Invasive meningococcal disease: Timing and cause of death in England, 2008–2015

2020 
Abstract Background Neisseria meningitidis is a major cause of bacterial meningitis and septicaemia, with death often occurring rapidly after onset of the first symptoms. Later death can also occur later, but may be due to other causes, such as underlying comorbidities. The study aimed to assess the timing and cause of death in patients with invasive meningococcal disease (IMD) prior to the introduction of two new meningococcal immunisation programmes in England Methods Public Health England (PHE) conducts IMD surveillance in England through its national meningococcal reference unit. Laboratory-confirmed IMD cases diagnosed during 2008-2015 were linked to weekly and annual electronic death registration records as well as the online Patient Demographic Service (PDS). Results Overall, 6,734 of 6,808 (99%) laboratory-confirmed IMD cases matched to PDS, including 668 fatalities. Of these, 667 linked to an annual death registrations compared to 405 to weekly registrations. In total, 429/667 (64.3%) of all deaths and 428/502 (85.3%) of IMD-related deaths occurred within one day of diagnosis. At 30 days after IMD diagnosis, 498/667 (74.7%) had died and 98.4% (490/498) were IMD-related. Serogroup B contributed to 64% (323/502) of IMD-related deaths, followed by serogroup W (84/502, 17%) and serogroup Y (70/502, 14%). Deaths occurring after 30 days were less likely to be IMD-related, mainly among ≥65 year-olds, with malignancy, chronic respiratory and cardiac conditions predominating. Conclusions Most IMD-related deaths occurred within a day of diagnosis and nearly all IMD-related deaths occurred within 30 days of diagnosis. The rapidity of death highlights the importance of prevention through vaccination.
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