Invasive meningococcal disease (IMD)
As many as 10% of adolescents and adults are asymptomatic transient carriers of N. meningitidis, most strains of which are not pathogenic. In more than 99% of the cases the infection is asymptomatic, but about 1% of the those infected develop acute illness (CDC, 2009). Invasive disease usually requires a seven-day course of antibiotic therapy (Brigham & Sandora, 2009; Tunkel 2004), but may also result in lifelong major sequelae.
Risk of complications
Meningitis is the most common manifestation of invasive disease, and may occur in 47.3% of all patients suffering from N. meningitidis symptomatic infection and in 52.2% of the patients who develop bacteraemia. It always follows hematogenous dissemination, which occurs in 91% of all patients suffering from symptomatic infection. Sepsis occurs in 5–20% of patients with invasive disease (CDC, 2009). Complications are also possible with non-invasive disease; pneumonia occurs in 6% of symptomatic infections, otitis media in 1% of cases and epiglottitis, which is rare, in 0.3% of all manifestations (CDC, 2009).
We decided to use surveillance data reported to TESSy on clinical presentations of the acute symptomatic disease to estimate the risk of meningitis (ECDC, 2013). Reported data indicates that meningitis and septicaemia together occur in 17–18% of cases, whereas meningitis alone occurs in 43–45% of cases, resulting in an overall risk of 60–63% of developing meningitis. The risk of developing meningitis during the acute phase of the disease is age-specific. Age-specific data were extracted for each gender from ECDC’s TESSy database on the meningitis complications of IMD for 2010 and 2011 (see Table 4). The risk of developing long-term sequelae is age and gender-specific.
Long term sequelae
Bacterial meningitis may cause long-term sequelae and permanent disabilities. The risk of developing these complications after meningitis episodes was extracted from Edmond et al. (Edmond, 2010).
Meningitis accounts for various long-term sequelae (each of which is multiplied by the risk of developing meningitis during the acute phase of the disease: 60–63%): cognitive difficulties (0.96–1.01%), seizure disorders (0.3–0.35%), hearing loss (1.56–1.64%), motor deficit (0.6–0.63%), visual disturbance (0.9–0.95%), behavioural problems (0.36–0.38%), clinical impairments (0.12–0.13%) and multiple impairments (0.78-0.82%) (Edmond, 2010).
Case fatality proportion
The parameters for the case fatality ratio were based on data for EU/EEA countries in 2011, see Table 3 (ECDC, 2013).
Model input summary
Table 1. Transition probabilities used in the outcome tree
Health outcome |
Distribution of health states in health outcome |
Transition probability |
Source/assumption |
Hearing loss |
|
1.56–1.64% |
Edmond, 2010 |
Cognitive difficulties |
|
0.96–1.01% |
Edmond, 2010 |
Seizure disorder |
|
0.3–0.35% |
Edmond, 2010 |
Motor deficit |
|
0.6–0.63% |
Edmond, 2010 |
Visual disturbance |
|
0.9–0.95% |
Edmond, 2010 |
Behavioural problems |
|
0.36–0.38% |
Edmond, 2010 |
Clinical impairments |
|
0.12–0.13% |
Edmond, 2010 |
Multiple impairments |
|
0.78–0.82% |
Edmond, 2010 |
Fatal cases due to symptomatic infection |
|
See Table 3 |
ECDC, 2013 |
Table 2. Disability weights and duration
Health
outcome |
Disability Weight (DW) (Haagsma, 2015) |
Duration |
||
DW |
Label |
In years |
Source |
|
Symptomatic infection |
0.655 (0.579-0.727) |
Intensive care unit admission |
0.019 |
Tunkel, 2004 Assuming the duration of antimicrobial therapy |
Permanent disability following meningitis: |
|
|
Remaining life expectancy |
|
1. Hearing loss |
0.008-0.103 |
From lowest to highest hearing loss related DWs |
|
|
2. Cognitive difficulties |
0.044-0.188 |
From lowest to highest intellectual disability related DWs |
|
|
3. Seizure disorder |
0.07 (0.057-0.088) |
Generic uncomplicated disease: worry and daily medication |
|
|
4. Motor deficit |
0.011-0.421 |
From lowest to highest motor impairment related DWs |
|
|
5. Visual disturbance |
0.004-0.171 |
From lowest to highest vision impairment related DWs |
|
|
6. Behavioural problems |
0.088 (0.07-0.108) |
Subacute sclerosing panencephalitis – phase 1 (assuming best fitting health state description) |
|
|
7. Clinical impairments |
0.004-0.421 |
From lowest to highest DW included in this model |
|
|
8. Multiple impairments |
0.004-0.421 |
From lowest to highest DW included in this model |
|
|
Table 3. CFP following symptomatic infection
Age |
CFR |
0 |
7.8% |
1-4 |
6.9% |
5-14 |
5.6% |
15-24 |
9.5% |
25-49 |
8.9% |
50-64 |
7.6% |
≥65 |
17.1% |
Table 4. Age specific distribution per gender of the 60-63% risk of developing meningitis manifestation during the symptomatic infection (TESSy 2010-2011)
Age |
% |
|
F |
M |
|
0 |
16.22 |
16.64 |
01-04 |
18.19 |
23.79 |
05-09 |
7.13 |
8.65 |
10-14 |
5.90 |
4.46 |
15-19 |
14.53 |
15.97 |
20-24 |
7.21 |
8.06 |
25-29 |
3.93 |
3.62 |
30-34 |
2.62 |
3.04 |
35-39 |
2.05 |
1.69 |
40-44 |
2.54 |
1.84 |
45-49 |
2.81 |
2.01 |
50-54 |
3.47 |
2.43 |
55-59 |
3.28 |
2.43 |
60-64 |
1.97 |
1.42 |
65-69 |
1.88 |
1.42 |
70-74 |
1.97 |
0.76 |
75-79 |
2.05 |
1.35 |
80-84 |
1.31 |
0.34 |
85+ |
0.93 |
0.08 |
Total |
100 |
100 |
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