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Published online March 2, 2009
PEDIATRICS Vol. 123 No. 3 March 2009, pp. e502-e509 (doi:10.1542/peds.2008-0581)
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ARTICLE

Outcomes of Meningococcal Disease in Adolescence: Prospective, Matched-Cohort Study

Jennie Borg, PhDa, Deborah Christie, PhDa, Pietro G. Coen, PhDb, Robert Booy, MBBS, MDb,c, Russell M. Viner, MBBS, PhDa

a Department of General and Adolescent Paediatrics, UCL Institute of Child Health, University College London, London, England
b Academic Department of Child Health, Queen Mary's School of Medicine and Dentistry, University of London, London, England
c National Centre for Immunisation, Research, and Surveillance, Children's Hospital Westmead, University of Sydney, Sydney, Australia

OBJECTIVE. We examined the physical, cognitive, educational, social, and psychological outcomes of invasive meningococcal disease in adolescence, as well as demographic and disease factors associated with outcomes.

METHODS. A population-based, matched-cohort study was performed. A total of 101 gender- and age-matched case-control pairs (15–19 years of age at the time of disease; 46% male) from 6 regions of England underwent follow-up evaluations 18 to 36 months after invasive meningococcal disease. Educational, social, and vocational function, mental health, social support, self-efficacy, and quality-of-life data were collected by using standardized questionnaires and neuropsychological tests.

RESULTS. Fifty-seven percent of case subjects (n = 58) had major physical sequelae. Survivors had greater depressive symptoms, greater fatigue, less social support, greater reduction in quality of life, and lower educational attainment compared with control subjects. Survivors with serogroup C disease had greater physical sequelae than did those with serogroup B disease. Greater cognitive deficits were associated with younger age at diagnosis. Only 53 of 101 case subjects reported any medical follow-up care after invasive meningococcal disease.

CONCLUSIONS. Survivors of invasive meningococcal disease in adolescence have a disturbing series of deficits, including poorer physical and mental health, quality of life, and educational achievement. Serogroup C is associated with poorer outcomes. Invasive meningococcal disease attributable to serogroup B disease remains a major cause of morbidity and death among adolescents. Medical care is poor after discharge from the hospital. Routine follow-up care of adolescent survivors may prevent or ameliorate physical and psychosocial morbidity after invasive meningococcal disease.

Key Words: adolescence • meningococcus • meningococcal disease • outcome study • adolescent

Abbreviations: ASBIR—Annotated Scale of Bodily Injuries Regulation • BDI-II—Beck Depression Inventory II • CSS—cognitive summary score • GCSE—General Certificate of Secondary Education • IMD—invasive meningococcal disease • QoL—quality of life • SF-36-II—Short Form 36 Health Survey, version II

Accepted Oct 17, 2008.


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