Cost-Effectiveness of 4CMenB Infant Vaccination in England: A Comprehensive Valuation Considering the Broad Impact of Serogroup B Invasive Meningococcal Disease.

OBJECTIVES: This cost-effectiveness analysis (CEA) of 4CMenB infant vaccination in England comprehensively considers the broad burden of serogroup B invasive meningococcal disease (MenB IMD), which has not been considered, or was only partially considered in previous CEAs. METHODS: A review of previous MenB vaccination CEAs was conducted to identify aspects considered in the evaluation of costs and health outcomes of the disease burden of MenB IMD. To inform the model structure and comprehensive analysis, the aspects were grouped into 5 categories. A stepwise analysis was conducted to analyze the impact of each category, and the more comprehensive consideration of disease burden, on the incremental cost-effectiveness ratio (ICER). RESULTS: MenB IMD incidence decreased by 46.0% in infants and children 0-4 years old within 5 years after introduction of the program. Stepwise inclusion of the 5 disease burden categories to a conventional narrow CEA setting reduced the ICER from £360 595 to £18 645-that is, considering the impact of all 5 categories, 4CMenB infant vaccination is cost-effective at a threshold of £20 000 per QALY gained. CONCLUSIONS: When considering comprehensively the MenB IMD burden, 4CMenB infant vaccination can be cost-effective, a finding contrary to previous CEAs. This analysis allows policy decision-makers globally to infer the impact of current disease burden considerations on the cost-effectiveness and the comprehensive assessment necessary for MenB IMD. Although this comprehensive CEA can help inform decision making today, it may be limited in capturing the full disease burden and complex interactions of health and economics of MenB IMD.

Meningococcal disease in Italy: public concern, media coverage and policy change.

BACKGROUND: Between 2015 and 2017 six deaths due to meningitis in the Lombardy Region, Northern Italy, caught the attention of media and increased concern among the population, with a consequent increase in demand for vaccination. Considering the evidence about the impact of media coverage of health issues on public behaviour, this paper investigates the trend of media coverage and internet searches regarding meningitis in the Lombardy Region. METHODS: Content analysis of online articles published from January 2015 to May 2017 and analysis of Google Trends were carried out. A codebook was created in order to assess the content of each article analysed, based on six areas: article characteristics, information about meningococcal disease and vaccination, Local Health Authority activities, accuracy of information and tone of the message. RESULTS: Both public interest and media attention peaked in December 2016 and January 2017, when the Lombardy Regional Authority changed its policy by offering co-payment to adults with a saving of 50%. The frequency of meningitis coverage decreased after the announcement of policy change. For example, articles containing new information on meningitis or meningococcal vaccine (76 to 48%, p = 0.01) and preventive recommendations (31% down to 10%, p = 0.006) decreased significantly. An alarmist tone appeared in 21% of pre-policy articles that decreased to 5% post-policy (p = 0.03). CONCLUSIONS: The findings suggest a role for the media in fostering public pressure towards health services and policy-makers. A collaboration between Public Health institutions and the media would be beneficial in order to improve communication with the public.

In the Digital Era, Is Community Outrage a Feasible Proxy Indicator of Emotional Epidemiology? The Case of Meningococcal Disease in Sardinia, Italy.

The aims of this study were (i) to evaluate the relationship between official data on invasive meningococcal disease cases in Sardinia and the reporting of the cases by a regional online newspaper and (ii) to identify indicators useful for understanding the community outrage related to health events. Cases of meningococcal disease, selected from articles published between 1999 and 2016 on a regional newspaper database, were compared to those reported to the Infectious Disease Information Service. In order to evaluate the equality of the two distribution records, the Kolgomorov Smirnov test for two samples was applied. A community outrage indicator was obtained by calculating the number of published articles for each case of meningococcal disease identified. The outrage indicator was evaluated in comparison with other phenomena: drinking water supply limitation and domestic accidents. Overall, 2724 articles on meningitis/sepsis referring to 89 cases related to meningococcal disease were considered. Significant differences between the distribution of cases officially reported and those found in the newspaper (combined K-S = 0.39; p = 0.08) were not observed. The meningococcal disease outrage indicator showed an average of seven items per case. Comparing the meningococcal disease outrage indicator with those regarding the limitation of drinking water supplies and domestic accidents, a different risk perception by the reference media was found, with the highest outrage for meningococcal disease. The present study supports the role played by emotional factors as behavioral determinants in emerging threats to public health. The analysis of the data allowed us to highlight that the proposed outrage indicator could be a feasible proxy of emotional epidemiology. Finally, data confirm that meningitis is perceived as a highly outrageous health threat.

