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September 1995, Vol 149, No. 9 >
Article | September 1995

Long-term Outcome of Haemophilus influenzae Meningitis in Navajo Indian Children FREE

Carl T. D'Angio, MD; Robert G. Froehlke, MD; Gary A. Plank, PhD; David J. Meehan, MD; Christine M. Aguilar, MD; Marc B. Lande, MD; Lily Hugar, MA
Arch Pediatr Adolesc Med. 1995;149(9):1001-1008. doi:10.1001/archpedi.1995.02170220067009.
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Objectives:  To determine the long-term neurologic, cognitive, and educational outcomes of Navajo children who survived Haemophilus influenzae type b meningitis.

Design:  Retrospective cohort study, with 3.6- to 15.0-year follow-up.

Setting:  Navajo Indian reservation.

Participants:  Population-based cohort of 76 Navajo children with Haemophilus meningitis at less than 5 years of age between 1975 and 1986, with 41(54%) consenting to undergo follow-up in 1990. Each case was matched to one nearest-age sibling and one unrelated age-matched control.

Main Outcome Measures:  Standardized intelligence test scores, neurologic abnormalities, and school performance.

Results:  The mean IQ for cases was lower than that for siblings (79 vs 87, P=.006) or age-matched controls (79 vs 95, P<.001). Twenty-nine percent of cases had severe neurologic sequelae, including mental retardation (24%), severe hearing loss (5%), cerebral palsy (7%), and seizure disorder (12%). Eight percent of siblings (relative risk for cases vs siblings, 8.0; P=.05) and 2% of age--matched controls (relative risk vs cases, 10.0; P=.01) had mental retardation. No siblings or age-matched controls had any other severe neurologic sequela. Twenty-nine percent of cases, 23% of siblings (relative risk, 2.5; P=.45), and 0% of age-matched controls (P=.001) required special education services, while 42% of cases, 23% of siblings (relative risk, 3.3; P=.10), and 11% of age-matched controls (relative risk, 4.0; P=.005) had been retained in a grade in school.

Conclusions:  Navajo survivors of Haemophilus meningitis suffer more long-term neurologic, cognitive, and school-related disability than siblings or age-matched controls. They may also suffer higher morbidity than Haemophilus meningitis survivors in the general population.(Arch Pediatr Adolesc Med. 1995;149:1001-1008)

