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Importance: A diagnosis of bacterial meningitis in childhood can lead to permanent neurological disabilities. Few studies have examined long-term consequences for work ability in adulthood.

Objective: To compare earnings, work loss, and educational attainment between adults diagnosed with bacterial meningitis in childhood and population comparators.

Design, Setting, and Participants: This nationwide registry-based matched cohort study included individuals in Sweden diagnosed with bacterial meningitis in childhood (aged <18 years) from January 1, 1987, to December 31, 2019, and general population comparators matched 1:9 on age, sex, and place of residence. Follow-up was completed December 31, 2020. Data were analyzed from February 7 to September 12, 2023.

Exposure: A diagnosis of bacterial meningitis in childhood recorded in the National Patient Register.

Main Outcomes and Measures: Annual taxable earnings (in 2020 US dollars), work loss (sum of sick leave and disability insurance), and educational attainment.

Results: The cohort included 2534 individuals diagnosed with bacterial meningitis in childhood (mean [SD] age at diagnosis, 4.7 [5.3] years) and 22 806 comparators (13 510 [53.3%] male). Among those with childhood bacterial meningitis, 812 (32.0%) were diagnosed at younger than 1 year and 1351 (53.3%) were male. From 18 to 34 years of age, those with childhood meningitis had lower adjusted earnings relative to comparators and higher adjusted work loss. When pooling observations for individuals 28 years or older, the annual mean reduction in earnings was -$1295 (95% CI, -$2587 to -$4), representing a 4.0% (95% CI, 0%-8.0%) reduction relative to comparators, and the annual increase in work loss was 13.5 (95% CI, 8.6-18.5) days. There was a larger reduction in earnings for those with childhood meningitis relative to comparators with pneumococcal (Streptococcus pneumoniae) vs meningococcal (Neisseria meningitidis) meningitis. For work loss, there was a difference among all 3 major causes of meningitis, with the largest increase for pneumococcal meningitis. Individuals diagnosed at a younger age (below the median) had lower earnings relative to comparators and higher work loss than individuals diagnosed at an older age (above the median). Fewer individuals with childhood meningitis relative to comparators had obtained a high school degree at age 30 years (adjusted odds ratio, 0.68 [95% CI, 0.56-0.81]).

Conclusions and Relevance: In this cohort study of adults diagnosed with bacterial meningitis in childhood, findings suggest that work ability decreases relative to population comparators, with lower earnings and higher work loss, especially among adults diagnosed with pneumococcal meningitis or diagnosed at a young age, with long-lasting costs for the individual patient and society at large.

IMPORTANCE: Few studies have examined the incidence of long-term disabilities due to bacterial meningitis in childhood with extended follow-up time and a nationwide cohort.

OBJECTIVE: To describe the long-term risks of disabilities following a childhood diagnosis of bacterial meningitis in Sweden.

DESIGN, SETTING, AND PARTICIPANTS: This nationwide retrospective registry-based cohort study included individuals diagnosed with bacterial meningitis (younger than 18 years) and general population controls matched (1:9) by age, sex, and place of residence. Data were retrieved from the Swedish National Patient Register from January 1, 1987, to December 31, 2021. Data were analyzed from July 13, 2022, to November 30, 2023.

EXPOSURE: A diagnosis of bacterial meningitis in childhood recorded in the National Patient Register between 1987 and 2021.

MAIN OUTCOMES AND MEASURES: Cumulative incidence of 7 disabilities (cognitive disabilities, seizures, hearing loss, motor function disorders, visual disturbances, behavioral and emotional disorders, and intracranial structural injuries) after bacterial meningitis in childhood.

RESULTS: The cohort included 3623 individuals diagnosed with bacterial meningitis during childhood and 32 607 controls from the general population (median age at diagnosis, 1.5 [IQR, 0.4-6.2] years; 44.2% female and 55.8% male, median follow-up time, 23.7 [IQR, 12.2-30.4] years). Individuals diagnosed with bacterial meningitis had higher cumulative incidence of all 7 disabilities, and 1052 (29.0%) had at least 1 disability. The highest absolute risk of disabilities was found for behavioral and emotional disorders, hearing loss, and visual disturbances. The estimated adjusted hazard ratios (HRs) showed a significant increased relative risk for cases compared with controls for all 7 disabilities, with the largest adjusted HRs for intracranial structural injuries (26.04 [95% CI, 15.50-43.74]), hearing loss (7.90 [95% CI, 6.68-9.33]), and motor function disorders (4.65 [95% CI, 3.72-5.80]). The adjusted HRs for cognitive disabilities, seizures, hearing loss, and motor function disorders were significantly higher for Streptococcus pneumoniae infection (eg, 7.89 [95% CI, 5.18-12.02] for seizure) compared with Haemophilus influenzae infection (2.46 [95% CI, 1.63-3.70]) or Neisseria meningitidis infection (1.38 [95% CI, 0.65-2.93]). The adjusted HRs for cognitive disabilities, seizures, behavioral and emotional disorders, and intracranial structural injuries were significantly higher for children diagnosed with bacterial meningitis at an age below the median.

