Community acquired bacterial meningitis and meningococcal septicaemia amongst adults in England and Wales : epidemiology and clinical management

Gjini, Ardiana (2010). Community acquired bacterial meningitis and meningococcal septicaemia amongst adults in England and Wales : epidemiology and clinical management. PhD thesis The Open University.



Background: Bacterial meningitis and meningococcal septicaemia are important causes of morbidity and mortality in the UK and elsewhere. There have been achievements in paediatric care, including vaccination; however mortality amongst otherwise healthy young adults remains high.

Objective: I undertook this study to examine the way by which the public health burden of meningitis in adults can be reduced.

Methods: I used routine surveillance data (laboratory reports, clinical notifications, hospital activity, mortality data) to examine the epidemiology and determine the changing trends. I undertook a capture-recapture study to quantify the underreporting through the routine surveillance. I conducted a retrospective review of clinical management of adult patients with meningitis in England and Wales using medical records of patients diagnosed with meningitis or meningococcal septicaemia. I examined the association of clinical management with the outcome of the disease (CABM and MS).

Findings: The epidemiology of adult meningitis in England and Wales is changing. Overall forms of CABM show no significant changing trend, whilst meningococcal septicaemia shows an increasing trend. Tubercular meningitis is increasing significantly, whilst pneumococcal, HiB and Listeria meningitis are falling. Mortality generally remains in a steady trend. There are differences by age-group and causative organisms. There is considerable (-50%) underreporting of both, incidence and mortality from all major routine surveillance systems. Hospital management of meningitis is largely sub-optimal. Main areas of deficiency in clinical care are: timely diagnosis and consequently administration of antibiotics, assessment of severity, and record keeping; and these appeared to vary between the hospitals. It is difficult to examine the association between clinical with the outcome of meningitis primarily due to confounding by severity of illness which in my study was further jeopardised by the lack of recorded data and study power.

Conclusion: This study has identified areas within public health interventions, such as vaccination policies, and clinical care, such as improved diagnosis and severity assessment, where there is potential for improvement towards a reduced public health burden of adult meningitis in England and Wales.

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