REFERENCES

1 +
Sproles ET III, Azerrad J, Williamson C, Merrill RE.  Meningitis due to Haemophilus influenzae: long-term sequelae . J Pediatr . 1969;:75:782-788.
2 +
Smith AL.  Neurologic sequelae of meningitis . N Engl J Med . 1988;;319:1012-1014.
3 +
Sell SH.  Long term sequelae of bacterial meningitis in children . Pediatr Infect Dis . 1983;;2:90-93.
4 +
Alon U, Naveh Y, Gardos M, Friedman A.  Neurological sequelae of septic meningitis: a follow-up study of 65 children . Isr J Med Sci . 1979;;6:512-517.
5 +
Sell SH, Webb WW, Pate JE, Doyne EO.  Psychological sequelae to bacterial meningitis: two controlled studies . Pediatrics . 1972;;49:212-217.
6 +
Feigin RD, Stechenberg BW, Chang MJ, et al.  Prospective evaluation of treatment of Hemophilus influenzae meningitis . J Pediatr . 1976;;88:542-548.
7 +
Claesson B, Trollfors B, Jodal U, Rosenhall U.  Incidence and prognosis of Haemophilus influenzae meningitis in children in a Swedish region . Pediatr Infect Dis . 1984;;3:35-39.
8 +
Lindberg J, Rosenhall U, Nylen O, Ringner A.  Long-term outcome of Haemophilus influenzae meningitis related to antibiotic treatment . Pediatrics . 1977;; 60:1-6.
9 +
Sell SH, Merrill RE, Doyne EO, Zimsky EP Jr.  Long-term sequelae of Haemophilus influenzae meningitis . Pediatrics . 1972;;49:206-211.
10 +
Tejani A, Dobias B, Sambursky J.  Long-term prognosis after H. influenzae meningitis: prospective evaluation . Dev Med Child Neurol . 1982;;24:338-343.
11 +
Taylor HG, Mills EL, Ciampi A, et al.  The sequelae of Haemophilus influenzae meningitis in school-age children . N Engl J Med . 1990;;323:1657-1663.
12 +
Pomeroy SL, Holmes SJ, Dodge PR, Feigin RD.  Seizures and other neurologic sequelae of bacterial meningitis in children . N Engl J Med . 1990;;323:1651-1657.
13 +
Raivio M, Koskiniemi M.  Hearing disorders after Haemophilus influenzae meningitis: comparison of different drug regimens . Arch Otolaryngol . 1978;:104: 340-344.
14 +
Wotton KA, Stiver HG, Hildes JA.  Meningitis in the central Arctic: a 4-year experience . Can Med Assoc J . 1981;;124:887-890.
15 +
Fortuine R.  Acute purulent meningitis in Alaska natives: epidemiology, diagnosis and prognosis . Can Med Assoc J . 1966;;94:19-22.
16 +
Coulehan JL, Michaels RH, Williams KE, et al.  Bacterial meningitis in Navajo Indians . Public Health Rep . 1976;;91:464-468.
17 +
Yost GC, Kaplan AM, Bustamente R, Ellison C, Hargrave AF III, Randall DL.  Bacterial meningitis in Arizona American Indian children . AJDC . 1986;;140:943-946.
18 +
Ward JI, Lum MKW, Hall DB, Silimperi DR, Bender TR.  Invasive Haemophilus influenzae type b disease in Alaska: background epidemiology for a vaccine efficacy trial . J Infect Dis . 1986;;153:17-26.
19 +
Gilsdorf JR.  Bacterial meningitis in southwestern Alaska . Am J Epidemiol . 1977;; 106:388-391.
20 +
Ward JI, Margolis HS, Lum MKW, Fraser DW, Bender TR, Anderson P.  Haemophilus influenzae disease in Alaskan Eskimos: characteristics of a population with an unusual incidence of invasive disease . Lancet . 1981;;1:1281-1285.
21 +
Losonsky GA, Santosham M, Sehgal VM, Zwahlen A, Moxon ER.  Haemophilus influenzae disease in the White Mountain Apaches: molecular epidemiology of a high risk population . Pediatr Infect Dis . 1984;;3:539-547.
22 +
Broome CV.  Epidemiology of Haemophilus influenzae type b infections in the United States . Pediatr Infect Dis J . 1987;;6:779-782.
23 +