CONCLUSIONS AND RELEVANCE: The findings of this cohort study of individuals diagnosed with bacterial meningitis during childhood suggest that exposed individuals may have had an increased risk for long-term disabilities (particularly when diagnosed with pneumococcal meningitis or when diagnosed at a young age), highlighting the need to detect disabilities among surviving children.

Backgrounds: Psychiatric disabilities affect one in three survivors of bacterial meningitis. Since current guidelines do not recommend psychiatric follow-up in all children, disabilities are often detected late. Identifying children with elevated risk of psychiatric disabilities using predictive scores could be one strategy for detecting psychiatric disabilities without having to conduct psychiatric evaluations in all children. Therefore, we searched for existing predictive scores and later tested five predictive scores’ ability to predict psychiatric disabilities following childhood bacterial meningitis.

Methods: From an existing dataset, we selected 73 children with bacterial meningitis of whom 22 later developed psychiatric disease and 15 experienced concentration or learning difficulties. Using these, we tested each predictive score’s sensitivity at their cut-off level for predicting psychiatric disease and concentration or learning difficulties using a chi-square test. Furthermore, we performed a receiver operating characteristic curve (ROC) analysis to assert the area under the curve (AUC) as a measure of overall predictive performance.

Results: The sensitivity of each predictive score’ ranged from 6 to 38% for psychiatric disease and from 8 to 57% for concentration or learning difficulties. In the ROC-analysis, the AUC was 0.59–0.73 and 0.53–0.72, respectively.

Conclusions: All predictive score failed at identifying children later developing psychiatric disabilities, excluding this as a feasible strategy for detecting psychiatric disabilities. Hence, current guidelines for bacterial meningitis need to be revised to recommend psychiatric evaluations in all children.

KEY NOTES

• Current guidelines not recommending psychiatric evaluations in all children following bacterial meningitis may result in late detection of psychiatric disabilities.
• We tested predictive scores’ ability to identify children later developing psychiatric disabilities following bacterial meningitis.
• All predictive score failed at identifying children later developing psychiatric disabilities, excluding this as a feasible strategy. Hence, current guidelines for bacterial meningitis need to be revised to recommend psychiatric evaluations in all children.

Objective: To examine the association between perinatal factors and hospitalisations for sepsis and bacterial meningitis in early childhood (from 28 days to 2 years of age).

Design: A population-based cohort study. The Swedish Medical Birth Register was combined with the National Inpatient Register, the Cause of Death Register, the Total Population Register and the Longitudinal integration database for health insurance and labour market studies. Associations between perinatal factors and hospitalisations were examined using negative binomial regression models.

Setting: Sweden.

Participants 1 406 547 children born in Sweden between 1997 and 2013.

Main outcome measures: Hospital admissions for sepsis and bacterial meningitis recorded between 28 days and 2 years of life.

Results: Gestational age was inversely associated with severe infections, that is, extreme prematurity was strongly associated with an increased risk of sepsis, adjusted incidence rate ratio (aIRR) 10.37 (95% CI 6.78 to 15.86) and meningitis aIRR 6.22 (95% CI 2.28 to 16.94). The presence of congenital malformation was associated with sepsis aIRR 3.89 (95% CI 3.17 to 4.77) and meningitis aIRR 1.69 (95% CI 1.09 to 2.62). Moreover, children born small or large for gestational age were more likely to be hospitalised for sepsis and children exposed to maternal smoking were more likely to be hospitalised for meningitis.

Conclusions: Prematurity and several other perinatal factors were associated with an increased risk of severe infections in young children. Therefore, clinical guidelines for risk assessment of infections in young children should consider perinatal factors.

BACKGROUND: Bacterial meningitis is known to cause hearing impairments and neurological deficits; however, less is known regarding psychiatric disabilities. In this study, we assessed psychiatric disabilities and other long-term consequences of childhood bacterial meningitis.

METHODS: From a previously validated dataset, we selected children having had bacterial meningitis. We then reviewed medical records and child health records from discharge onwards to identify disabilities. We calculated the occurrence of disabilities with a 95% confidence interval (CI), and we used a χ test to assess possible individual risk factors associated with occurrence of disabilities.

