Epidemiology and prognostic factors in meningococcal disease in a small island population: Malta 1994-1998.

STUDY OBJECTIVE

To review the epidemiology of meningococcal disease in Malta over the period 1994-1998, and to identify factors at presentation and in the management of meningococcal disease which may influence mortality.

DESIGN

All admissions with meningococcal disease to a national hospital in a population-based study over the period 1994-1998 were studied retrospectively.

MAIN RESULTS

Fifty-six cases were diagnosed over 1994-1998, the incidence rising from 0.8/100,000 to 7.2/100,000 total population (p < 0.0001). The median time interval from arrival at hospital to administration of parenteral antibiotic decreased over the 5-year period from 4.4 to 1.2 hours (p = 0.025), with no significant change in the case-fatality rate. There was no association between the time interval from arrival at hospital to parenteral antibiotic administration, and mortality. The following features at presentation were associated with increased mortality: older age (p = 0.03), meningococcaemia compared with meningitis (p = 0.05), shock (p < 0.0001), disseminated intravascular coagulation (p = 0.0001), a normal/low white blood cell count (p = 0.0003), a low platelet count (p = 0.0001) and a high serum creatinine (p = 0.003).

CONCLUSIONS

The upsurge of cases in the population was accompanied by a decrease in intervention time in the general hospital, probably due to increased awareness of the disease. This study did not show a positive relationship between early in-hospital administration of antibiotics and improved survival, probably because antibiotics were given earlier to those with fulminant disease and, with therefore, an inherently worse outcome. Stratification of cases by severity on admission is recommended in future studies.