Sustained reductions of invasive infectious disease following general infant Haemophilus influenzae type b and pneumococcal vaccination in a Swedish Arctic region

Abstract

Aim: Vaccine-preventable pathogens causing severe childhood infections include Haemophilus influenzae type b (Hib), Streptococcus pneumoniae and Neisseria meningitidis. In this study conducted in a Swedish Arctic region, we evaluated the effects of general infant Hib and pneumococcal vaccination on invasive infectious diseases among children and assessed the need of meningococcal vaccination. Methods:We identified cases of bacterial meningitis and sepsis from diagnosis and laboratory registers in the V€ asterbotten Region, Sweden, during 1986-2015. We then reviewed medical records to confirm the diagnosis and extract data for assessing incidence changes, using an exploratory data analysis and a time-series analysis.Results: Invasive Haemophilus disease declined by 89.1% (p < 0.01), Haemophilus meningitis by 95.3% (p < 0.01) and all-cause bacterial meningitis by 82.3% (p < 0.01) in children aged 0 to four years following general infant Hib vaccination. Following pneumococcal vaccination, invasive pneumococcal disease declined by 84.7% (p < 0.01), pneumococcal meningitis by 67.5% (p = 0.16) and all-cause bacterial meningitis by 48.0% (p = 0.23). Incidence of invasive meningococcal disease remained low during the study period.Conclusion: Remarkable sustained long-term declines of invasive infectious diseases in younger children occurred following infant Hib and pneumococcal vaccinations in this Swedish Arctic region. Despite not offering general infant meningococcal vaccination, incidence of invasive meningococcal disease remained low.

MeningiSSS: A New Predictive Score to Support Decision on Invasive Procedures to Monitor or Manage the Intracerebral Pressure in Children with Bacterial Meningitis

“…At discharge, a full recovery (PCPC category one) was seen for 78% (CI 69-85) of all children, whereas an adverse short-term outcome (PCPC category two to six) occured in 22% (CI 15-31) either neurological disabilities (PCPC category two to five) seen in 16% (CI [10][11][12][13][14][15][16][17][18][19][20][21][22][23][24] or death (PCPC category six) seen in 6% (CI [3][4][5][6][7][8][9][10][11][12]. No additional deaths occurred within 30 days of discharge.…”

“…In this retrospective study, we developed a new predictive score for children with bacterial meningitis, the "Meningitis Swedish Survival Score" (MeningiSSS), based on a systematic review [2]. We then used a database containing 101 cases of bacterial meningitis [1,19] to test our score's predictive ability for a limited number of predefined outcomes and to compare it with existing predictive scores and individual risk factors (Table 1).…”

“…During two previous studies [1,19], we created a database containing information on 1143 cases of severe infections in children aged one month to 17 years being treated in Västerbotten County, Sweden, during the period 1986-2015. Cases for this database were identified using Västerbotten County Council's diagnosis registry searching for international classification of disease diagnostic (ICD) codes of bacterial meningitis and sepsis (ICD-8/9: 036, 038 and 320, ICD-10: A39, A40, A41 and G00), as well as laboratory records of positive bacterial cultures.…”

Hib and pneumococcal vaccines work also in far North

“…Colleagues from Sweden have analysed a fairly large (N 364) series of invasive (i.e. culture‐positive) infections of childhood in the Northern Västerbotten region from years 1986 to 2015 . Special attention was paid to bacterial meningitis.…”

“…The bulk of data depict, however, the declining incidence of children’s occult bacteraemia, not sepsis, meningitis, or severe pneumonia. This said, of special importance was the information from Västerbotten that the incidence of Pnc meningitis at age 0–4 years declined by 48% from 5.0 to 1.1 per 100.000 per year . Comparative data would have been welcome for sepsis and blood‐culture‐positive pneumonia, but perhaps their paucity hindered reliable figures.…”