350. Epidemiology of Bacterial Meningitis in Pediatric Population After the Introduction of Pneumococcal Conjugated Vaccine in Costa Rica

Abstract

BackgroundIn Costa Rica (CR), bacterial meningitis (BM) is an important cause of morbi-mortality in the pediatric population. Pneumococcal meningitis was the leading cause of BM before 2009. PCV7 was introduced in the National Immunization Schedule (NIS) in 2009 (3 + 1 schedule) and then changed to PCV13 (2 + 1 schedule) in 2012. Our objective was to describe the epidemiology, bacteriology, clinical findings, and complications in patients with BM admitted to the only tertiary pediatric hospital in CR and compare these findings with the epidemiology of the pre-PCV era.MethodsRetrospective, descriptive study of patients hospitalized with BM from January 2009 to December 2015. We described the first epidemiological study of BM after the introduction of PCV in NIS in CR.ResultsSeventy-six patients were enrolled. Forty-nine patients (64.5%) were male and the median age at admission was 18 months; 63 patients (82.8%) under 24 months of age, but 20 patients (31.7%) were under 2 months of age. Mean length of stay was 19.3 days (range 16.07–22.59). Only 13.2% patients had at least one PCV dose. S. pneumoniae was isolated in 21/76 (27.6%), followed by S. agalactiae in 20/76 (26.3%) and E. coli 13/76 (17.1%). N. meningitidis was not isolated during the study period. Only 9/21 pneumococcal isolates were typified: vaccine serotypes 5, 6B, 7F, and 14 were found in 3/9 patients (33.3%) and in 1/9 patients (11.1%) each, respectively; non-vaccine serotypes 9N, 10A, and 13 were found in 1/9 patients each. All of the CSF pneumococcal isolates were penicillin susceptible. Complications were documented in 24/76 patients (31.6%), been hypoacusia and neurological disabilities the most common. Mortality was documented in 4/76 (5.3%). The incidence of BM in the post-PCV was dramatically reduced in comparison with the pre-PCV era, with a 54.7% reduction of all causes of BM and a 46.7% reduction in pneumococcal meningitis. Letality due to pneumococcal meningitis was also reduced from 20% to 14.3%.ConclusionIn CR, BM is an important cause of high morbidity. Pneumococcal meningitis is still the leading cause of BM in our pediatric population, but a dramatic reduction in pneumococcal meningitis was observed after the introduction of PCV’s in our NIS. Mortality was lower than what is reported in industrialized countries.Disclosures All authors: No reported disclosures.