Describing meningococcal disease: understanding, perceptions and feelings of people in a regional area of NSW, Australia.

OBJECTIVES: To explore understanding, perceptions and feelings about meningococcal disease in members of higher risk groups. To explore what people say are the most important health messages and communication preferences about invasive meningococcal disease (IMD). METHODS: Three focus groups and two semistructured interviews were conducted with people at higher risk of IMD in Hunter New England Local Health District in New South Wales. RESULTS: Participants generally had a low understanding of IMD, but described intense feelings about the disease and empathy for those who had experienced the disease. Fear of stigma and the impact of stigma were identified. Participants identified reasons for delaying presentation for care as perceptions of invincibility (particularly among young people), the cost of care (for all groups), and racism (particularly for Aboriginal people). These issues were both potential and experienced barriers for participants accessing help when acutely unwell. Factors for effective communication to improve understanding of IMD included the communication being acceptable, accessible and appropriate. CONCLUSIONS: IMD is a serious but uncommon disease that has a range of impacts on people, families and communities. Higher risk groups may benefit from receiving more appropriate and accessible information about early signs and symptoms of IMD. Communication and understanding about the disease could be improved by working with new technologies and partnering with key people in high-risk groups. Use of text messages and social networking for urgent communication could be considered and trialled in public health practice. It is also important to recognise the potential direct or indirect experience of racism and stigma for patients with IMD and their families. Management of IMD could be strengthened by connecting people and families with support groups or services to reduce the impact of the disease.

Parents' experiences of support during and after their child's diagnosis of meningococcal disease.

AIM: To understand parents'/carers' experiences of support received following their child's diagnosis of invasive meningococcal serogroup B disease (MenB). METHODS: Structured interviews with parents/carers of 244 survivors of MenB disease in childhood, drawn from a population-based case-control study. RESULTS: Responses indicated that optimal support should encompass the whole treatment pathway, beginning with fast and accurate recognition of MenB by clinicians, followed by the provision of information about the symptoms and possible sequelae of MenB, better communication about the treatment process and disease progression and greater follow-up care. CONCLUSION: Parents' experience of support following their child's diagnosis of MenB could be significantly enhanced through better education and enhanced knowledge in health care professionals, improved access to information about short- and long-term sequelae and easier access to follow-up support and advice. Much of the data generated pertained to situations and processes common to most serious illnesses occurring in children and therefore it is likely that these findings pose wider questions about support and communication in paediatrics.

Longer-term psychiatric adjustment of children and parents after meningococcal disease.

OBJECTIVE: To ascertain whether increases in psychological symptoms in children and parents after meningococcal disease are sustained over time, and to examine the psychosocial and illness associations of 12-mo psychological outcome. DESIGN: A prospective, cohort study using repeated measures. SETTING: Three pediatric intensive care units and 19 general pediatric wards across greater London. PATIENTS: Fifty-six children, aged 3 to 16 yrs, admitted to hospital with meningococcal disease and their parents. MEASURES AND MAIN RESULTS: Child and parent psychological symptoms were measured, using the Strengths and Difficulties Questionnaire (SDQ) and the General Health Questionnaire (GHQ) at three time points: before/during hospital admission, 3 mos, and 12 mos after discharge. The Impact of Event Scale (IES) was used at the two follow-up points. During the follow-up period, there were statistically significant increases over child pre-illness levels in parent-rated emotional, conduct, hyperactivity, and impact SDQ scores; the most significant change at 12-mo follow-up was an increase in impact on daily living scores. At 12 mos, five (11%) of 43 children were at risk for posttraumatic stress disorder. The strongest correlations of 12-mo child psychological symptoms (total SDQ scores)--in addition to premorbid total SDQ score--were illness-related changes in parenting, maternal IES and GHQ scores. At 12 mos, 13 (24%) of 54 mothers and six (15%) of 40 fathers scored at high risk for posttraumatic stress disorder. The strongest correlation of maternal posttraumatic stress disorder symptoms (IES scores) was paternal posttraumatic stress disorder symptoms. CONCLUSIONS: Admission to the hospital with meningococcal disease is followed by an increase in psychological symptoms in children at home, some of which are persistent and impairing, and by continuing posttraumatic stress symptoms in a proportion of children and parents. Psychosocial (pre- and postmorbid) factors predict problems at 12-mo follow-up.

