Deaths from meningitis among children have plummeted in southern England by almost 60 per cent within five years, after the establishment of a specialist unit, reports research in the Archives of Disease in Childhood. The unit, at St Mary's Hospital, London, was opened in 1992 and includes the use of a mobile intensive care service.
One in 10 patients with meningitis, and as many of those with meningococcal shock will die, despite treatment with antibiotics. Those who survive may be permanently disabled as a result of limb amputation, extensive scarring, or neurological injury. Vaccination does not currently cover all strains of the bacterium.
The research involved an audit of all admissions and deaths at the Unit between 1992 and 1997 at the hospital. Referrals to the Unit are taken from hospitals across the south of England.
Some 331 children between the ages of 2 and 17 were admitted over the five years of the study. Over half were girls. Septicaemia, or blood poisoning, a common consequence of infection, and its most serious form, accounted for three quarters of the cases. Among the 33 deaths over five years, 29 were in children with septicaemia.
In 1992-3 the death rate in patients ran to 23 per cent, the expected level. But despite the numbers of admissions increasing rapidly to well over 100 in 1997, only two children died in that year, well below the expected rate of 38.
Year on year, those figures translate to a 59 per cent decline in the risk of dying from the infection. The complication rate among survivors remained more or less the same, although the rate of neurological complications fell slightly from just below 10 per cent to 7.3 per cent in 1996-7.
The authors suggest that several factors are likely to have contributed to the dramatic decline in deaths from meningitis, including improvements in intensive care. But they say, a specialist unit with mobile intensive care provides for greater expertise, and more effective and faster treatment, factors which are critical to cutting the death rate.
[Reduction in case fatality rate from meningococcal disease associated with improved healthcare delivery 2001; 85: 386-90]
Journal
Archives of Disease in Childhood