Increasing microbiological confirmation and changing epidemiology of meningococcal disease on Merseyside, England

Objectives To determine, for the last 5 years in children on Merseyside wit h clinical meningococcal disease (MCD), the impact on diagnostic yield of n ewer bacteriologic methods; bacterial antigen detection (AD) and polymerase chain reaction (PCR). Methods Prospective data collection at Royal Liverpool Children's Hospital over two epochs: 1 September 1992 to 30 April 1994 (epoch A, n = 126) and 1 7 November 1997 to 15 September 1998 (epoch B, n = 85). Results Epoch A was compared with epoch B. Diagnosis was confirmed by detec tion of meningococci in 78 of 126 (61.9%) versus 64 of 85 (75.3%, P = 0.04) , but with a significantly lower rate of positive blood and cerebrospinal f luid culture in the later epoch. The proportion of cases receiving penicill in pretreatment was unchanged at 32%, but the proportion undergoing lumbar puncture decreased significantly Median ages were higher in epoch B: 1.7 ye ars Versus 2.49 years (P = 0.013, Mann-Whitney). There was a significant in crease in the proportion of cases due to serogroup C (14/78 (18%) versus 30 /64 (46.9%), P = 0.001). Conclusions Culture detection of meningococci from children with MCD has re duced, as less lumbar punctures are done. However, improved diagnosis by PC R and AD has increased microbiological confirmation overall. Serogroup C di sease and the median age of cases continue to rise.