Meningococcal disease among children who live in a large metropolitan area, 1981-1996

Neisseria meningitidis is an important cause of serious bacterial infection s in children. We undertook a study to identify meningococcal infections of the blood, cerebrospinal fluid, or both of children in a defined geographi c area to describe the burden of disease and the spectrum of illness. We re viewed the medical records of all children aged <18 years who had meningoco ccal infections at the 4 pediatric referral hospitals in Boston, Massachuse tts, from 1981 through 1996. We identified 231 patients with meningococcal disease; of these 231 patients, 194 (84%) had overt disease and 37 (16%) ha d unsuspected disease. Clinical manifestations included meningitis in 150 p atients, hypotension in 26, and purpura in 17. Sixteen patients (7%) died. Although meningococcal disease is devastating to a small number of children , we found that the burden of pediatric disease that it caused at the 4 ped iatric referral centers in this geographic region was limited; that patient s with overt meningococcal disease are most likely to have meningitis; and that individual practitioners are unlikely to encounter a patient with unsu spected meningococcal disease.