Bacterial meningitis in babies <90 days of age: Defining the current burden of disease ( NEOMEN)

1. Bacterial meningitis in babies <90 days of age: Defining the current burden of disease (NEOMEN) IO Okike, PT Heath St George’s Vaccine Institute London SW17 0QT. St. George’s Vaccine Institute Abstract: Meningitis is associated with significant mortality and morbidity in infants in the first 3 months of life. The most recent national surveillance study (1996-7) identified an overall mortality of 10% with 50% of cases having some form of disability at 5 year follow-up (24% serious); a risk of serious disability 16-fold higher than that of GP-matched controls. The mortality has declined over the last 2 decades but there has been no change in the long term morbidity. There are a number of reasons why the epidemiology and management of meningitis in this age group may have changed over the last 10 years and an accurate picture of this is needed to allow prioritisation and development of new strategies. BPSU surveillance will be undertaken for 13 months. • OBJECTIVES • Primary Objective: • To define the minimum incidence of meningitis in the UK and Ireland in infants aged less than 90 days • Secondary objectives: • To define the bacterial pathogens that cause meningitis in this age group (and the antibiotic resistance profiles of these pathogens). • 2. To describe the clinical presentation of cases of meningitis in this age group. • 3. To describe the mortality and short-term (at hospital discharge or date of BPSU notification) complication rates of meningitis in this age group. Case Definition: Case definitions and reporting instructions: Any case where the clinician has made a clinical diagnosis of bacterial meningitis in babies less than 90 days of age. Analytical case definitions: Confirmed case Isolation# of a significant* bacterial pathogen from CSF; OR Isolation# of a significant* bacterial pathogen from blood cultures AND CSF pleocytosis. (≥20 cells / mm3 for babies 0-28days old and ≥10cells/ mm3 for babies 29-90days) Probable case The presence of clinical signs of meningitis~ AND CSF pleocytosis (≥20 cells / mm3 for babies 0-28days old and ≥10cells/ mm3 for babies 29-90days) AND where appropriate IV antibiotics are given for > 7 days BUT where no significant pathogen is isolated from blood or CSF. Possible case The presence of clinical signs of meningitis~ AND a positive blood culture with a significant* pathogen AND where appropriate IV antibiotics are given for > 7 days BUT where no CSF was obtained. #Isolation refers to a positive culture. In the cases of Neisseria meningitidis, listeria monocytogenes andGroup B streptococcus a positive PCR from blood or CSF is acceptable and in the case of Streptococcus pneumoniae a positive PCR from CSF is acceptable. *Positive CSF or blood cultures for organisms generally considered to be contaminants will be excluded e.g. corynebacterium, propionibacterium, diphtheroids. In the case of coagulase negative staphylococcal (CoNS) meningitis, a definite case will be defined where the CoNS is cultured from a CSF specimen together with CSF pleocytosis (≥20 cells / mm3 for babies 0-28days old and ≥10cells/ mm3 for babies 29-90days) and clinical signs~. ~Clinical signs of meningitis are: fever or hypothermia or temperature instability PLUS 1 or more neurological findings e.g. coma, seizures, neck stiffness, apnoea, bulging fontanelle. Clinical signs of meningitis are: fever or hypothermia or temperature instability PLUS 1 or more neurological findings e.g. coma, seizures, neck stiffness, apnoea, bulging fontanelle. Age range for cases: From birth to 90 chronological days. Reporting instructions: Please report any infant seen in the last month who meets the case definition. Exclusion Criteria 1. Any baby with any type of intraventricular shunt device: Ventricular-peritoneal (VP), ventricular-atrial ( VA) or external ventricular device (EVD) 2. Any baby with spina bifida or its spectrum Study Design: The is a surveillance study in the UK and Ireland to be conducted under the auspices of the British Paediatric Surveillance Unit (BPSU). Using a monthly report card, paediatricians will be asked to notify cases of bacterial meningitis in babies of 90days of age or less. A questionnaire to the reporting paediatrician will seek details on demographics, clinical presentation, pathogen type, antibiotic profile, case fatality, outcome and aspects of management. Additionally, patients will also be identified via the HPA laboratory reporting. Cases that are reported to the HPA but not reported via the orange card will be identified by the research fellow who holds an honorary contact with the HPA. Once identified as unique case, a standard letter and questionnaire is sent to the local paediatrician for verification and completion of the questionnaire. Parents can also report a case via collaborating charities (Meningitis Research Foundation, Meningitis UK, Meningitis Trust and Group B Strep Support) Collaborators: Prof Mary Cafferkey Consultant Microbiologist, Director Irish Meningococcal and Meningitis Ref lab Dr. Katy Sinka Health Protection Scotland Dr Laura Jones Consultant paediatrician, Immunology and Infectious Diseases, Edinburgh Jane Plumb Group B Strep Support Group Dr. Nelly Ninis Consultant Paediatrician, St Mary’s Hospital, Paddington Dr Alan Johnson Clinical Scientist, HPA Dr. Mark Anthony Consultant Neonatologist Chief Investigator: Dr. Paul T Heath Funding: Meningitis Research Foundation Ethics approvalfor BPSU study Cambridgeshire 2 REC (Ref: 10/H0308/45) Study contact: Dr. Ifeanyichukwu O Okike. St George‘s Vaccine Institute, 2nd Floor Ingleby House, Blackshaw Road, Tooting London SW17 0QT Tel: +44(0)208 725 3887, Fax: +44 (0)208 725 0170. email: meningitis@sgul.ac.uk web: www.neonin.org.uk