RESULTS: Of the 80 children included in this study, permanent disabilities not attributed to preexisting diseases were noted in 56% (CI: 45-67) during the mean observation period of 19 years and 2 months. Psychiatric disease was diagnosed in 30% (CI: 21-41), and another 5% (CI: 2-13) were under ongoing investigations for symptoms of psychiatric disease. Hearing impairments affected at least 30% (CI: 20-40), and neurological deficits affected at least 23% (CI: 15-34). While other disabilities were often detected within the first year, psychiatric disabilities were detected after a mean time period of 14 years (CI: 11:1-16:11). Although some associations were noted, no individual risk factor was able to predict the occurrence of disabilities.

CONCLUSIONS: Psychiatric disabilities affect more than one-third of survivors and are among the most common long-term consequence of childhood bacterial meningitis. Late discovery and predictive difficulties call for a revision of current guidelines to include a specific long-term strategy for detecting psychiatric disabilities.

Bacterial meningitis, one of the most severe infections a child can contract, can be caused by several different strains of bacteria. Most commonly, Haemophilus influenzae type b (Hib), Streptococcus pneumoniae and Neisseria meningitidis. These colonize the upper respiratory tract, then either cause localized infections acting as primary foci or directly spread to the brain. As preventive measure, general infant Hib and pneumococcal vaccinations were introduced in Sweden in 1993 and in 2009, respectively. Although evaluated extensively elsewhere, their long-term effects in Arctic regions are less studied. For the individual child with bacterial meningitis, treatment involves many challenges starting with correctly identifying the condition, guiding treatment, and finally identifying both short-term and long-term disabilities.

In this thesis, the overall aim was to study clinical aspects of bacterial meningitis and preventive effects of vaccinations in an Arctic region. We used two datasets in the Västerbotten Region to investigate incidence rates during the time-periods adjacent to vaccine introductions. This allowed us to study the preventive effects of general infant vaccinations on bacterial meningitis in one of the Swedish Arctic regions. More precisely, we investigated changes in incidence of bacterial meningitis and sepsis during the period of 1986-2015 and of respiratory tract infections during the period of 2005-2014, in the Västerbotten Region, Sweden. We also reviewed medical records of children being treated for bacterial meningitis in the Västerbotten Region to study clinical presentation, short-term outcome, and to develop a new predictive score for identifying adverse outcome and need of invasive procedures. Additionally, by reviewing medical records and child health records from discharge and onwards we assessed long-term disabilities and evaluated clinical guidelines’ follow-up recommendations.

Following introduction of general infant Hib vaccination, incidence of all-cause bacterial meningitis and Haemophilus meningitis in children aged one month to four years declined by 82.3% and 95.3%, respectively. Likewise, all-cause bacterial meningitis and pneumococcal meningitis declined by 48.0% and 67.5%, respectively, following pneumococcal vaccination. In addition, incidence of sepsis caused by H. influenzae and by S. pneumonia also decreased in the same age group. Finally, respiratory tract infections in children under five years of age decreased following pneumococcal vaccination; by 41.5% for all-cause acute otitis media, by 80.7% for sinusitis and by 28.6% for pneumonia.

At admission to the hospital, difference in clinical presentation mostly depended on age. Younger children were more ill at admission but also presented with more diffuse symptoms. When evaluating clinical decision rules for detecting bacterial meningitis, none reached 100% sensitivity. The predictive score developed by us could identify all children in need of invasive procedures to manage the intracerebral pressure and were graded as excellent in the ROC analysis at this task. However, neither this score nor any other could adequately predict complications or death. Finally, permanent disabilities affected more than half of surviving children with psychiatric disease being diagnosed in 30%, and another 5% had ongoing investigations for symptoms of psychiatric disease. Notably, psychiatric disabilities were detected late, in average 14 years after having had bacterial meningitis.

From these findings, we concluded that vaccinations are excellent at protecting children against bacterial meningitis, also in the Arctic region, with the added bonus of providing protection against sepsis and less severe infections such as pneumonia and acute otitis media. Further, treating children with bacterial meningitis involves several challenges starting with correctly identifying this sever disease. For this task, no clinical decision rule is perfect. When making difficult treatment decisions such as deciding on invasive procedures to manage the intracerebral pressure, the predictive score developed and tested by us, the MeningiSSS, can be very helpful. Finally, permanent disabilities may be more common than previously thought. With more than one third of survivors being affected by psychiatric disabilities, specific long-term follow-up strategies are needed to reduce suffering caused by undetected psychiatric disabilities.

Background: Knowing the individual child’s risk is highly useful when deciding on treatment strategies, especially when deciding on invasive procedures. In this study, we aimed to develop a new predictive score for children with bacterial meningitis and compare this with existing predictive scores and individual risk factors.

