Borg-Longhurst, E.; (2008) Social, psychological and functional outcomes after meningococcal disease in adolescents. Doctoral thesis , University of London.

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Abstract

Meningococcal disease (MD) remains a major source of mortality and morbidity in adolescence despite the introduction in some countries of the seroGroup C conjugate vaccine. This study is the first which comprehensively assesses the outcomes of MD in adolescence. In pursuing this aim, a population-based matched cohort study was undertaken and 101 sex and age matched case-control pairs (aged 15-19 years at disease) from 6 regions of England (representing 65% of the population of England) were followed up 18-36 months after MD (46% males). Educational, social and vocational function, mental health, social support, cognitive and quality of life data were collected using standardised questionnaires and neuropsychological tests. In addition, demographic and disease factors associated with outcome were also examined. The results show that 57% (N=58) of cases had physical sequelae ranging from minor scarring to bilateral amputations. Survivors had greater mental fatigue, lower social support, greater reduction in quality of life, and lower educational attainment compared with controls. Cognitive testing revealed no overall change in intellectual ability however, cases had deficits in aspects of memory (short and long-term), attention (selective and sustained), cognitive flexibility and psychomotor speed. Greater cognitive deficit was associated with a younger age at diagnosis. Cases with SeroGroup C disease had greater physical sequelae than those with B disease. MD status increased the risk of depression. Only 53/101 cases reported any medical follow-up after MD. The findings suggest that survivors of MD in adolescence have a disturbing series of deficits including poorer physical and mental health, quality of life and educational achievement. SeroGroup C is associated with poorer outcome. Of concern, medical care is poor after discharge from hospital. Routine follow up of adolescent survivors is essential to address issues and concerns that are important for adolescent MD survivors and to mitigate or prevent physical and psychosocial morbidity after MD.

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