Affiliations: Department of Pediatrics and Institute for Infectious
Diseases, University of Bern, CH-3010 Bern, Switzerland
Note: [] Correspondence: Prof. Christoph Aebi, MD, Department of
Pediatrics, University of Bern, CH-3010 Bern, Switzerland. Tel.: +41 31 632
9487; Fax: +41 31 632 9468; E-mail: [email protected]
Abstract: Pediatric cases of invasive meningococcal disease (IMD) during the
1998 to 2001, hyperendemic period in Switzerland, were investigated.
Retrospective analysis of confirmed and probable cases of IMD, in patients
<16 years of age, identified at the University of Bern Children's Hospital,
during a 5-year period beginning on February 1, 1997, was done. Sixty-two cases
were identified (22% of nationally reported cases of pediatric IMD).
Thirty-eight cases (61% were culture confirmed. Probable cases were clinically
indistinguishable, but significantly more likely to be secondary referrals and
to have received pre-admission antibiotics (OR 5.4; 95% 1.8–16.4). The
proportion of confirmed cases was significantly smaller than among all cases
reported to the Swiss Federal Office of Public Health (83%; OR 0.32, 95%CI
0.19–0.57). The distance between the patients' place of residence and the
tertiary care center did not correlate with the delay from onset of IMD to
treatment and admission. The presence of petechiae (n=38) was associated with a
significantly shorter median delay from onset of IMD to admission (18 vs. 25
hours, P=0.016). Case fatality rate was 5%. In conclusion, secondary referrals
of IMD patients, having received pre-admission antibiotics, reduce the number
of culture-confirmed cases. The large proportion of culture-negative (i.e.,
probable) IMD cases in comparison with national data indicates that probable
cases are incompletely reported to the federal authorities. Additional efforts
(e.g., meningococcal polymerase chain reaction) are needed to improve the
surveillance of pediatric IMD in Switzerland.