Coulehan JL, Michaels RH, Hallowell C, Schults R, Welty TK, Kuo JS.  Epidemiology of Haemophilus influenzae type B disease among Navajo Indians . Public Health Rep . 1984;;99:404-409.
24 +
Herson VC, Todd JK.  Prediction of morbidity in Haemophilus influenzae meningitis . Pediatrics . 1977;;59:35-39.
25 +
Feldman HM, Michaels RH.  Academic achievement in children ten to 12 years after Haemophilus influenzae meningitis . Pediatrics . 1988;;81:339-344.
26 +
Division of Health Program Statistics. Indian Health Service Chart Series Book . Rockville, Md: Indian Health Service; 1991;:21.
27 +
Rowe PC, ed. The Harriet Lane Handbook . 11th ed. Chicago, III: Year Book Medical Publishers; 1987;:358.
28 +
Hollingshead AG. Two-Factor Index of Social Position. New Haven, Conn: Yale University; 1957. Thesis.
29 +
Kaufman A, ed. Handbook of Intelligence . New York, NY: John Wiley & Sons Inc; 1985;.
30 +
Shertzer B, Linden J, eds. Fundamentals of Individual Appraisal . Boston, Mass: Houghton Mifflin Co; 1979;.
31 +
Dawson-Saunders B, Trapp RG. Basic and Clinical Biostatistics . Norwalk, Conn: Appleton-Lange; 1990;.
32 +
Shackleford PG, Bobinski JE, Feigin RD, Cherry JD.  Therapy of Haemophilus influenzae meningitis reconsidered . N Engl J Med . 1972;;287:634-638.
33 +
Barson WJ, Miller MA, Brady MT, Powell DA.  Prospective comparative trial of ceftriaxone vs conventional therapy for treatment of bacterial meningitis in children . Pediatr Infect Dis . 1985;;4:362-368.
34 +
Kaplan SL, Catlin FI, Weaver T, Feigin RD.  Onset of hearing loss in children with bacterial meningitis . Pediatrics . 1984;;73:575-578.
35 +
Vienny H, Despland PA, Lütschg J, Deonna T, Dutoit-Marco ML, Gander C.  Early diagnosis and evolution of deafness in childhood bacterial meningitis: a study using brainstem auditory evoked potentials . Pediatrics . 1984;;73:579-586.
36 +
Baraff LJ, Lee SI, Schriger DL.  Outcomes of bacterial meningitis in children: a meta-analysis . Pediatr Infect Dis J . 1993;;12:389-394.
37 +
Taylor HG, Michaels RH, Mazur PM, Bauer RE, Liden CB.  Intellectual, neuropsychological and achievement outcomes in children six to eight years after recovery from Haemophilus influenzae meningitis . Pediatrics . 1984;;74:198-205.
38 +
Letson GW, Gellin BC, Bulkow LR, Parks DJ, Ward JI.  Severity and frequency of sequelae of bacterial meningitis in Alaska Native infants . AJDC . 1992;:146: 560-566.
39 +
Gary N, Powers N, Todd JK.  Clinical identification and comparative prognosis of high-risk patients with Haemophilus influenzae meningitis . AJDC . 1989;:143: 307-311.
40 +
Snedeker JD, Kaplan SL, Dodge PR, Holmes SJ, Feigin RD.  Subdural effusion and its relationship with neurologic sequelae of bacterial meningitis in infancy: a prospective study . Pediatrics . 1990;;86:163-170.
41 +
Odio CM, Faingezicht I, Paris M, et al.  The beneficial effects of early dexamethasone administration in infants and children with bacterial meningitis . N Engl J Med . 1991;;324:1525-1531.
42 +
Lebel MH, Freij BJ, Syrogiannopoulos GA, et al.  Dexamethasone therapy for bacterial meningitis: results of two double-blind, placebo-controlled trials . N Engl J Med . 1988;;319:964-971.
43 +
Teeter A, Roore CL, Peterson JD.  Verbal and performance abilities of Native Americans with school problems . Psychol Schools . 1982;;19:39-44.
44 +
Blake J.  Number of siblings and educational attainment . Science . 1989;:245: 32-36.
45 +
Adams WG, Deaver KA, Cochi SL, et al.  Decline of childhood Haemophilus influenzae type b (Hib) disease in the Hib vaccine era . JAMA . 1993;;269:221-226.

