Abstract
The indirect effect of pneumococcal conjugate vaccine on adult pneumococcal meningitis has not been thoroughly investigated. We present data from active surveillance on pneumococcal meningitis in adults in Israel occurring during July 2009–June 2015. Pneumococcal meningitis was diagnosed for 221 patients, 9.4% of all invasive pneumococcal disease (IPD) cases. Although overall IPD incidence decreased during the study period, meningitis increased nonsignificantly from 0.66 to 0.85 cases/100,000 population. Incidence of vaccine type (VT) pneumococcal meningitis (VT13) decreased by 70%, but non-VT13 pneumococcal meningitis increased from 0.32 to 0.75 cases/100,000 population (incident rate ratio 2.35, 95% CI 1.27–4.35). Pneumococcal meningitis patients were younger and healthier than nonmeningitis IPD patients, and 20.2% had a history of previous head surgery or cerebrospinal fluid leak compared with <2.0% of nonmeningitis patients (p<0.0001). Non-VT13 types that rarely cause IPD (15B/C, 6C, 23A, 23B, 24F) seem to be emerging as common causes of meningitis.
Highlights
The indirect effect of pneumococcal conjugate vaccine on adult pneumococcal meningitis has not been thoroughly investigated
We previously described the indirect effect of pneumococcal conjugate vaccines (PCVs) on the adult population in Israel and reported an ≈20% decrease of overall invasive pneumococcal disease (IPD) incidence 4 years after the introduction of PCV7 and 2.5 years after the introduction of PCV13; we reported that the proportion of pneumococcal meningitis cases among all IPD cases increased and that incidence did not decrease as did other IPDs [4]
Of the 221 patients with pneumococcal meningitis diagnoses, S. pneumoniae was isolated from both cerebrospinal fluid (CSF) and blood
Summary
The indirect effect of pneumococcal conjugate vaccine on adult pneumococcal meningitis has not been thoroughly investigated. Overall IPD incidence decreased during the study period, meningitis increased nonsignificantly from 0.66 to 0.85 cases/100,000 population. Since the introduction of pneumococcal conjugate vaccines (PCVs) into the national immunization plans (NIPs) for children in different countries, IPD incidence has declined, among children and among unvaccinated adult populations through herd (indirect) protection [3,4,5,6]. We previously described the indirect effect of PCV on the adult population in Israel and reported an ≈20% decrease of overall IPD incidence 4 years after the introduction of PCV7 and 2.5 years after the introduction of PCV13; we reported that the proportion of pneumococcal meningitis cases among all IPD cases increased and that incidence did not decrease as did other IPDs [4]. We assess meningitis IPD and nonmeningitis IPD incidence and the change in associated serotypes in adults 6 years after PCV7 introduction
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