General practice

Prospective study of bacterial meningitis in North East Thames region, 1991-3, during introduction of Haemophilus influenzae vaccine

^a Department of Medical Microbiology, The London Hospital Medical College, London E1 2AD, ^b Department of Epidemiology and Medical Statistics, The London Hospital Medical College at QMW, London E1 4NS

Correspondence to: Professor Feldman.

Abstract

Objective: To describe the epidemiology of primary bacterial meningitis in the North East Thames region over a three year period before and during the introduction of the vaccine for Haemophilus influenzae type b.
Design: Analysis of information on cases of primary bacterial meningitis identified by microbiology laboratories in the region, with collection of case data by questionnaire.
Main outcome measures: Annual incidence rates for types of meningitis according to age and ethnic group.
Results: The annual incidence rates for the three major causes of bacterial meningitis in the general population were 1.9/100000 for Neisseria meningitidis, 1.6/100000 for Haemophilus influenzae before vaccination, and 1.0/100000 for Streptococcus pneumoniae. Higher rates of H influenzae meningitis were found in Asians compared with white people (3.6/100000 v 1.5/100000, P = 0.01). As a result of the vaccine programme introduced in October 1992 the number of cases of H influenzae meningitis in children under 5 years has fallen by 87%.
Conclusions: Bacterial meningitis is a serious problem especially in preschool children. There are differences in the incidence of some causes of bacterial meningitis in different ethnic groups; with H influenzae type b being significantly more common among black and Asian people than among white people. The immunisation programme for H influenzae type b in the North East Thames region has been successful in reducing the incidence of this type of meningitis in Asian and white populations. The numbers were too small to evaluate in the black population.

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