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Meningitis in children in Fiji: Etiology, epidemiology, and neurological sequelae

Biaukula, Viema Lewagalu, Tikoduadua, Lisi, Azzopardi, Kristy, Seduadua, Anna, Temple, Beth, Richmond, Peter, Robins-Browne, Roy, Mulholland, E. Kim and Russell, Fiona Mary (2012). Meningitis in children in Fiji: Etiology, epidemiology, and neurological sequelae. International Journal of Infectious Diseases,16(4):e289-e295.

Document type: Journal Article

IRMA ID bsmithxPUB95
Title Meningitis in children in Fiji: Etiology, epidemiology, and neurological sequelae
Author Biaukula, Viema Lewagalu
Tikoduadua, Lisi
Azzopardi, Kristy
Seduadua, Anna
Temple, Beth
Richmond, Peter
Robins-Browne, Roy
Mulholland, E. Kim
Russell, Fiona Mary
Journal Name International Journal of Infectious Diseases
Publication Date 2012
Volume Number 16
Issue Number 4
ISSN 1201-9712   (check CDU catalogue open catalogue search in new window)
Scopus ID 2-s2.0-84858285995
Start Page e289
End Page e295
Total Pages 7
Place of Publication United Kingdom
Publisher Elsevier Ltd
HERDC Category C1 - Journal Article (DIISR)
Abstract
Objectives
To describe the etiology, epidemiology, neurological sequelae, and quality of life of children aged 1 month to less than 5 years admitted with meningitis to the Colonial War Memorial Hospital (CWMH), Suva, Fiji.

Methods
Over a 3-year period, all eligible children with suspected meningitis admitted to CWMH had blood drawn for culture. Of these children, those for whom is was possible were tested for a four-fold rise in antibody titers to Haemophilus influenzae type b (Hib) and pneumococcal surface adhesin A (PsaA). Cerebrospinal fluid (CSF) was taken for bacteriological culture and antigen testing. CSF was also tested by PCR for Streptococcus species, Neisseria meningitidis, Hib, Mycobacterium tuberculosis, and enterovirus. Pneumococcal isolates were serotyped using multiplex-PCR reverse-line blot hybridization. Following discharge, cases underwent a neurological assessment, audiometry, and quality of life assessment (Pediatric Quality of Life Inventory (PedsQL) tool).

Results
There were 70 meningitis cases. Meningitis was more common in indigenous Fijian than Indo-Fijian children. Enterovirus was the most common etiological agent and appeared to be outbreak-associated. Streptococcus pneumoniae was the most common bacterial cause of meningitis with an annual incidence of 9.9 per 100 000 under 5 years old (95% confidence interval 4.9–17.7) and a case fatality rate of 36%. With the exception of deafness, neurological sequelae were more frequent in cases of bacterial meningitis than in viral meningitis (18.5% vs. 0%, p = 0.04). Quality of life at follow-up was significantly lower in patients with bacterial meningitis than in those with viral meningitis (p = 0.003) or meningitis of unknown etiology (p = 0.004).

Conclusions
During the study period an outbreak of enterovirus occurred making it the most common etiological agent identified. However in the absence of this outbreak, S. pneumoniae was the most common cause of childhood meningitis in Fiji. Bacterial meningitis is associated with serious sequelae and a reduced quality of life.
Keywords Pneumococcal
Meningitis
Sequelae
Epidemiology
Etiology
Children
DOI http://dx.doi.org/10.1016/j.ijid.2011.12.013   (check subscription with CDU E-Gateway service for CDU Staff and Students  check subscription with CDU E-Gateway in new window)
 
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