Correspondence: Ásgeir Haraldsson, Children’ s Hospital Iceland, Landspitali – University Hospital, 101 Reykjavík, Iceland. E-mail: asgeir@lsh.is (Received 15 April 2013; accepted 17 June 2013) Scandinavian Journal of Infectious Diseases, 2013; Early Online: 1–6 ISSN 0036-5548 print/ISSN 1651-1980 online © 2013 Informa Healthcare DOI: 10.3109/00365548.2013.817680 ORIGINAL ARTICLE Bacterial meningitis in children in Iceland, 1975–2010: A nationwide epidemiological study KOLFINNA SNAEBJARNARDÓTTIR 1 , HELGA ERLENDSDÓTTIR 1,2 , INGI KARL REYNISSON 1 , KARL KRISTINSSON 1 , SANDRA HALLDÓRSDÓTTIR 1 , HJÖRDÍS HARDARDÓTTIR 2 , THÓRÓLFUR GUDNASON 1,3,4 , MAGNÚS GOTTFREDSSON 1,5 & ÁSGEIR HARALDSSON 1,3 From the 1 University of Iceland Faculty of Medicine, 2 Department of Clinical Microbiology, Landspitali University Hospital, 3 Children’ s Hospital Iceland, Landspitali University Hospital, 4 Directorate of Health, and 5 Department of Infectious Diseases, Landspitali University Hospital, Reykjavik, Iceland Abstract Background: Bacterial meningitis is a serious and potentially rapid life-threatening disease. Therefore, to ensure appropriate treatment, early recognition of signs and symptoms is imperative, along with knowledge of the epidemiology and microbi- ology of the disease. Methods: A long-term, nationwide epidemiological study of bacterial causes of meningitis in children (  18 y) in Iceland during the period 1975–2010 was carried out. A detailed chart review was performed of all cases diag- nosed in 1995–2010. Results: A total of 477 children were diagnosed with bacterial meningitis during the period 1975–2010. Of these, 67% were aged under 5 y. The most common pathogens were Neisseria meningitidis ( n = 265), Haemophilus influenzae ( n = 132), Streptococcus pneumoniae ( n = 47), and Streptococcus agalactiae ( n = 19); their incidences varied according to age. The age-specific incidence (cases/100,000/y) dropped from 26 in 1975 to 1 in 2010 ( p  0.001). The most common symptoms during the period 1995–2010 were fever (92%), vomiting (67%), nuchal rigidity (60%), and rashes/ petechiae (51%). H. influenzae type b disappeared following implementation of Hib vaccination in 1989, and, likewise, the incidence of meningococcal meningitis fell significantly after vaccination against meningococcus serogroup C was initiated in 2002 ( p  0.001). The overall 30-day case fatality rate of bacterial meningitis was 4.4% and remained unchanged during the study period. Conclusions: The incidence of childhood bacterial meningitis has been reduced significantly by successful vaccinations against H. influenzae type b and N. meningitidis serogroup C. Nevertheless, the case fatality rate has remained unchanged and thus the disease is still a serious threat to childhood health. Further prevention by novel vaccines and improved management of childhood meningitis is an exciting challenge. Keywords: Meningitis, epidemiology , children, vaccination Introduction Despite advances in diagnosis and treatment, bacte- rial meningitis remains a life-threatening disease worldwide, with a high incidence in childhood and amongst the elderly [1–3]. The most common bacte- rial causes of meningitis are Streptococcus pneu- moniae, Haemophilus influenzae, and Neisseria meningitidis [2,4,5], in addition to group B Strepto- coccus (GBS) in newborns [2,6]. It is important to know the causative agents of bacterial meningitis in different communities and the antimicrobial suscep- tibility of these bacteria so an effective empirical treatment can be given until results of culture and susceptibility tests are known [1]. Bacterial meningitis was almost uniformly fatal or resulted in severe sequelae before the advent of antibiotics. However, despite the availability of effec- tive antibiotics, the disease still carries a high mortal- ity and morbidity [5,7,8], as reviewed by Edmond et al. [9]. In a meta-analysis, the morbidity was described to be 9–25% in World Health Organization (WHO) countries, the highest incidence being in Africa and Asia [9]. The most common long-term effects are Scand J Infect Dis Downloaded from informahealthcare.com by Landspitali University Hospital on 08/23/13 For personal use only.