**4. Clinics**

Among the 18,914 cases of IMD reported in Ukraine, 38.4% were meningococcemia, 29.9% were meningococcemia with meningitis, 27.9% meningitis and others 2.8% were of different minor etiologies. Other clinical forms have not been also clearly recognized and characterized as pneumonia or mixed clinical forms.

Also, the distribution of clinical forms of IMD in Ukraine is very different from the one observed in the EU countries in which meningitis prevails for 43.0%. Meningococcemia and meningococcemia with meningitis represent, respectively, 21.0 and 29.0% of total IMD in the EU [10].

Case fatality rate (CFR) of Meningococcal disease in Ukraine for the period considered (1992–2012) was of: 12.1% for IMD (n = 18,914); 18.9% for Meningococcemia (n = 7448); 10.1% for Meningococcemia (n = 5660); 5.94% of Meningitis (n = 5273); and 5.6% for others undefined clinical forms (n = 538).

In 2012, overall CFR in EU/EEA countries was 7.9%, (3185 confirmed IMD cases). The highest CFR reported (n = 1563) among cases presenting septicemia was 18.8%, followed by cases meningitis with septicemia of 11.1%, and then by cases with meningitis (3.7%) [11]. In Ukraine, the higher observed overall CFR of IMD greater than in the EU can be attributed to the frequency of septicemia.

Meningococcal disease CFR among children in Ukraine during the period of 2010–2015 ranged from 14.7 to 19.1% occurring as follows with respect to the age class: first year of life, 66%; 1–3 year old, 30%; over three-year old, 4%. Among 77% of patient death occurred during the first 24 h after onset.

According to the children's infectious hospital of Kiev, for the past 15 years, serotypes prevail as follows: meningococcal serogroup B, 57%; serogroup A, 19%; serogroup C, 20%; and other serogroup, 4%. Meningococcemia was diagnosed in 47% of patient with meningococcemia, 41% meningitis, while 12–76% of children with meningococcal disease had a complicated course of the disease, including septic shock, brain edema, multiple organ failure, disseminated intravascular coagulation syndrome, among others.
