Epidemiology of pediatric meningitis caused by Haemophilus influenzae B, Streptococcus pneumoniae and Neisseria meningitidis in Israel.

Bacterial meningitis remains a serious cause of morbidity and mortality in childhood. We report 3 year data on meningitis caused by Haemophilus influenzae b, Streptococcus pneumoniae and Neisseria meningitidis in Israeli children younger than 13 years of age. The data were obtained prospectively through an active surveillance system involving all 25 centers in which children are hospitalized. A case was defined by: a) culture positive cerebrospinal fluid; or b) positive blood culture with > 10 cells. During the study period, 482 cases of meningitis due to the three organisms were identified. Of these, 58%, 20% and 22% were caused by H. influenzae b, S. pneumoniae and N. meningitidis, respectively. The male/female ratio was 1.5:1. An over-representation of the non-Jewish population was seen only in cases caused by S. pneumoniae. The median age was 11 months and 59% of all cases occurred by the age of 12 months. The median age was 10, 12 and 36 months and the age-specific incidence for children aged 0-4 years was 18.5, 5.3 and 5.2 per 100,000, respectively, for H. influenzae b, S. pneumoniae and N. meningitidis. The chance of being hospitalized with meningitis during the first 5 years of life was estimated at 146.2 per 100,000. Meningitis was seasonal: 59% al all cases occurred during fall and winter and only 18% during summer. A total of 2,097 hospitalization days were required when extrapolated to a population in which 100,000 live births occur yearly. The case fatality rate was 2.2%, 5.9% and 6.3% for H. influenzae b, S. pneumoniae and N. meningitidis, respectively, with a higher fatality in females and non-Jews.