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The Burden of Pediatric Invasive Meningococcal Disease in Spain (2008–2013)

Rivero-Calle, Irene MD; Vilanova-Trillo, Lucia LPN; Pardo-Seco, Jacobo; Salvado, Lidia Blanco MD; Quinteiro, Laura Illade MD; Martinon-Torres, Federico PhD and MENDICOS Research Network

The Pediatric Infectious Disease Journal: April 2016 - Volume 35 - Issue 4 - p 407–413
doi: 10.1097/INF.0000000000001048
Original Studies
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Background: Invasive meningococcal disease remains a rare infectious disease not only with high mortality but also with important morbidity. Until recently no universal vaccine existed against serogroup B, which explains most of the cases in settings like Europe. The objective of this study was to analyze the clinical course and sequelae of meningococcal disease in Spain.

Methods: Retrospective review of all children younger than 15 years admitted to any of the 36 hospitals in the MENDICOS Spanish network (www.mendicos.org) with confirmed or probable invasive meningococcal disease in children between January 2008 and December 2013.

Results: A total of 458 cases were identified across the country, most of them occurring in previously healthy children (91.5%; n = 419/458). Median (interquartile range) age was 1.7 (0.7 and 4.6) years, with 53.1% of the cases occurring in children younger than 2 years; 82.1% (n = 368) were laboratory confirmed cases; 95.2% (n = 256) of those serogrouped were serogroup B. The diagnosis was meningitis in 24.9% (n = 114) of the cases, sepsis in 37.1% (n = 170) and both in 38.0% (n = 174). Mean hospital length of stay was 11.6 (10.9) days; 79.2% (n = 354) of the patients required pediatric intensive care unit admission, with a mean pediatric intensive care unit stay of 3.9 (4.9) days; 3.5% (n = 16) died; 12.9% (n = 59) of the survivors were discharged with some kind of physical sequelae, mainly neurological (n = 23).

Conclusions: Serogroup B invasive meningococcal infection explains substantial morbidity and mortality in Spain, occurring mainly in infants. The recent availability of a vaccine against serogroup B may change this scenario. Given that the vast majority of the cases occur in otherwise healthy children, inclusion of the meningococcal B vaccine in the national immunization program should be carefully considered.

From the *Translational Pediatrics and Infectious Diseases Section, Pediatrics Department, Hospital Clinico Universitario de Santiago de Compostela, Santiago de Compostela, Spain; Genetics Vaccines Infections and Pediatrics Research Group (GENVIP), Healthcare Research Institute of Santiago de Compostela, Santiago de Compostela, Spain; and Members of MENDICOS Research Network are listed in Appendix.

Accepted for publication November 23, 2015.

I.R.-C., L.V.-T. and F.M.-T. contributed equally to this article.

This study was funded by Novartis through an unrestricted grant for research in meningococcal disease granted to Healthcare Research Institute of Santiago (E0409/13). The sponsor of the study agreed the study design but had no role in the data collection, data analysis, data interpretation, or writing of the report. The corresponding author had full access to all the data in the study and had final responsibility for the decision to submit for publication. FMT’s research activities have been supported by grants from Instituto Carlos III (Intensificación de la actividad investigadora) and Fondo de Investigación Sanitaria (FIS; PI10/00540 and PI13/02382) del Plan Nacional de I+D+I and “fondos FEDER.” FMT has received research grants and/or honoraria as a consultant/advisor and/or speaker and for conducting vaccine trials from GlaxoSmithKline, Sanofi Pasteur MSD, Merck, Sanofi Pasteur, Pfizer Inc/Wyeth, Novartis, and MedImmune Inc. The rest of the authors have no conflicts of interest or funding to disclose.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal’s website (www.pidj.com).

Address for correspondence: Federico Martinón-Torres, PhD, Translational Pediatrics and Infectious Diseases Section, Pediatrics Department, Hospital Clínico Universitario de Santiago de Compostela. Travesía da Choupana, s/n, 15706., Santiago de Compostela, Spain. E-mail: federico.martinon.torres@sergas.es.

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