaccines have recently undergone phase 3 trials,4, 5 and are currently being assessed for introduction by national agencies in many countries. Analyses are hampered by the scarcity of robust data on the burden of deficit after serogroup B meningococcal disease, which is likely to differ from that of serogroup C disease.2 We undertook a case-control study (Meningococcal outcomes in adolescents and in children, MOSAIC) to examine the disease burden in survivors of serogroup B meningococcal disease in childhood.
Section snippets
Study design and participants
We undertook a population-based case-control study, with children with meningococcal disease recruited from the UK Meningococcal Reference Unit (MRU), which identifies more than 92% of meningococcal disease reported in England, UK.6 Eligible cases were survivors with serogroup B meningococcal disease proven by culture or PCR from any normally sterile site, notified from a hospital in one of five adjacent English regions (East Midlands, West Midlands, East of England, Southeast of England, and
Results
Of 537 participants with previous serogroup B meningococcal disease who were available for recruitment, 246 (46%) were recruited, of which one withdrew during assessment (figure). The recruited participants were highly similar to unrecruited individuals in terms of age at disease (p=0·9), sex (p=0·4), and severity of disease (median length of hospital stay was 5 days [IQR 4] in both groups; p=0·4; data not shown). Non-recruited children with serogroup B meningococcal disease were more likely to
Discussion
We present comprehensive data about outcomes of survival of serogroup B meningococcal disease in childhood. Survivors were significantly more likely than matched controls to have a range of objectively measured deficits across various domains. About a tenth had major sequelae resulting in major physical or neurological disability, including major amputations, very low IQ, seizures, moderately severe bilateral hearing loss, and major hearing loss. Additionally, just over a third of survivors had
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