Meningococcal Disease in Oklahoma, 1988-2004

Background: Meningococcal disease (MD) is the leading cause of bacterial meningitis in children age 2-18 in the U.S. and a leading cause in all age groups. The purpose of this study was to determine the epidemiology of MD in Oklahoma, including trends, high-risk populations, and outcomes. Methods: Cases from the statewide passive reporting system with disease onset between 1988 and 2004 were included. A multivariate logistic regression of variables predicting death was performed. Results: There were 545 total cases (average annual incidence rate 1.0/100,000); 13% died. Rates were highest for children under two years; black males had rates 2.0 times higher than the state rate. Persons with meningitis were more likely to survive than those with meningococcemia (OR 1.80, 95%CI 1.03-3.19) and persons under 65 years were more likely to have meningitis (OR 6.24, 95%CI 3.32-11.90). For every 10 years of age, the risk of death increased 12% (95%CI 1.002-1.019). Persons under 40 who developed MD between October and February were 4 times more likely to die than in other months (OR 4.34, 95%CI 1.84-10.57); the increased risk of death during these months was elevated but not statistically significant in those aged 40 and over (OR 1.42, 95%CI 0.61-3.31). Case linkage with hospital discharge data for 2002-2003 revealed an average length of stay of 12 days and average charges of $37,724. Conclusions: This study demonstrates the importance of using statewide public health surveillance data to characterize the epidemiology of MD, as state patterns may not reflect national trends.