Many children continue to suffer functionally important deficits

Papers p 533

The global burden of childhood bacterial meningitis is substantial. A systematic review of 36 studies from the world's developing nations estimated that there are 126 000 cases of neonatal meningitis annually, with over 50 000 deaths.1 In these countries the major neonatal pathogens are Gram negative bacilli, such as Escherichia coli and Klebsiella species. A further recent review of almost 30 000 children and adults in 50 studies from 25 African countries found Streptococcus pneumoniae and Haemophilus influenzae type b to be the commonest causes of bacterial meningitis, with Neisseria meningitidis ranked third.2 Annually there are 400 000 cases alone of H influenzae b meningitis in the developing world: 80% are in infants, nearly 30% die, and another 30% have major impairments.3 Experience in the developed world suggests that even if mortality can be greatly reduced, the burden of continuing morbidity from meningitis in infancy remains high.

After the introduction of conjugate H influenzae b vaccines the United States has seen a 73% reduction in the incidence of paediatric bacterial meningitis, with fewer than 3000 cases each year.4 A meta-analysis of 1602 prospectively enrolled children with bacterial meningitis from 19 studies in Europe and …