Abstract
BackgroundLong-term complications and a case mortality rate of 7.5% make meningitis caused by Streptococcus pneumoniae a serious clinical threat. In 2006, a general pneumococcal conjugate vaccination (PCV) recommendation was issued for all children under 2 years in Germany. Here, we investigate serotype changes in meningitis cases after this vaccine recommendation.MethodsThe German National Reference Center for Streptococci (NRCS) has conducted surveillance for invasive pneumococcal disease (IPD) in Germany since 1992. Pneumococcal isolates were serotyped by the Neufeld’s Quellung reaction and antibiotic susceptibility was tested using the broth microdilution method.ResultsOf 22,204 IPD isolates sent to the NRCS from July 1992 to June 2013, 3,086 were meningitis cases. Microbiological and statistical investigations were performed to characterize and quantify all meningitis cases, focusing on changes reflecting implementation of the national PCV recommendation. 1,766 isolates (57.2% of meningitis cases) were from adults (≥16 years) and 1,320 isolates (42.8%) originated from children (<16 years). Overall, the leading serotypes were 14 (9.7%), 7F (7.8%), 3 (6.9%), 19F (5.7%) and 23F (5.0%). Among children, serotypes 14 (16.2%), 7F (8.9%) and 19F (7.1%) were most common, whereas among adults, serotypes 3 (9.6%), 7F (6.9%), 22F (5.0%), 23F (4.9%) and 14 (4.8%) were most prevalent. After the introduction of general PCV7/10/13 vaccination a significant decrease for most vaccine serotypes was observed. Generally, the differences in antibiotic nonsusceptibility between children <16 years and adults ≥16 were low. For macrolides in the pre-PCV7 period, a significantly higher proportion of resistant isolates was found in children (25.1%), compared to the post-vaccination period (9.7%; p<0.0001).ConclusionsImplementation of the pneumococcal conjugate vaccines broadly reduced vaccine-type meningitis cases. Changes in serotype prevalence must be continuously monitored to observe future trends concerning pneumococcal meningitis.
Highlights
Long-term complications and a case mortality rate of 7.5% make meningitis caused by Streptococcus pneumoniae a serious clinical threat
When meningitis was specified as the definite clinical diagnosis on the case form, and the samples originated from blood, these samples were considered to represent meningitis cases, even if cerebrospinal fluid (CSF) from these patients was not received
The absolute number of meningitis cases reported to National Reference Center for Streptococci (NRCS) per pneumococcal season varied between 8 and 121 for children, and between 26 and 183 for adults
Summary
Long-term complications and a case mortality rate of 7.5% make meningitis caused by Streptococcus pneumoniae a serious clinical threat. In 2006, a general pneumococcal conjugate vaccination (PCV) recommendation was issued for all children under 2 years in Germany. We investigate serotype changes in meningitis cases after this vaccine recommendation. Streptococcus pneumoniae is among the most important pathogens in bacterial meningitis worldwide [1]. The capsular polysaccharide of S. pneumoniae contributes to pathogenicity [9], and pneumococcal toxins (such as pore-forming pneumolysin or hydrogen peroxide) as well as excessive host immune responses have been suggested as harmful influencing factors [10,11]. Regarding Streptococcus pneumoniae, regional epidemiologic features may affect the possible therapeutic benefit of corticosteroids [13], emphasizing the relevance of a systematic description of the respective isolates
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