Surviving meningococcal septic shock: health consequences and quality of life in children and their parents up to 2 years after pediatric intensive care unit discharge.

OBJECTIVE: To assess health consequences and health-related quality of life (HR-QoL) in children with meningococcal septic shock up to 2 yrs after discharge from the pediatric intensive care unit and to assess their parents. To determine major predictors of that outcome. PATIENTS AND METHODS: A prospective cohort study. Follow-up of all consecutive children with septic shock and purpura requiring intensive care treatment between 2001 and 2005, and their parents. HR-QoL was assessed with the Child Health Questionnaire (children) and Medical Outcomes Study 36-item Short-Form Health Survey (parents). RESULTS: Of 53 eligible families, 47 participated (28 boys/19 girls; median age at the time of pediatric intensive care unit admission, 3.7 yrs; median Pediatric Risk of Mortality score, 21). A total of 26 children (55%) had scars as a result of skin necrosis; two (4%) had amputation of a digit or digits. In 21 children (45%), chronic complaints were reported. Children with and without chronic complaints did not differ significantly with regard to severity of illness and age at the time of pediatric intensive care unit admission. Significantly lower scores were found on HR-QoL scales concerning mainly physical functioning and health perception in comparison with normative data. There was a significant negative association between severity of illness and the HR-QoL scale concerning physical functioning. Children with chronic complaints had significantly lower scores on the HR-QoL scale concerning pain. Eight of 47 mothers (17%) at the time of the study had anxiety or depression requiring professional help. Mothers with and without these problems differed significantly with regard to age of their child at the time of pediatric intensive care unit admission. Parents showed significantly higher scores on HR-QoL scales concerning physical functioning and bodily pain in comparison with normative data. There was a significantly negative association between the presence of emotional problems and HR-QoL scores in mothers. CONCLUSIONS: Up to 2 yrs after discharge from the pediatric intensive care unit, there is still a considerable effect on health and HR-QoL in children, especially on the physical scales. Severity of illness and chronic complaints negatively affected HR-QoL scales in children. Quite a few mothers suffered from emotional problems.

Behavioural, emotional, and post-traumatic stress problems in children and adolescents, long term after septic shock caused by Neisseria meningitidis.

OBJECTIVES: To assess the occurrence of a wide range of behavioural, emotional, and post-traumatic stress problems in children and adolescents, long term after septic shock caused by Neisseria meningitidis (MSS). DESIGN: This study included 6- to 17-year-old patients who survived MSS and were admitted to the PICU of the Medical Centre between 1988 and 2001. To assess behavioural, emotional, and post-traumatic stress problems, the Child Behaviour Checklist (CBCL), the Teacher's Report Form (TRF), and the Youth Self-Report (YSR) were used. METHODS: Parents of 89 MSS children, aged 6-17 years, completed the CBCL. Teachers of 65 same-aged MSS children completed the TRF, and 45 11- to 17-year-old MSS children completed the YSR. These data were compared with those from the normative reference groups. RESULTS: Overall, the proportions of MSS children scoring in the deviant range for problem behaviour were comparable to the proportions in the reference groups, according to parents', teachers', and self-reports. As to the level of emotional and behavioural problems, mothers of the MSS children reported more somatic complaints regarding their children in comparison with the reference groups. Severity of illness was not a significant predictor of behavioural, emotional, and post-traumatic stress problems. Age at the time of illness was a significant predictor of behavioural, emotional, and post-traumatic stress problems in MSS children, indicating that the younger the child at the time of illness, the more problems were reported by parents at follow-up. CONCLUSION: Overall, the results showed long-term behavioural, emotional, and post-traumatic stress outcomes for MSS children, which were comparable to those in the general population.

