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Meningococcal Disease in Children in Argentina A 3-year Active Sentinel Hospital Surveillance Study

Gentile, Ángela MD; Bakir, Julia MD; Agosti, María Rosa MD; Ensinck, Gabriela MD; Abate, Hector MD; Gajo Gane, Andrea MD; Santillán Iturres, Alejandro MD; Efron, Adriana MSc; Regueira, Mabel MSc; Rüttimann, Ricardo MDon behalf of the Neisseria meningitidis Working Group

The Pediatric Infectious Disease Journal: March 2017 - Volume 36 - Issue 3 - p 296–300
doi: 10.1097/INF.0000000000001429
Original Studies

Background: Meningococcal disease (MD) is a medical emergency and a serious public health problem. As new meningococcal vaccines become available, MD surveillance is crucial to provide baseline epidemiologic data before implementing preventive measures. We estimated MD incidence and epidemiology in Argentina using hospital-based surveillance.

Methods: Three-year prospective active surveillance in patients ≤15 years of age was conducted at 6 pediatric hospital sentinel units (March 2012 to February 2015).

Results: Of 184,360 hospitalized patients, 1444 (0.78%) had suspected meningitis or MD. Of these, 268 (19%) presented probable acute bacterial meningitis or MD, 168 (63%) were culture positive and 51 (30%) tested positive for Neisseria meningitidis. Of 100 culture-negative cases, 30 had positive meningococcal polymerase chain reaction. Thirteen patients presented other uncommon MD manifestations, resulting in a total of 94 MD cases and an annual incidence of 5.1/104 hospitalized patients [95% confidence interval (CI): 4–6]. Fifty-four (57%) patients were males, 48% were <1 year of age and the median age was 12.5 months (1 month to 15 years). Clinical presentations were the following: meningococcemia and meningitis (37%), meningitis (30%), meningococcemia (16%), arthritis (10%), bacteremia (5%) and pneumonia (2%). Twenty-eight percent had complications. Nine children died (case fatality rate: 10%), and 8 had sequelae. Serogroups were identified for 84 isolates. Serogroup W was associated with age <1 year (odds ratio: 3.18; 95% CI: 1.14–8.99); meningococcemia was associated with mortality (P = 0.0038).

Conclusions: Highest rates of MD were observed among young infants. This study provides baseline data to estimate the impact of introducing meningococcal vaccines in Argentina.

Supplemental Digital Content is available in the text.

From the *Epidemiology Unit, Ricardo Gutiérrez Children’s Hospital, Buenos Aires, Argentina; Infectious Disease Unit, Sor María Ludovica Children’s Hospital, La Plata, Argentina; Infectious Disease Unit, Victor Vilela Children’s Hospital, Rosario, Argentina; §Infectious Disease Unit, Humberto Notti Pediatric Hospital, Mendoza, Argentina; Infectious Disease Unit, Juan Pablo II Pediatric Hospital, Corrientes, Argentina; Infectious Disease Unit, Eva Perón Children’s Hospital, Catamarca, Argentina; **Bacteriology Unit, INEI-ANLIS “Dr. Carlos G. Malbrán”; and ††Infectious Disease Unit, FUNCEI, Buenos Aires, Argentina.

Accepted for publication September 12, 2016.

Novartis Vaccines provided financial support for the conduct of this study. The authors have no conflict of interest 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: Ángela Gentile, MD, Ricardo Gutiérrez Children´s Hospital, Beauchef 214, C1424BDF Buenos Aires, Argentina. E-mail: angelagentile21@gmail.com.

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