Epidemiology and prognostic factors in meningococcal disease in a small island population: Malta 1994-1998

Study objective: To review the epidemiology of meningococcal disease in Mal ta over the period 1994-1998, and to identify factors at presentation and i n the management of meningococcal disease which may influence mortality. De sign: All admissions with meningococcal disease to a national hospital in a population-based study over the period 1994-1998 were studied retrospectiv ely. Main results: Fifty-six cases were diagnosed over 1994-1998, the incid ence rising from 0.8/100,000 to 7.2/100,000 total population (p < 0.0001). The median time interval from arrival at hospital to administration of pare nteral antibiotic decreased over the 5-year period from 4.4 to 1.2 hours (p = 0.025), with no significant change in the case-fatality rate. There was no association between the time interval from arrival at hospital to parent eral antibiotic administration, and mortality. The following features at pr esentation were associated with increased mortality: older age (p = 0.03), meningococcaemia compared with meningitis (p = 0.05), shock (p < 0.0001), d isseminated intravascular coagulation (p = 0.0001), a normal/low white bloo d cell count (p = 0.0003), a low platelet count (p = 0.0001) and a high ser um creatinine (p = 0.003). Conclusions: The upsurge of cases in the populat ion was accompanied by a decrease in intervention time in the general hospi tal, probably due to increased awareness of the disease. This study did not show a positive relationship between early in-hospital administration of a ntibiotics and improved survival, probably because antibiotics were given e arlier to those with fulminant disease and, with therefore, an inherently w orse outcome. Stratification of cases by severity on admission is recommend ed in future studies.