Mortality and Neurodevelopmental Outcomes of Acute Bacterial Meningitis in Children Aged <5 Years in Pakistan.


Khowaja, AR; Mohiuddin, S; Cohen, AL; Khalid, A; Mehmood, U; Naqvi, F; Asad, N; Pardhan, K; Mulholland, K; Hajjeh, R; Zaidi, AK; Shafqat, S; Pakistan Hib Vaccine Study Group; (2013) Mortality and Neurodevelopmental Outcomes of Acute Bacterial Meningitis in Children Aged <5 Years in Pakistan. The Journal of pediatrics, 163 (1 Suppl). S86-S91.e1. ISSN 0022-3476 DOI: 10.1016/j.jpeds.2013.03.035

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Abstract

OBJECTIVE Significant neurodevelopmental sequelae are known to occur after acute bacterial meningitis (ABM). This study determined the burden of such sequelae in Pakistani children aged <5 years to guide policies for Haemophilus influenzae type b (Hib) and pneumococcal vaccination. STUDY DESIGN Cases of ABM were recruited from hospital-based surveillance and assigned to 1 of 3 etiologic groups (Hib, Streptococcus pneumoniae, or unknown etiology). Two age-matched controls were recruited for each case. Six months after enrollment, each case underwent neurologic history and examination, neurodevelopmental evaluation, and neurophysiological hearing test. Controls were assessed in parallel. RESULTS Of 188 cases, 64 (34%) died. Mortality among subgroups were 7 (27%), 14 (28%), and 43 (39%) for Hib, Streptococcus pneumoniae, and unknown etiology, respectively. Eighty cases and 160 controls completed the assessments. Sequelae among cases included developmental delay (37%), motor deficit (31%), hearing impairment (18.5%), epilepsy (14%), and vision impairment (14%). Sequelae were higher after pneumococcal meningitis (19, 73%) compared with Hib meningitis (8, 53%). Compared with controls, cases were at significantly higher risk for all sequelae (P < .0001). CONCLUSIONS ABM causes a substantial long-term burden of poor neurodevelopmental outcomes. Hib and pneumococcal vaccines are very effective interventions to prevent meningitis and its disabling sequelae.

Item Type: Article
Faculty and Department: Faculty of Epidemiology and Population Health > Dept of Infectious Disease Epidemiology
Research Centre: Centre for Maternal, Reproductive and Child Health (MARCH)
PubMed ID: 23773600
Web of Science ID: 320652700014
URI: http://researchonline.lshtm.ac.uk/id/eprint/1090273

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