Severity and Frequency of Sequelae of Bacterial Meningitis in Alaska Native Infants

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Abstract
• Objectives. —To (1) determine the frequency and severity of sequelae ofHaemophilus influenzaetype b and Streptococcuspneumoniaemeningitis in Alaska Native children, (2) compare morbidity and mortality of Hinfluenzaeb and S pneumoniae meningitis, and (3) evaluate the applicability of the Herson-Todd prognostic score (HTPS) to both Hinfluenzaeb and Spneumoniaemeningitis in this population. Design. —A retrospective study of all cases of Hinfluenzaeb and Spneumoniaemeningitis in Alaska Native children younger than age 5 years. Data on meningitis sequelae, obtained from medical charts and records of the Infant Learning Program, were collected, and incidence of sequelae tabulated. Data obtained on admission to the hospital were used to calculate HTPS. Setting. —Indian Health Service facility for the Yukon-Kuskokwin Delta region of southwest Alaska. Study Subjects. —51 of 63 Alaska Native children with Hinfluenzaeb meningitis and 13 of the same 63 Alaska Native children with Spneumoniaemeningitis occurring between 1980 and 1988. One child was infected with both organisms, producing a total of 64 cases for study. Selection Procedures. —Cases were identified by surveillance for these diseases between January 1,1980, and December 31, 1988, maintained by the Arctic Investigations Program, Centers for Disease Control. Measurements and Results. —Sequelae of bacterial meningitis caused by Hinfluenzaeb were equal to or exceeded rates of sequelae described in other children in the United States. After H influenzae b meningitis, motor abnormalities (29%) and hydrocephalus (7%) occurred two to four times more often in Alaska Native children than in children in other parts of the United States. Differences in severity of Hinfluenzaeb sequelae could not be accounted for by microbiologic markers of the Hinfluenzaeb strain, including ampicillin sensitivity, biotype, outer membrane protein type, or electropherotype. Numbers of cases of Spneumoniaemeningitis were too small for statistically valid comparison, but sequelae of Spneumoniaemeningitis occurred in roughly equal proportion as sequelae of Hinfluenzaeb meningitis. The HTPS was applied to Alaska Native children with Hinfluenzaeb meningitis and was found to be very accurate in predicting children with major sequelae. Analysis of the prognostic factors used in deriving the HTPS revealed a unique set of predictors for sequelae in Alaska Native children: seizures at admission, glucose levels in cerebrospinal fluid of less than 1.1 mmol/L; and male gender, with a significant predictive interaction between male gender and age less than 6 months at admission. Conclusions. —Alaska Native children suffer greater neurologic morbidity as a result of Hinfluenzaeb meningitis than do their non-Native counterparts. The HTPS was a good predictor of major sequelae in Alaska Native children with Hinfluenzaeb or Spneumoniaemeningitis and could be useful in determining which patients need referral to a tertiary care center. (AJDC. 1992;146:560-566)