Adolescents who survived invasive meningococcal disease, particularly
disease attributable to serogroup C, had poorer physical and mental health,
quality of life and educational achievements than those who did not experience
Routine follow-up care of adolescent survivors may prevent or
ameliorate physical and psychosocial morbidity after invasive meningococcal
disease, the researchers wrote.
They conducted a population-based, matched-cohort study involving 101
sex- and age-matched case-control pairs. Participants were aged 15 to 19 years
and follow-up evaluations were performed 18 to 36 months following invasive
Following illness, 53 of the 101 participants who had experienced
disease reported contact with a health care professional. After adjustment for
life stressors, cases were significantly more likely to report depressive
symptoms, and about 20% of participants within the clinical range for
depressive symptoms had received referral to an appropriate specialist.
Results from the Annotated Scale of Bodily Injuries Regulation (ASBIR)
revealed that 57% (n=58) had major physical sequelae including skin scarring;
vertigo; mobility, speech and hearing problems; amputation; seizures; and
symptoms consistent with Raynauds phenomenon. Physical outcomes were
worse among patients with serogroup C invasive meningococcal disease with an
average ASBIR score of 60% compared with scores of 20% reported by patients
with serogroup B invasive meningococcal disease (P=.06).
Overall, participants who experienced invasive meningococcal disease
reported significantly higher total and mental fatigue scores compared with
controls and achieved fewer passes at the General Certificate of Secondary
Education level. Patients who experienced IMB were also more likely to have
failed an exam in the year following illness than those who did not.
Further assessment of outcomes at multiple time points is required
to evaluate whether the deficits reported here persist beyond the medium
term, the researchers wrote. by Nicole Blazek
Borg J. Pediatrics. 2009;doi:10.1542/peds.2008-0581.
It is critical that providers are aware of and screen for both mental
health consequences and school achievement issues in addition to physical
disability after IMD. Scheduled follow-up care must become part of the
discharge planning for any patient treated for IMD; adolescents should receive
care specifically targeted for any noted deficits. The study authors note that
poorer mental health functioning seems to be associated with the impact of
physical disability, and poorer school function may be related to cognitive
deficits as a result of disease. Either way, physicians who address these
issues specifically in follow-up could prevent further morbidity and improve
overall outcome among this vulnerable adolescent group of survivors.
Amy Middleman, MD, MPH
Infectious Diseases in Children Editorial