Adolescent survivors of invasive meningococcal disease often do not receive appropriate follow-up services

Adolescents who survived invasive meningococcal disease, particularly disease attributable to serogroup C, had poorer physical and mental health, quality of life and educational achievements than those who did not experience the disease.

“Routine follow-up care of adolescent survivors may prevent or ameliorate physical and psychosocial morbidity after invasive meningococcal disease,” the researchers wrote.

They conducted a population-based, matched-cohort study involving 101 sex- and age-matched case-control pairs. Participants were aged 15 to 19 years and follow-up evaluations were performed 18 to 36 months following invasive meningococcal disease.

Following illness, 53 of the 101 participants who had experienced disease reported contact with a health care professional. After adjustment for life stressors, cases were significantly more likely to report depressive symptoms, and about 20% of participants within the clinical range for depressive symptoms had received referral to an appropriate specialist.

Results from the Annotated Scale of Bodily Injuries Regulation (ASBIR) revealed that 57% (n=58) had major physical sequelae including skin scarring; vertigo; mobility, speech and hearing problems; amputation; seizures; and symptoms consistent with Raynaud’s phenomenon. Physical outcomes were worse among patients with serogroup C invasive meningococcal disease with an average ASBIR score of 60% compared with scores of 20% reported by patients with serogroup B invasive meningococcal disease (P=.06).

Overall, participants who experienced invasive meningococcal disease reported significantly higher total and mental fatigue scores compared with controls and achieved fewer passes at the General Certificate of Secondary Education level. Patients who experienced IMB were also more likely to have failed an exam in the year following illness than those who did not.

“Further assessment of outcomes at multiple time points is required to evaluate whether the deficits reported here persist beyond the medium term,” the researchers wrote.– by Nicole Blazek

Borg J. Pediatrics. 2009;doi:10.1542/peds.2008-0581.

It is critical that providers are aware of and screen for both mental health consequences and school achievement issues in addition to physical disability after IMD. Scheduled follow-up care must become part of the discharge planning for any patient treated for IMD; adolescents should receive care specifically targeted for any noted deficits. The study authors note that poorer mental health functioning seems to be associated with the impact of physical disability, and poorer school function may be related to cognitive deficits as a result of disease. Either way, physicians who address these issues specifically in follow-up could prevent further morbidity and improve overall outcome among this vulnerable adolescent group of survivors.

– Amy Middleman, MD, MPH

Infectious Diseases in Children Editorial Board member