Sequelae at Hospital Discharge in 61 Children With Invasive Meningococcal Disease, Chile, 2009-2019.

BACKGROUND: Invasive meningococcal disease (IMD) is an unpredictable and severe infection caused by Neisseria meningitidis . Its case fatality rate could vary from 9.7% to 26% and up to 36% of survivors may experience long-term sequelae, representing a challenge for public health. AIMED: To describe the sequelae at hospital discharge caused by IMD in children between years 2009-2019. METHODS: Cross-sectional study performed in 2 pediatric hospitals. Patients with microbiologically confirmed diagnosis of IMD from 2009 to 2019 were included. Bivariate and logistic regression analysis were performed. RESULTS: The records of 61 patients were reviewed and included. Sixty-seven percent were male, median age 9 months (interquartile range 4-27), 72% were admitted to intensive care unit. Thirty-seven (60.5%) had at least 1 sequela (75% and 37% in patients with or without meningitis, respectively). The most frequents sequelae were neurological 72%, hearing loss 32%, and osteoarticular 24%. Significant differences were found comparing patients with and without sequelae: drowsiness 67.6% versus 41.7% ( P = 0.04), irritability 67.6% versus 25% ( P = 0.01), meningeal signs 62.2% versus 29.2% ( P = 0.01). In logistic regression analysis, postdischarge follow-up had OR 21.25 (95% confidence intervals [CI]: 4.93-91.44), irritability had OR 8.53 (95% CI: 1.64-44.12), meningeal signs had OR 8.21 (95% CI: 0.71-94.05), invasive mechanical ventilation had OR 8.23 (95% CI: 0.78-85.95), meningitis plus meningococcemia OR 1.70 (95% CI: 0.18-15.67) to have sequelae, while children with meningococcemia and vomiting had a OR 0.04 (95% CI: 0.00-0.36) and OR 0.27 (95% CI: 0.03-2.14), respectively. N. meningitidis serogroup W (MenW) was isolated in 54.1% (33/61), and N. meningitidis serogroup B (MenB) in 31.1% (19/61) of cases. A significant difference was found in osteoarticular sequelae ( P = 0.05) between MenB and MenW. There was a decrease in cases after the meningococcal conjugate vaccine against serogroups A, C, W and Y was implemented (2015-2019). CONCLUSIONS: IMD remains as a public health concern. A high rate of sequelae was found in pediatric patients in our series, even in the clinical manifestations other than meningitis. Neurological sequelae were the most prevalent. Multidisciplinary follow-up protocols to reduce long-term impact must be urgently established to assess all children with IMD.

BCG 1948 – 2014: la misma cepa? / BCG 1948 – 2014: is the same strain yet?

Tuberculosis remains a public health problem and its control is a global health priority. One of the most successful tools to control infectious diseases has been the use of vaccines. Bacille Calmette-Guérin is one of the oldest available vaccines used today, the only licensed against tuberculosis. It has been administered to billions of people, as part of national immunization programs around the world. Immunological mechanisms by which it induces protection are not fully understood, but a role in the innate immune system maturation and the activation of T CD4 + and CD8 +, have been considered. Its effectiveness in terms of pulmonary tuberculosis is variable and controversial but highly cost - efficient to control tuberculous meningitis and miliary dissemination. However, it has not been enough to solve the global problem of tuberculosis, especially in countries with high rates, so that scientific development aiming at getting a new vaccine remains active.

La tuberculosis sigue siendo un problema de salud pública mundial y su control es una prioridad de salud global. Una de las herramientas más exitosas que se han utilizado para controlar enfermedades infecciosas ha sido el uso de vacunas. El bacilo de Calmette-Guérin es una de las vacunas más antiguas disponibles utilizadas en la actualidad, la única licenciada contra tuberculosis. Ha sido administrada en miles de millones de personas, siendo parte de distintos programas de vacunación nacionales en el mundo. Los mecanismos inmunológicos por los cuales induce protección aún no son completamente comprendidos, planteándose un rol sobre la maduración del sistema inmune innato y activación de células T CD4+ y CD8+. Su eficacia respecto de tuberculosis pulmonar es variable y controvertida, pero altamente costo eficiente para controlar meningitis tuberculosa y diseminación miliar, sin embargo no ha sido suficiente para resolver el problema global de la tuberculosis, especialmente en los países con endemias más altas, por lo que el desarrollo científico en miras de obtener una nueva vacuna se mantiene vigente.