Incidence of Unsuspected Meningococcal Disease

I read with interest the article by Wang et al¹ on unsuspected meningococcal disease. In the pediatric emergency department of Jackson Memorial Hospital/University of Miami School of Medicine, Miami, Fla, we have had 5 such cases over a period of 20 years during which we have had approximately 710 000 patient visits. The incidence of this entity in our population is approximately 1 in 142 000 patient visits. I am interested in knowing the incidence of this entity in the series of patients that Wang et al studied. Two (not initially treated) of our patients died, 1 (not initially treated) required bilateral below the knee amputations, and 2 (both initially treated) survived with no obvious sequelae. Although this represents only a few patients, it is in concordance with the finding of Dr Wang et al that antibiotic use is associated with a better outcome in patients with unsuspected meningococcal disease.