Effect of Pneumococcal Conjugate Vaccine on Pneumococcal Meningitis

Abstract

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.

Revisão sistemática do uso da dexametasona como terapia adjuvante na meningite bacteriana em crianças

“…The studies discussed above corroborate the hypothesis of this epidemiological shift by demonstrating benefits of dexamethasone in those patient populations with a high percentage of Hib meningitis and the absence of protective effects in pneumococcal meningitis. Besides the Hib vaccine, the introduction of the pneumococcal conjugate vaccine in the 2000s was responsible for an almost 60% decrease of cases of pneumococcal meningitis in children under 18 years, from 1998 to 2005, in a U.S. epidemiological study (32) . Therefore, it is plausible that the major contribution of prevention strategies has minimized the effectiveness of adjuvant dexamethasone and that it has lost its role in the current epidemiological context of BM in the pediatric population.…”

“…The low number of studies found could be explained by the large decrease in the incidence of bacterial meningitis (32) , especially in developed countries, reducing its epidemiological importance. This low incidence could also explain the existence of several studies with small samples and containing adults and children in the same group.…”

Current Trends in Streptococcus pneumoniae Infections and Their Treatment

“…The epidemiology of IPD changed significantly after infant PCV7 vaccination program [12,14,47,48]. A population-and laboratory-based active bacterial core (ABC) surveillance system report a reduction in incidence of IPD among children aged \5 years from 99 cases per 100,000 population during 1998-1999 to 21 cases per 100,000 population in 2008 (79 % reduction) [17 •• ].…”

“…Following PCV7 implementation in resource-rich countries, non-PCV7 serotypes have increased among asymptomatic carriers (''serotype replacement'') [13]. Also, an increase in incidence of IPD due to non-vaccine types (especially serotype 19A) was noted in the US and several other countries in Europe and Asia-Pacific region [12,15,25,45,54]. The absolute rate increase in IPD due to serotype 19A is estimated at *5 cases per 100,000 population compared with decline in the rate of IPD due to PCV7 serotypes [55,56].…”

Pneumococcal meningitis in Cuban children and adolescents: A fifteen years follow up

“…The advent of pneumococcal vaccines provided a potential way of preventing pneumococcal infections effectively. Available pneumococcal conjugate vaccines can induce protection in children aged 2 months and are well-tolerated, decreasing considerably the incidence after their introduction as showed different studies by Clarke (2006), Tsai et al, (2008) and Hsu et al, (2009 …”