Childhood bacterial meningitis in Bulgaria: a population-based retrospective study in six regions during 1992–1996

OBJECTIVES: We conducted a study to provide information on the importance of bacterial pathogens causing childhood meningitis in Bulgaria. METHODS: A 5-year population-based retrospective survey for bacterial meningitis in children <5 years of age was performed at all hospitals in the six largest regions of Bulgaria. RESULTS: There were 297 cases of meningitis reported, of which 211 (71.0%) were classified as bacterial in origin. The most common causes were Neisseria meningitidis (49 cases) and Haemophilus influenzae type b (Hib) (44 cases), accounting for 36% and 32% of etiologically confirmed cases. Thirty-one cases (70.5%) of Hib meningitis occurred in children <2 years of age, and 26 (59.1%) occurred in children 6-23 months of age. Average annual incidence rates of Hib meningitis based on the population of children <5 years of age for each region ranged from 1.3 to 9.8 per 100,000 (mean 5.9/100,000). CONCLUSION: The estimated incidence rates from this study were similar to those reported from southern European and Mediterranean countries. Further studies are planned to provide information on appropriate strategies for preventing childhood meningitis in Bulgaria.