Selective primary health care: strategies for control of disease in the developing world. XIII. Acute bacterial meningitis.

Three species of bacteria (Haemophilus influenzae type b, Neisseria meningitidis, and Streptococcus pneumoniae) cause approximately three-quarters of all cases of acute bacterial meningitis in industrialized and developing countries. Infections due to N. meningitidis, S. pneumoniae, and H. influenzae type b are endemic in most countries; major epidemics of meningococcal disease still occur regularly, especially in sub- Saharan Africa. Such epidemics may be large, involving many thousands of patients, with a mortality that can exceed 10%. Both chemoprophylaxis and immunization are used to prevent meningococcal, pneumococcal, and H. influenzae type b meningitis. Chemoprophylaxis may involve the use of expensive antibiotics, and it can encourage the emergence of drug resistance. Mass immunization with meningococcal polysaccharide vaccine can effectively halt an epidemic of group A or group C meningococcal disease, and immunization protects close contacts. However, polysaccharide vaccines are ineffective in infants, who are very susceptible to bacterial meningitis. New protein-polysaccharide conjugated vaccines may be more effective in this young population.