Methods: We developed the Meningitis Swedish Survival Score (MeningiSSS) based on a previous systematic review of risk factors. From this, we selected risk factors identified in moderate-to-high-quality studies that could be assessed at admission to the hospital. Using data acquired from medical records of 101 children with bacterial meningitis, we tested the overall capabilities of the MeningiSSS compared with four existing predictive scores using a receiver operating characteristic curve (ROC) analysis to assert the area under the curve (AUC). Finally, we tested all predictive scores at their cut-off levels using a Chi-square test. As outcome, we used a small number of predefined outcomes; in-hospital mortality, 30-day mortality, occurrence of neurological disabilities at discharge defined as Pediatric Cerebral Performance Category Scale category two to five, any type of complications occurring during the hospital stay, use of intensive care, and use of invasive procedures to monitor or manage the intracerebral pressure.

Results: For identifying children later undergoing invasive procedures to monitor or manage the intracerebral pressure, the MeningiSSS excelled in the ROC-analysis (AUC = 0.90) and also was the only predictive score able to identify all cases at its cut-off level (25 vs 0%, p < 0.01). For intensive care, the MeningiSSS (AUC = 0.79) and the Simple Luanda Scale (AUC = 0.75) had the best results in the ROC-analysis, whereas others performed less well (AUC ≤ 0.65). Finally, while none of the scores’ results were significantly associated with complications, an elevated score on the MeningiSSS (AUC = 0.70), Niklasson Scale (AUC = 0.72), and the Herson–Todd Scale (AUC = 0.79) was all associated with death.

Conclusions: The MeningiSSS outperformed existing predictive scores at identifying children later having to undergo invasive procedures to monitor or manage the intracerebral pressure in children with bacterial meningitis. Our results need further external validation before use in clinical practice. Thus, the MeningiSSS could potentially be helpful when making difficult decisions concerning intracerebral pressure management.

Aim: Vaccine‐preventable pathogens causing severe childhood infections include Haemophilus influenzae type b (Hib), Streptococcus pneumoniae and Neisseria meningitidis. In this study conducted in a Swedish Arctic region, we evaluated the effects of general infant Hib and pneumococcal vaccination on invasive infectious diseases among children and assessed the need of meningococcal vaccination.

Methods: We identified cases of bacterial meningitis and sepsis from diagnosis and laboratory registers in the Västerbotten Region, Sweden, during 1986–2015. We then reviewed medical records to confirm the diagnosis and extract data for assessing incidence changes, using an exploratory data analysis and a time‐series analysis.

Results: Invasive Haemophilus disease declined by 89.1% (p < 0.01), Haemophilus meningitis by 95.3% (p < 0.01) and all‐cause bacterial meningitis by 82.3% (p < 0.01) in children aged 0 to four years following general infant Hib vaccination. Following pneumococcal vaccination, invasive pneumococcal disease declined by 84.7% (p < 0.01), pneumococcal meningitis by 67.5% (p = 0.16) and all‐cause bacterial meningitis by 48.0% (p = 0.23). Incidence of invasive meningococcal disease remained low during the study period.

Conclusion: Remarkable sustained long‐term declines of invasive infectious diseases in younger children occurred following infant Hib and pneumococcal vaccinations in this Swedish Arctic region. Despite not offering general infant meningococcal vaccination, incidence of invasive meningococcal disease remained low.

AIM: Streptococcus pneumoniae commonly causes respiratory tract infections including acute otitis media and pneumonia. In this study, we evaluated the impact of general infant pneumococcal vaccination, introduced in Sweden in 2009, on respiratory tract infections.

METHODS: We studied the incidence of respiratory tract infections and antibiotic consumption in Västerbotten County, Sweden, during 2005-2014 using the County Council's diagnosis register.

RESULTS: Comparing the prevaccination period of 2005-2008 to 2014, the incidences of all-cause acute otitis media decreased significantly in children aged 0-4 and five years to 17 years, by 41.5% and 20.9%, respectively. In addition, we also noted significant reductions in sinusitis and other upper respiratory tract infections, and some reductions in adults. Antibiotic consumption for upper respiratory tract infections decreased by 37.1%, with the largest decrease occurring in children aged 0-4 years. For pneumonia, the incidence significantly decreased by 28.6% for children aged 0-4 years, with no significant changes in older children or adults.

CONCLUSION: Pneumococcal vaccination was followed by reduced incidence of upper respiratory tract infections and antibiotic consumption in vaccinated children, with some indications of possible herd immunity. For pneumonia, a major reduction was noted limited to the youngest children.