Epidemiology and outcome of bacterial meningitis in Canadian children: 1998-1999

Background: The introduction of Hemophilus influenzae type b (Hib) conjugate vaccine as part of the routine childhood vaccination schedule in Canada has resulted in a dramatic reduction in the cases of Hib meningitis. We describe the epidemiology and outcome of bacterial meningitis in Canadian children six years after the introduction of Hib conjugate vaccine and prior to the introduction of the conjugate Streptococcus pneumoniae vaccine. Methods: A retrospective chart review from January 1998 to December 1999 of children with meningitis identified at eight Canadian tertiary care children's hospitals belonging to the PICNIC network. Results: Bacterial meningitis was documented in 104 (11%) of 970 children presenting with meningitis. The most common isolated organisms were: Streptococcus pneumoniae (54%), group B streptococci (13%), and Neisseria meningitidis (11%). The mean age was 2.2 ± 3.5 yr. Forty seven percent of the children required admission to Intensive Care Unit (ICU), and 19% required artificial ventilation. Sequelae were documented among 32 children (31%) prior to discharge and there were 6 (5.6%) deaths attributable to meningitis and sepsis. Conclusions: Bacterial meningitis is an important cause of morbidity in Canadian children with S. pneumoniae replacing H. influenzae as the leading potentially vaccine preventable cause. Despite proper initiation of antimicrobial therapy, meningitis results in great morbidity and mortality in children in Canada.