Journal Article

Impact of 13-valent pneumococcal conjugate vaccine on pneumococcal meningitis in children

Casado-Flores, Juan, Méndez, Cristina, del Amo, María, Otheo, Enrique, Ruiz-Contreras, Jesus, Baquero-Artigao, Fernando, Picazo, Juan, Hernández-Sampelayo, Teresa, Balseiro, César

2017

Overview

•PCV13 reduced the incidence pneumococcal meningitis in children in Madrid.•The reduction was mainly due to a decrease of those cases caused by serotype 19A.•Isolates nonsusceptible to cefotaxime almost disappeared after PCV13 use.•A shift of pneumococcal meningitis towards older ages occurred after PCV13 vaccination.•Case fatality rate and sequelae were similar before and after the use of PCV13. To evaluate the impact of 13-valent pneumococcal conjugate vaccine on pneumococcal meningitis in children. Children younger than 15years of age attending 27 hospitals in the Region of Madrid with confirmed pneumococcal meningitis were identified in a prospective surveillance study, from 2007 to 2015. Clinical data, neurological sequelae, pneumococcal vaccination status, serotyping and antibiotic susceptibility were recorded. One hundred and four cases of pneumococcal meningitis were identified, 63 during the period of routine 7-valent pneumococcal conjugate vaccine immunisation (May 2007–April 2010) and 41 during the period of 13-valent pneumococcal conjugate vaccine immunisation (May 2010–April 2015). When both periods were compared, a 62% (95% CI: 45–75%) decrease in the incidence of pneumococcal meningitis was observed, from 2.19 cases per 100,000 inhabitants in the PCV7 period to 0.81 per 100,000 inhabitants in the PCV13 period (p=0.0001), mainly due to an 83% (95% CI: 30–96%) reduction in cases caused by serotype 19A. Isolates not susceptible to cefotaxime (MIC>0.5μg/L) decreased from 27% to 8%, (p=0.02). Mean patient ages rose from 28.7months to 38.5months (p<0.05). Case fatality rate across both periods was 5%. An unfavourable outcome (death or neurological sequelae) occurred in 27% of patients, while the rate was similar in both periods. There was no increase in meningitis caused by pneumococcal serotypes not included in 13-valent pneumococcal conjugate vaccine throughout the years of the study. Immunisation with 13-valent pneumococcal conjugate vaccine has reduced the rate of pneumococcal meningitis in children less than 15years, with a near-elimination of cefotaxime-resistant isolates, but morbidity has remained unchanged. A shift of pneumococcal meningitis towards slightly higher age groups was also observed.

• Publisher: Elsevier Ltd,Elsevier Limited
• Subject: Age / antibiotic resistance / Antibiotics / Cefotaxime / Children / complications (disease) / death / Disease / Fatalities / Health care / Hospitals / Immunization / Incidence / Inhabitants / Laboratories / Meningitis / Minimum inhibitory concentration / monitoring / Morbidity / mortality / Neurological complications / patients / Pneumococcal conjugate vaccine / Pneumococcal meningitis / Serotypes / Serotyping / Streptococcus infections / Streptococcus pneumoniae / Surveillance / Vaccination / Vaccines