Figures

Tables

Interactive Graphics

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Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature

Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal

References

1 +
Sproles ET III, Azerrad J, Williamson C, Merrill RE.  Meningitis due to Haemophilus influenzae: long-term sequelae . J Pediatr . 1969;:75:782-788.
2 +
Smith AL.  Neurologic sequelae of meningitis . N Engl J Med . 1988;;319:1012-1014.
3 +
Sell SH.  Long term sequelae of bacterial meningitis in children . Pediatr Infect Dis . 1983;;2:90-93.
4 +
Alon U, Naveh Y, Gardos M, Friedman A.  Neurological sequelae of septic meningitis: a follow-up study of 65 children . Isr J Med Sci . 1979;;6:512-517.
5 +
Sell SH, Webb WW, Pate JE, Doyne EO.  Psychological sequelae to bacterial meningitis: two controlled studies . Pediatrics . 1972;;49:212-217.
6 +
Feigin RD, Stechenberg BW, Chang MJ, et al.  Prospective evaluation of treatment of Hemophilus influenzae meningitis . J Pediatr . 1976;;88:542-548.
7 +
Claesson B, Trollfors B, Jodal U, Rosenhall U.  Incidence and prognosis of Haemophilus influenzae meningitis in children in a Swedish region . Pediatr Infect Dis . 1984;;3:35-39.
8 +
Lindberg J, Rosenhall U, Nylen O, Ringner A.  Long-term outcome of Haemophilus influenzae meningitis related to antibiotic treatment . Pediatrics . 1977;; 60:1-6.
9 +
Sell SH, Merrill RE, Doyne EO, Zimsky EP Jr.  Long-term sequelae of Haemophilus influenzae meningitis . Pediatrics . 1972;;49:206-211.
10 +
Tejani A, Dobias B, Sambursky J.  Long-term prognosis after H. influenzae meningitis: prospective evaluation . Dev Med Child Neurol . 1982;;24:338-343.
11 +
Taylor HG, Mills EL, Ciampi A, et al.  The sequelae of Haemophilus influenzae meningitis in school-age children . N Engl J Med . 1990;;323:1657-1663.
12 +
Pomeroy SL, Holmes SJ, Dodge PR, Feigin RD.  Seizures and other neurologic sequelae of bacterial meningitis in children . N Engl J Med . 1990;;323:1651-1657.
13 +
Raivio M, Koskiniemi M.  Hearing disorders after Haemophilus influenzae meningitis: comparison of different drug regimens . Arch Otolaryngol . 1978;:104: 340-344.
14 +
Wotton KA, Stiver HG, Hildes JA.  Meningitis in the central Arctic: a 4-year experience . Can Med Assoc J . 1981;;124:887-890.
15 +
Fortuine R.  Acute purulent meningitis in Alaska natives: epidemiology, diagnosis and prognosis . Can Med Assoc J . 1966;;94:19-22.
16 +
Coulehan JL, Michaels RH, Williams KE, et al.  Bacterial meningitis in Navajo Indians . Public Health Rep . 1976;;91:464-468.
17 +
Yost GC, Kaplan AM, Bustamente R, Ellison C, Hargrave AF III, Randall DL.  Bacterial meningitis in Arizona American Indian children . AJDC . 1986;;140:943-946.
18 +
Ward JI, Lum MKW, Hall DB, Silimperi DR, Bender TR.  Invasive Haemophilus influenzae type b disease in Alaska: background epidemiology for a vaccine efficacy trial . J Infect Dis . 1986;;153:17-26.
19 +
Gilsdorf JR.  Bacterial meningitis in southwestern Alaska . Am J Epidemiol . 1977;; 106:388-391.
20 +
Ward JI, Margolis HS, Lum MKW, Fraser DW, Bender TR, Anderson P.  Haemophilus influenzae disease in Alaskan Eskimos: characteristics of a population with an unusual incidence of invasive disease . Lancet . 1981;;1:1281-1285.
21 +
Losonsky GA, Santosham M, Sehgal VM, Zwahlen A, Moxon ER.  Haemophilus influenzae disease in the White Mountain Apaches: molecular epidemiology of a high risk population . Pediatr Infect Dis . 1984;;3:539-547.
22 +
Broome CV.  Epidemiology of Haemophilus influenzae type b infections in the United States . Pediatr Infect Dis J . 1987;;6:779-782.
23 +