Adjustment to appearance changes resulting from meningococcal septicaemia during adolescence: a qualitative study.

STATEMENT OF PURPOSE: Meningococcal Septicaemia (ms) is an acute, life-threatening illness characterized by rapid progression and if not treated swiftly can result in death within hours. Those who survive may require skin grafting or amputation of digits and limbs, and be left with severe scarring. Despite the trauma associated with ms, surprisingly little research has been conducted to determine its psychosocial impact. This study therefore explored the impact of ms during adolescence, with an emphasis on adjustment to a permanently altered appearance following a life-threatening illness. METHODS USED: Eleven in-depth, semi-structured interviews were conducted with adolescents (7 female) and analysed using Interpretative Phenomenological Analysis (IPA). RESULTS: Interviews highlighted the life-altering nature of the experience and the impact this had on finding meaning, life evaluation and adjustment to an altered appearance. Participants spoke at length about differences in themselves, 'pre and post ms', how they assimilated their altered self into life after ms, and the symbolisation attributed to their scars. Issues relating to healthcare provision also arose as a significant theme. DISCUSSION: Participants demonstrated a high degree of resilience in response to their experiences. The means by which this has been achieved, including social comparison are examined in detail and offer a fertile area for further research.

Health-related quality of life problems of children aged 8-11 years with a chronic disease.

In paediatric research, Health-Related Quality-of-Life (HRQoL) has received increasing recognition as an important health outcome. This study aimed to investigate the nature and prevalence of HRQoL problems in children with different chronic diseases. Data were available on 318 children aged 8-11 years with different diseases: congenital heart disease (n = 50); coeliac disease (n = 105); asthma (n = 32); cancer (n = 23); juvenile chronic arthritis (n = 45); children with capillary haemangioma (n = 25) and severe meningococcal disease (n = 38). They all answered a validated generic instrument [TNO-AZL Children's Quality of life questionnaire] (TACQoL), in the outpatient clinic or at home. Analyses of variance were performed to investigate differences in mean scores for children with chronic conditions in comparison to healthy children. Prevalence of children at risk for substantial HRQoL problems was based on the 25th percentile in the norm population. In comparison to healthy children, only a small number of differences were found in mean scores of children studied. In contrast, prevalence of HRQoL problems in children with chronic diseases was higher in several domains. It is concluded that using an indicator variable of the norm 25th percentile seems important in identifying at-risk children with chronic disease.

Long-term psychological distress in parents of child survivors of severe meningococcal disease.

OBJECTIVE: To study psychological distress in parents of child survivors of Severe Meningococcal Disease (SMD) after discharge of their child from the Paediatric Intensive Care Unit (PICU). METHODS: This study approached parents of child survivors of SMD treated on the PICU between 1993-2001. Five cross-sectional groups were created for mothers and fathers separately. The five groups differed from each other by the period after discharge they entered the project (ranging from 3 months to 7 years after discharge). For research purposes, mothers and fathers (n = 192) individually completed the Goldberg General Health Questionnaire-30 (GHQ), measuring their level of psychological distress. STATISTICS: Mean group scores were examined and a one-way-analysis of variance (ANOVA) performed to study differences between groups for mothers and fathers separately. In addition, percentages of parents with GHQ scores above cut-off were calculated and it was determined whether it differed from norm data. RESULTS: Data reveal that both mothers and fathers experience high mean levels of psychological distress after discharge, showing no significant differences in group means over time. High percentages of parents experience psychological distress after discharge, if compared with the normal population. CONCLUSIONS: Parents of child survivors of SMD experience profound and prolonged psychological distress after discharge. Future interventions should focus on follow-up care for this population to help them re-adjust after this stressful event.

Parents' experiences of living through their child's suffering from and surviving severe meningococcal disease.

