Pneumococcal meningitis in adults in 2014\u20132018 after introduction of pediatric 13-valent pneumococcal conjugate vaccine in Japan

Bin Chang,Reiko Shimbashi,Tomimasa Sunagawa,Junichiro Nishi,Tomoe Shimada,Kosuke Tamura,Munehisa Fukusumi,Kei Kasahara,Takaya Maruyama,Kengo Oshima,Hiroshi Watanabe,Tetsuya Kubota,Yoshinari Tanabe,Yuki Kinjo,Motoi Suzuki,Shuichi Abe,Jiro Fujita,Hiroyuki Fujikura,Yusuke Serizawa,Koji Kuronuma,Kazunori Oishi

doi:10.1038/s41598-022-06950-w

Abstract

We assessed the impact of the pediatric 13-valent pneumococcal conjugate vaccine (PCV13) on pneumococcal meningitis in adults in Japan in 2014–2018 by comparing epidemiological characteristics of adults with invasive pneumococcal disease with (n = 222) and without (n = 1258) meningitis. The annual incidence of pneumococcal meningitis in 2016–2018 was 0.20–0.26 cases/100,000 population. Age (p < 0.001) and case fatality rate (p = 0.003) were significantly lower in patients with meningitis than in those without meningitis. The odds of developing meningitis were higher in asplenic/hyposplenic or splenectomized patients (adjusted odds ratio [aOR] 2.29, 95% CI 1.27–4.14), for serotypes 10A (aOR 3.26, 95% CI 2.10–5.06) or 23A (aOR 3.91, 95% CI 2.47–6.19), but lower for those aged ≥ 65 years (aOR 0.59, 95% CI 0.44–0.81). PCV13 had an indirect effect on nonmeningitis, but its impact on meningitis was limited because of an increase in non-PCV13 serotypes. Of meningitis isolates, 78 (35.1%) and 3 (1.4%) were penicillin G- or ceftriaxone-resistant, respectively. We also confirmed an association of the pbp1bA641C mutation with meningitis (aOR 2.92, 95% CI 1.51–5.65).

Highlights

We assessed the impact of the pediatric 13-valent pneumococcal conjugate vaccine (PCV13) on pneumococcal meningitis in adults in Japan in 2014–2018 by comparing epidemiological characteristics of adults with invasive pneumococcal disease with (n = 222) and without (n = 1258) meningitis
We consider that the number of invasive pneumococcal diseases (IPD) cases was underreported during 2014–2015, but we were able to estimate that the annual incidence of IPD and pneumococcal meningitis in adults was 1.40–1.98 cases and 0.20–0.26 cases/100,000 population during 2016–2018 (Table 1)
We determined the annual incidence of pneumococcal meningitis in adults in Japan during the period 2016–2018

Summary

Introduction

A recent genome-wide association study from the United States reported a significant association of the pbp1bA641C mutation with the clinical occurrence of meningitis in patients with IPD, but there is no evidence that this mutation results in β-lactam resistance[11]. The incorporation of pneumococcal conjugate vaccines (PCVs) into infant immunization programs worldwide resulted in significant reductions ranging from 41 to 97% in the vaccine-type IPD, including pneumococcal meningitis, in children and older age g roups[12]. In 2014, a 23-valent pneumococcal polysaccharide vaccine (PPSV23) was included in the national immunization program for adults aged ≥ 65 years, while PCV13 was licensed for this group in 2014, and became available on a voluntary basis. The epidemiological and bacteriological characteristics of pneumococcal meningitis have been recently reported from Israel, England and W ales[15,16], the epidemiological features of meningitis have not been fully investigated in adult patients with IPD in Japan

Methods

Results

Conclusion