Increased Risk of Invasive Meningococcal Disease in Children with Underlying Medical Conditions

Background: Neisseria meningitidisis a leading cause of meningitis and sepsis worldwide.

Known risk factors for susceptibility to invasive meningococcal disease (IMD) include deficiencies in the complement pathway, asplenia and possibly HIV infection. A possible risk associated with other chronic conditions is, however, unknown.

Here we estimate the risk of IMD associated with comorbidities in a population of non-immunized Danish children.

Methods: Nationwide case-control study. Cases < 18 years with IMD from 1977 through 2015 were identified by linkage between national Danish registries. Ten controls were age- and sex-matched per case. Chronic disease diagnoses preceding IMD were based on International Classification of Disease-8 and 10. The association between chronic disease and IMD were expressed as adjusted odds ratios (aOR) estimated in a conditional logistic regression after adjustment for year of IMD and for other chronic disease.

Results: We included 5121 cases of IMD with a median age of 4.1 years (IQR 1.5-12.6 years). Among cases 6.9 % had a history of chronic disease compared to 5.6 % of the controls (P=0.0001).

Several comorbidities were associated with an increased risk of IMD: cerebrospinal fluid leak (aOR 8.8 (95% CI 1.23-62.40)), HIV infection (aOR 6.9 (1.16-41.34)), chromosomal abnormalities (aOR 3.2 (2.02-5.17)), esophageal disease (aOR 2.5 (1.37-4.69)), autoimmune disease (aOR 2.2 (95% CI 1.31-3.88)), hydrocephalus (aOR 1.9 (1.10-3.27)), epilepsy (aOR 1.8 (95% CI 1.36-2.26)), chronic heart disease (aOR 1.7 (95% CI 1.05-2.90)), and congenital heart disease (aOR 1.5 (95% CI 1.18-1.95)).

Conclusion: Children with certain neurological conditions, HIV infection, chromosomal abnormalities, esophageal disease, autoimmune disease and heart disease appear particularly susceptible to IMD. HIV infection exempted, these are previously undescribed risk factors for IMD. Future guidelines should consider these medical conditions as risk factors that may warrant meningococcal vaccination.