The aim of this study was to describe the lived experience of parents whose child had suffered from and survived severe meningococcal disease. A Heideggerian phenomenological approach was used within the study and data were collected from long focused interviews. In total, eight parents took part in the study; one was a woman recruited as a pilot interview and the other seven were recruited for the main study. The data were analysed using Colaizzi's (1978) method. Eleven themes emerged: (1) complications/side effects; (2) emotional turmoil; (3) child's physical appearance; (4) family disruption; (5) fear of death; (6) loss of parenting role; (7) need for support and understanding; (8) need and value of communication, information and publicity; (9) parental intuition; (10) technological interventions and (11) the impact of care delivery. A review of the literature arising out of the data was undertaken, and a final synthesis statement as perceived by the parents was achieved. Living through this experience is perceived as a major emotional stressor, and although health professionals have some insight into the experience, they are largely naive to the enormity of the situation.

Short-term psychiatric adjustment of children and their parents following meningococcal disease.

OBJECTIVE: To assess short-term changes in child and parent psychiatric status following meningococcal disease. DESIGN: Prospective cohort study; 3-month follow-up using parent, teacher, and child questionnaires. SETTING: Hospital admissions to three pediatric intensive care units and 19 general pediatric wards. PATIENTS: Sixty children aged 3-6 yrs, 60 mothers, and 45 fathers. INTERVENTIONS: We administered measures of illness severity (Glasgow Meningococcal Septicaemia Prognostic Score, days in hospital) and psychiatric morbidity (Strengths and Difficulties Questionnaires, parent and teacher versions; Impact of Event scales; General Health Questionnaire-28). MEASUREMENTS AND MAIN RESULTS: In children admitted to pediatric intensive care units, parental reports at 3-month follow-up showed a significant increase in emotional and hyperactivity symptoms and in related impairment; symptoms of posttraumatic stress disorder were present in four of 26 (15%) children >8 yrs old. Regarding the parents, 26 of 60 (43%) mothers in the total sample had questionnaire scores indicative of high risk for psychiatric disorder and 22 of 58 (48%) for posttraumatic stress disorder. In fathers there was high risk for psychiatric disorder in 11 of 45 (24%) and for posttraumatic stress disorder in 8 of 43 (19%). Severity of the child's physical condition on admission was significantly associated with hyperactivity and conduct symptoms at follow-up. Length of hospital admission was associated with psychiatric symptoms in the child and posttraumatic stress disorder symptoms in parents. There were also significant associations between psychiatric symptoms in children and parents. CONCLUSIONS: Admission of children to pediatric intensive care units for meningococcal disease is associated with an increase in and high levels of psychiatric and posttraumatic stress disorder symptoms in children and parents. Length of admission is associated with psychiatric symptoms in children and posttraumatic stress disorder symptoms in parents. Pediatric follow-up should explore psychiatric as well as physical sequelae in children and parents.

Rehabilitation of a child with meningococcal septicemia and quadrilateral limb loss: a case report.

Acquired quadrilateral limb loss is a rare occurrence in children. One cause of this condition is severe meningococcal septicemia. We present the case of a boy who, at 14 months of age, required extensive amputation after an episode of meningococcal septicemia. We review his medical recovery and rehabilitation, including upper- and lower-limb prosthetic prescription and training, and adaptation to his altered body. A multidisciplinary approach led to effective management of his complex clinical and psychologic needs. This case illustrates the need to address a range of medical, prosthetic, and family issues central to successful clinical outcome.

Psychiatric adjustment following meningococcal disease treated on a PICU.

OBJECTIVE: To describe the psychiatric status of child survivors of meningococcal disease and their mothers. DESIGN AND SETTING: Home interviews with 3-12 month follow-up.PATIENTS. 29 children aged 2-15 years admitted to a Paediatric Intensive Care Unit (PICU) with meningococcal disease. MEASUREMENTS AND RESULTS: Questionnaires to assess psychiatric risk in children and parents. We found an overall risk for child psychiatric disorder in 20%. Symptoms of post-traumatic stress disorder (PTSD) were present in 62% of children, and 10% had the features of a stress disorder. In 40% of mothers there was an increased risk for psychiatric disorder, 48% experienced clinically significant PTSD symptoms, and 29% were seeking psychological help. Maternal stress symptoms were significantly associated with severity of their child's illness. CONCLUSIONS: A significant proportion of children surviving meningococcal disease and their parents are likely to suffer psychological stress symptoms to a degree that warrants attention.