Coulehan JL, Michaels RH, Hallowell C, Schults R, Welty TK, Kuo JS.  Epidemiology of Haemophilus influenzae type B disease among Navajo Indians . Public Health Rep . 1984;;99:404-409.
24 +
Herson VC, Todd JK.  Prediction of morbidity in Haemophilus influenzae meningitis . Pediatrics . 1977;;59:35-39.
25 +
Feldman HM, Michaels RH.  Academic achievement in children ten to 12 years after Haemophilus influenzae meningitis . Pediatrics . 1988;;81:339-344.
26 +
Division of Health Program Statistics. Indian Health Service Chart Series Book . Rockville, Md: Indian Health Service; 1991;:21.
27 +
Rowe PC, ed. The Harriet Lane Handbook . 11th ed. Chicago, III: Year Book Medical Publishers; 1987;:358.
28 +
Hollingshead AG. Two-Factor Index of Social Position. New Haven, Conn: Yale University; 1957. Thesis.
29 +
Kaufman A, ed. Handbook of Intelligence . New York, NY: John Wiley & Sons Inc; 1985;.
30 +
Shertzer B, Linden J, eds. Fundamentals of Individual Appraisal . Boston, Mass: Houghton Mifflin Co; 1979;.
31 +
Dawson-Saunders B, Trapp RG. Basic and Clinical Biostatistics . Norwalk, Conn: Appleton-Lange; 1990;.
32 +
Shackleford PG, Bobinski JE, Feigin RD, Cherry JD.  Therapy of Haemophilus influenzae meningitis reconsidered . N Engl J Med . 1972;;287:634-638.
33 +
Barson WJ, Miller MA, Brady MT, Powell DA.  Prospective comparative trial of ceftriaxone vs conventional therapy for treatment of bacterial meningitis in children . Pediatr Infect Dis . 1985;;4:362-368.
34 +
Kaplan SL, Catlin FI, Weaver T, Feigin RD.  Onset of hearing loss in children with bacterial meningitis . Pediatrics . 1984;;73:575-578.
35 +
Vienny H, Despland PA, Lütschg J, Deonna T, Dutoit-Marco ML, Gander C.  Early diagnosis and evolution of deafness in childhood bacterial meningitis: a study using brainstem auditory evoked potentials . Pediatrics . 1984;;73:579-586.
36 +
Baraff LJ, Lee SI, Schriger DL.  Outcomes of bacterial meningitis in children: a meta-analysis . Pediatr Infect Dis J . 1993;;12:389-394.
37 +
Taylor HG, Michaels RH, Mazur PM, Bauer RE, Liden CB.  Intellectual, neuropsychological and achievement outcomes in children six to eight years after recovery from Haemophilus influenzae meningitis . Pediatrics . 1984;;74:198-205.
38 +
Letson GW, Gellin BC, Bulkow LR, Parks DJ, Ward JI.  Severity and frequency of sequelae of bacterial meningitis in Alaska Native infants . AJDC . 1992;:146: 560-566.
39 +
Gary N, Powers N, Todd JK.  Clinical identification and comparative prognosis of high-risk patients with Haemophilus influenzae meningitis . AJDC . 1989;:143: 307-311.
40 +
Snedeker JD, Kaplan SL, Dodge PR, Holmes SJ, Feigin RD.  Subdural effusion and its relationship with neurologic sequelae of bacterial meningitis in infancy: a prospective study . Pediatrics . 1990;;86:163-170.
41 +
Odio CM, Faingezicht I, Paris M, et al.  The beneficial effects of early dexamethasone administration in infants and children with bacterial meningitis . N Engl J Med . 1991;;324:1525-1531.
42 +
Lebel MH, Freij BJ, Syrogiannopoulos GA, et al.  Dexamethasone therapy for bacterial meningitis: results of two double-blind, placebo-controlled trials . N Engl J Med . 1988;;319:964-971.
43 +
Teeter A, Roore CL, Peterson JD.  Verbal and performance abilities of Native Americans with school problems . Psychol Schools . 1982;;19:39-44.
44 +
Blake J.  Number of siblings and educational attainment . Science . 1989;:245: 32-36.
45 +
Adams WG, Deaver KA, Cochi SL, et al.  Decline of childhood Haemophilus influenzae type b (Hib) disease in the Hib vaccine era . JAMA . 1993;;269:221-226.

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