662 — Archives of Disease in Childhood

662 -- Archives of Disease in Childhood

In this nationwide population-based cohort study using national Danish registries, in the period 1980–2008, our aim was to study employment and receipt of disability pension after central nervous system infections. This study evaluates to what extent the ACI surveillance is able to meet its objectives to monitor ACI trends and to detect signals of public health importance such as enteroviral outbreaks, tick-borne encephalitis (TBE) endemic foci, poliovirus appearance or emergence of new neurotropic viruses. In addition, ICD-9 is very outdated in regards to the current medical technology and terminology code capture. Affordable fold coast dentist will quote you a good price on dental work like check-up and cleans. Start at the root of ICD-9-CM, check the 2012 ICD-9-CM Index or use the search engine at the top of this page to lookup any code. Other symptoms may include visual impairment, lack of growth, deafness, blindness, spastic quadriparesis (paralysis), and intellectual deficits. Acute otitis media in children with moderate to severe bulging of the tympanic membrane or new onset of otorrhea (drainage) is not due to external otitis.

the inflammation may be caused by infection with viruses, bacteria, or other microorganisms, and less commonly by certain drugs. Deaths as a result of meningitis are recorded through the medical certificate of cause of death at the Office of National Statistics (ONS). These routine systems are also used conjointly with enhanced surveillance schemes to monitor meningococcal and pneumococcal meningitis,4,5 and alongside special studies (including the British Paediatric Surveillance Unit “orange card” system (www.bpsu.inopsu.com/)) in the surveillance of neonatal meningitis.6 A further source is Hospital Episode Statistics (HES) (www.doh.gov.uk//hes/). Among the survivors, the proportion that recovers its previous work capacity is not known but is an important indicator of complete rehabilitation, as is employment itself. In relation to neuroinvasive pathogens, all countries should have efficiently operating surveillance systems for aseptic central nervous system infections (ACI) in place that are able to identify potential threats and raise timely alarms, especially if international spread is involved. CDI and coding staff as well as clinicians (e.g., CDI Physician Champions) can use these ICD-10 documentation tips now to identify documentation deficiencies in order to provide documentation improvement awareness and education and give feedback to medical providers. In 2001, 1216 clinically diagnosed cases of meningitis in children in England were formally notified to the PHLS CDSC.

662 -- Archives of Disease in Childhood
Meningococcal meningitis was the most common reported cause (48%), with other bacteria (12%), viruses (19%), and other or unknown causes accounting for the rest. These proportions are unlikely to reflect true differences in incidence, however, since the completeness of notification is better for more serious diseases. This disease is much more common in persons with poor Eustachian tube function and very common in certain races such as Native North Americans. In contrast, viral meningitis is probably under-diagnosed and under-notified. HES records around 600 admissions for viral meningitis in children in England each year, which suggests that notifications under-estimate the burden of meningitis requiring admission to hospital by approximately 160%. Data from laboratories are also prone to bias because of different methods of confirmation and different clinical practices. The DNRP provided data on inpatient admissions and hospital outpatient services (10).

Reports on incident ACI cases are aggregated and forwarded every two weeks to the provincial SES, where, in turn, they are aggregated and sent to the Department of Epidemiology at the National Institute of Public Health (PZH). Transmission is primarily via the faecal, oral, and respiratory routes. Virus is shed in stools and can be detected for weeks after infection. The virus inhabits the intestinal tract, causing gastrointestinal diseases, but once in the bloodstream it can show affinities for many organs, including the brain.17 Most confirmed infections reported are isolates from faecal specimens and are not associated with infection of the central nervous system. Weekly totals of laboratory reports of enterovirus isolates, however, parallel clinically notified cases of viral meningitis (fig 1), with summer peaks occurring when particularly virulent strains are circulating.12,18 This supports the hypothesis that enteroviruses are the main cause of notified viral meningitis. Children 24 months or older with non-severe disease can have either antibiotics or observation. The most common causes of bacterial meningitis in children in England and Wales are meningococcal, Haemophilus influenzae type b (Hib), and pneumococcal infections.

Less common causes include group B streptococci, Escherichia coli, Listeria sp., and staphylococcus. Between 1982 and 2001, the most common bacterial isolate from the CSF reported to the PHLS was Neisseria meningitidis (fig 2). There is no general recommendation for use of the meningococcal vaccine (14). From each hospital, information on the possibility to hospitalise ACI cases was requested, as well as on the availability of laboratory diagnostics for viral pathogens in the hospital or a subcontracted laboratory. Following the success of conjugate vaccines against Hib, similar vaccines have now been developed against serogroup C meningococcal infection and against the major serotypes of S pneumoniae. Meningococcal meningitis can present alone or in combination with meningococcal septicaemia. Case fatality rates for meningitis are generally low, and most deaths from meningococcal infection are therefore a result of septicaemia.

The number of cases and deaths from meningococcal disease (both meningitis and septicaemia) started to rise in 1995, because of an increase in serogroup C infections, particularly C2a strains. PMID 24453496. In 1996, a national polymerase chain reaction (PCR) diagnostic service became available,20 and this improved ascertainment of confirmed meningitis and septicaemia. This came against a background change in clinical practice away from performing lumbar punctures,21 which meant CSF isolates of N meningitidis started to decline (fig 2). The trend in CSF isolates was in contrast to increases in the overall number of confirmed cases (http://cdsc.hpa.org.uk/topics_az/meningo/data_meni-t3a.htm). A score of 1, 2, 3, or 6 was assigned to a range of comorbid conditions, and 3 levels of comorbidity were defined: none (Charlson score = 0), low (Charlson score = 1–2), or high (Charlson score ≥3). For data analysis we used STATA version 10 [15].

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