BACKGROUND: Invasive pneumococcal disease declined among children and adults after the introduction of the pediatric heptavalent pneumococcal conjugate vaccine (PCV7) in 2000, but its effect on pneumococcal meningitis is unclear. METHODS: We examined trends in pneumococcal meningitis from 1998 through 2005 using active, population-based surveillance data from eight sites in the United States. Isolates were grouped into PCV7 serotypes (4, 6B, 9V, 14, 18C, 19F, and 23F), PCV7-related serotypes (6A, 9A, 9L, 9N, 18A, 18B, 18F, 19B, 19C, 23A, and 23B), and non-PCV7 serotypes (all others). Changes in the incidence of pneumococcal meningitis were assessed against baseline values from 1998-1999. RESULTS: We identified 1379 cases of pneumococcal meningitis. The incidence declined from 1.13 cases to 0.79 case per 100,000 persons between 1998-1999 and 2004-2005 (a 30.1% decline, P<0.001). Among persons younger than 2 years of age and those 65 years of age or older, the incidence decreased during the study period by 64.0% and 54.0%, respectively (P<0.001 for both groups). Rates of PCV7-serotype meningitis declined from 0.66 case to 0.18 case (a 73.3% decline, P<0.001) among patients of all ages. Although rates of PCV7-related-serotype disease decreased by 32.1% (P=0.08), rates of non-PCV7-serotype disease increased from 0.32 to 0.51 (an increase of 60.5%, P<0.001). The percentages of cases from non-PCV7 serotypes 19A, 22F, and 35B each increased significantly during the study period. On average, 27.8% of isolates were nonsusceptible to penicillin, but fewer isolates were nonsusceptible to chloramphenicol (5.7%), meropenem (16.6%), and cefotaxime (11.8%). The proportion of penicillin-nonsusceptible isolates decreased between 1998 and 2003 (from 32.0% to 19.4%, P=0.01) but increased between 2003 and 2005 (from 19.4% to 30.1%, P=0.03). CONCLUSIONS: Rates of pneumococcal meningitis have decreased among children and adults since PCV7 was introduced. Although the overall effect of the vaccine remains substantial, a recent increase in meningitis caused by non-PCV7 serotypes, including strains nonsusceptible to antibiotics, is a concern. Massachusetts Medical Society
BACKGROUND:Invasive pneumococcal disease declined among children and adults after the introduction of the pediatric heptavalent pneumococcal conjugate vaccine (PCV7) in 2000, but its effect on pneumococcal meningitis is unclear. METHODS: We examined trends in pneumococcal meningitis from 1998 through 2005 using active, population-based surveillance data from eight sites in the United States. Isolates were grouped into PCV7 serotypes (4, 6B, 9V, 14, 18C, 19F, and 23F), PCV7-related serotypes (6A, 9A, 9L, 9N, 18A, 18B, 18F, 19B, 19C, 23A, and 23B), and non-PCV7 serotypes (all others). Changes in the incidence of pneumococcal meningitis were assessed against baseline values from 1998-1999. RESULTS: We identified 1379 cases of pneumococcal meningitis. The incidence declined from 1.13 cases to 0.79 case per 100,000 persons between 1998-1999 and 2004-2005 (a 30.1% decline, P<0.001). Among persons younger than 2 years of age and those 65 years of age or older, the incidence decreased during the study period by 64.0% and 54.0%, respectively (P<0.001 for both groups). Rates of PCV7-serotype meningitis declined from 0.66 case to 0.18 case (a 73.3% decline, P<0.001) among patients of all ages. Although rates of PCV7-related-serotype disease decreased by 32.1% (P=0.08), rates of non-PCV7-serotype disease increased from 0.32 to 0.51 (an increase of 60.5%, P<0.001). The percentages of cases from non-PCV7 serotypes 19A, 22F, and 35B each increased significantly during the study period. On average, 27.8% of isolates were nonsusceptible to penicillin, but fewer isolates were nonsusceptible to chloramphenicol (5.7%), meropenem (16.6%), and cefotaxime (11.8%). The proportion of penicillin-nonsusceptible isolates decreased between 1998 and 2003 (from 32.0% to 19.4%, P=0.01) but increased between 2003 and 2005 (from 19.4% to 30.1%, P=0.03). CONCLUSIONS: Rates of pneumococcal meningitis have decreased among children and adults since PCV7 was introduced. Although the overall effect of the vaccine remains substantial, a recent increase in meningitis caused by non-PCV7 serotypes, including strains nonsusceptible to antibiotics, is a concern. Massachusetts Medical Society
Authors: A Schuchat; K Robinson; J D Wenger; L H Harrison; M Farley; A L Reingold; L Lefkowitz; B A Perkins Journal: N Engl J Med Date: 1997-10-02 Impact factor: 91.245
Authors: Cynthia G Whitney; Monica M Farley; James Hadler; Lee H Harrison; Nancy M Bennett; Ruth Lynfield; Arthur Reingold; Paul R Cieslak; Tamara Pilishvili; Delois Jackson; Richard R Facklam; James H Jorgensen; Anne Schuchat Journal: N Engl J Med Date: 2003-05-01 Impact factor: 91.245
Authors: Lauri A Hicks; Lee H Harrison; Brendan Flannery; James L Hadler; William Schaffner; Allen S Craig; Delois Jackson; Ann Thomas; Bernard Beall; Ruth Lynfield; Arthur Reingold; Monica M Farley; Cynthia G Whitney Journal: J Infect Dis Date: 2007-10-04 Impact factor: 5.226
Authors: E Bingen; C Levy; E Varon; F de La Rocque; M Boucherat; P d'Athis; Y Aujard; R Cohen Journal: Eur J Clin Microbiol Infect Dis Date: 2007-11-30 Impact factor: 3.267
Authors: Sheldon L Kaplan; Edward O Mason; Ellen R Wald; Gordon E Schutze; John S Bradley; Tina Q Tan; Jill A Hoffman; Laurence B Givner; Ram Yogev; William J Barson Journal: Pediatrics Date: 2004-03 Impact factor: 7.124
Authors: G William Letson; Pratap Singhasivanon; Eduardo Fernandez; Nihal Abeysinghe; Juan Jose Amador; Harold S Margolis; Robert Edelman Journal: Hum Vaccin Date: 2010-10-01
Authors: Joann M Schulte; Robyn Kay; Janet J Hamilton; Cathy Mellinger; Phyllis Yambor; Christie Luce; Dawn Ginzl; Julia Gill; Richard S Hopkins Journal: Public Health Rep Date: 2010 Sep-Oct Impact factor: 2.792
Authors: Claire von Mollendorf; Cheryl Cohen; Linda de Gouveia; Vanessa Quan; Susan Meiring; Charles Feldman; Keith P Klugman; Anne von Gottberg Journal: Antimicrob Agents Chemother Date: 2014-03-31 Impact factor: 5.191