Meningitis in children in Fiji

Etiology, epidemiology, and neurological sequelae

Viema Lewagalu Biaukula, Lisi Tikoduadua, Kristy Azzopardi, Anna Seduadua, Ellinor Temple, Peter C Richmond, Roy M Robins-Browne, Edward (Kim) MULHOLLAND, Fiona Russell

Research output: Contribution to journalArticleResearchpeer-review

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. 
Original languageEnglish
Pages (from-to)e289-e295
Number of pages7
JournalInternational Journal of Infectious Diseases
Volume16
Issue number4
DOIs
Publication statusPublished - Apr 2012

Fingerprint

Fiji
Meningitis
Epidemiology
Bacterial Meningitides
Quality of Life
Enterovirus
Viral Meningitis
Disease Outbreaks
Haemophilus influenzae type b
Streptococcus pneumoniae
Cerebrospinal Fluid
Audiometry
Neisseria meningitidis
Multiplex Polymerase Chain Reaction
Deafness
Streptococcus
Mycobacterium tuberculosis
Confidence Intervals
Pediatrics
Antigens

Cite this

Biaukula, V. L., Tikoduadua, L., Azzopardi, K., Seduadua, A., Temple, E., Richmond, P. C., ... Russell, F. (2012). Meningitis in children in Fiji: Etiology, epidemiology, and neurological sequelae. International Journal of Infectious Diseases, 16(4), e289-e295. https://doi.org/10.1016/j.ijid.2011.12.013
Biaukula, Viema Lewagalu ; Tikoduadua, Lisi ; Azzopardi, Kristy ; Seduadua, Anna ; Temple, Ellinor ; Richmond, Peter C ; Robins-Browne, Roy M ; MULHOLLAND, Edward (Kim) ; Russell, Fiona. / Meningitis in children in Fiji : Etiology, epidemiology, and neurological sequelae. In: International Journal of Infectious Diseases. 2012 ; Vol. 16, No. 4. pp. e289-e295.
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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. ",
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Biaukula, VL, Tikoduadua, L, Azzopardi, K, Seduadua, A, Temple, E, Richmond, PC, Robins-Browne, RM, MULHOLLAND, EK & Russell, F 2012, 'Meningitis in children in Fiji: Etiology, epidemiology, and neurological sequelae', International Journal of Infectious Diseases, vol. 16, no. 4, pp. e289-e295. https://doi.org/10.1016/j.ijid.2011.12.013

Meningitis in children in Fiji : Etiology, epidemiology, and neurological sequelae. / Biaukula, Viema Lewagalu; Tikoduadua, Lisi; Azzopardi, Kristy; Seduadua, Anna; Temple, Ellinor; Richmond, Peter C; Robins-Browne, Roy M; MULHOLLAND, Edward (Kim); Russell, Fiona.

In: International Journal of Infectious Diseases, Vol. 16, No. 4, 04.2012, p. e289-e295.

Research output: Contribution to journalArticleResearchpeer-review

TY - JOUR

T1 - Meningitis in children in Fiji

T2 - Etiology, epidemiology, and neurological sequelae

AU - Biaukula, Viema Lewagalu

AU - Tikoduadua, Lisi

AU - Azzopardi, Kristy

AU - Seduadua, Anna

AU - Temple, Ellinor

AU - Richmond, Peter C

AU - Robins-Browne, Roy M

AU - MULHOLLAND, Edward (Kim)

AU - Russell, Fiona

PY - 2012/4

Y1 - 2012/4

N2 - 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. 

AB - 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. 

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KW - article

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KW - cerebrospinal fluid

KW - child

KW - childhood disease

KW - Enterovirus

KW - fatality

KW - female

KW - fever

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KW - Haemophilus influenzae type b

KW - human

KW - inappropriate vasopressin secretion

KW - incidence

KW - infant

KW - male

KW - meningitis

KW - Neisseria meningitidis

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KW - paresis

KW - perception deafness

KW - photophobia

KW - pneumonia

KW - preschool child

KW - quality of life

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KW - shock

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KW - Staphylococcus aureus

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KW - Streptococcus pneumoniae

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KW - Child, Preschool

KW - Female

KW - Humans

KW - Incidence

KW - Infant

KW - Male

KW - Meningitis, Pneumococcal

KW - Meningitis, Viral

KW - Prospective Studies

KW - Seizures

U2 - 10.1016/j.ijid.2011.12.013

DO - 10.1016/j.ijid.2011.12.013

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SP - e289-e295

JO - International Journal of Infectious Diseases

JF - International Journal of Infectious Diseases

SN - 1201-9712

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