Papers

Case fatality rates for meningococcal disease in an English population, 1963-98: database study

BMJ 2003; 327 doi: http://dx.doi.org/10.1136/bmj.327.7415.596 (Published 11 September 2003) Cite this as: BMJ 2003;327:596
  1. Michael J Goldacre, professor of public health1 (michael.goldacre{at}dphpc.ox.ac.uk),
  2. Stephen E Roberts, statistician1,
  3. David Yeates, computer scientist1
  1. Unit of Health-Care Epidemiology, Department of Public Health, University of Oxford, Oxford OX3 7LF
  1. Correspondence to: M Goldacre
  • Accepted 16 June 2003

Introduction

Meningococcal septicaemia and meningitis are common causes of death in children and young adults. In fatal cases, the time from onset to death is often short. We analysed casefatality rates for meningococcal disease between 1963 and 1998 to determine whether they have decreased.

Methods and results

We used data on meningococcal disease from the Oxford record linkage study database, which includes anonymised statistical abstracts of records of admission to hospital and death certificates in a defined population of 0.35 million people from 1963, 0.9 million from 1966, 1.9 million from 1974, and 2.5 million from 1987 to 1998. We calculated incidence of meningococcal disease and case fatality rates and assessed the significance of trends over time with logistic regression.

From 1963 to 1998, 1223 people had a record of admission to hospital for meningococcal meningitis or meningococcal septicaemia and 25 for other diagnoses—mainly meningitis or septicaemia without specification of an organism and a death certificate that specified meningococcal disease. The median age of these 1248 was 6 years; 255 (20%) were < 1 year old, 422 (34%) were 1-9 years old, 279 (22%) were 10-19 years old, 290 (23%) were ≥20 years old, and the ages of two were unknown; 116 died within 30 days and five more within 365 days of admission.

Analysis of the database showed that a further 25 people had died from meningococcal disease. Fifteen died in a hospital in the region but had no record of admission; they had probably been brought in dead or died soon after arrival at hospital without a formal admission. Ten had died at residential addresses. The median age of the 25 was 16 years, and 11 (44%) were aged at least 20 years. Of all 146 people who died, 25 (17%) died without admission to hospital, 41 (28%) died on the day of admission, and 40 (27%) died the day after admission.

Incidence has risen substantially in recent years (table). Case fatality rates have not significantly declined over time (P = 0.31 for cases admitted to hospital, and P = 0.28 for all cases). We found no significant trends in case fatality rates within individual age groups (see tables on bmj.com). For those admitted to hospital, case fatality rates at 30 days were similar in the teaching hospital (8.9%; 95% confidence interval 5.6% to 12.2%) and non-teaching hospitals (9.4%; 7.6% to 11.3%), and in males and females.

Cases of meningococcal disease* from the Oxford record linkage study database, number of deaths within 30 days and case fatality rate per 100 000, 1963-98

View this table:

Comment

Case fatality rates for meningococcal disease in the Oxford region have not fallen since the late 1960s. Others have also reported no recent reduction in case fatality rates in population based studies,13 although recent declines in a specialist paediatric unit have been described.4 In our study, a relatively high percentage of people who died outside hospital, or on arrival, were adults and perhaps had been less closely observed than children in their illness outside hospital. Our case fatality rate of 11% is the same as that found in a study based on multiple source case ascertainment and case note review in an adjacent health region in 1969-74.4 In that study, 22% of all deaths, compared to 17% in this study, occurred without admission to hospital or in people who were dead on arrival.5

The time from onset to death is usually rapid. This, and the fact that death rates have not declined, emphasises the need for vigilance in making the diagnosis and the importance of prevention through immunisation and, when appropriate, chemoprophylaxis for contacts.

Footnotes

  • Embedded Image Tables for specific age groups are on bmj.com

  • Contributors MJG designed the study and wrote the manuscript. SER did the analyses and wrote the manuscript. DY programmed the Oxford record linkage study database. MJG and SER are guarantors.

  • Funding SER receives funding from the Department of Health as part of its funding for the National Centre for Health Outcomes Development; and the Unit of Health-Care Epidemiology is funded by the Research and Development Directorate of the Department of Health and Social Care (South). The views expressed in this paper are those of the authors and not necessarily those of the Department of Health.

  • Competing interests None declared.

References