Department of Health

Meningococcal infection remains a life-threatening disease despite advances in early recognition and therapy. While the incidence of meningococcal infection is extremely low in Japan, nationwide data on its clinical outcomes have been lacking. We conducted a retrospective cohort study using the Japanese Diagnosis Procedure Combination (DPC) inpatient database from July 2010 to March 2023. Patients with a main diagnosis of meningococcal infection (International Classification of Diseases, 10th Revision code A39) were included. The primary outcome was in-hospital mortality. Secondary outcomes included impaired consciousness at discharge and functional status, assessed using the Barthel Index. Multivariable logistic regression was performed to identify prognostic factors. A total of 465 patients were analyzed. The median age was 55 years, and 57.0% were male. The in-hospital mortality rate was 8.2%, and 40.2% of survivors had a Barthel Index ≤90 at discharge. Early antibiotic administration did not significantly reduce mortality but was associated with improved neurological outcomes. Baseline impaired consciousness was the strongest predictor of mortality and poor functional status, while chronic comorbidities also contributed to worse outcomes. Notably, older age itself was not independently associated with mortality after adjustment for severity and comorbidities. Meningococcal infection outcomes in Japan are predominantly determined by the severity of illness at presentation and comorbid health conditions rather than age alone. Early antibiotic therapy improves neurological recovery but may not prevent death once critical illness is established. These findings underscore the importance of prevention through vaccination and early recognition strategies to reduce the burden of this devastating infection.

Europe is currently facing novel security threats in many different areas, reinforcing the need for a well prepared and protected health and care workforce to ensure health system resilience and service provision for the population under conditions of a poly-crisis. However, the health and care workforce is weakened by persisting shortages, competency gaps and mismatches, and poor working and mental health conditions. Health and care workers are not prepared for yet another crisis and a systematic strategy is lacking. This policy commentary argues for health and care workforce preparedness and protection as a structural pillar and integral part of an emerging EU health and security landscape, calling for a coherent European Union strategy and highlighting capacities for implementation and co-benefits for democratic societies and economies. Key policy recommendations include: developing a coordinated EU strategy that is capable to protect, prepare and retain health and care workers; closing the competencies gaps to align preparedness for military aggression, cyberattacks, climate change, and new infectious diseases; investing in research and data spaces to strengthen evidence-based information and policy; creating governance structures and building on existing EU programs and budgets to freeing resources for the health and care workforce.