TY - JOUR
T1 - Changing Epidemiology of Bacterial Meningitis since Introduction of Conjugate Vaccines
T2 - 3 Decades of National Meningitis Surveillance in the Netherlands
AU - Koelman, Diederik L.H.
AU - Van Kassel, Merel N.
AU - Bijlsma, Merijn W.
AU - Brouwer, Matthijs C.
AU - Van De Beek, Diederik
AU - Van Der Ende, Arie
N1 - Funding Information: This work was supported by the Netherlands Organisation for Health Research and Development (ZonMw; NWO-Vidi- Grant [grant number 917.17.308 to M. C. B.]); NWO-Vici-Grant (grant number 918.19.627 to D. v. d. B); Academic Medical Center (AMC PhD Scholarship to D. L. H. K.); AMC Innovative Impulse Grant (to M. W. B. and D.v.d.B.); Steun Emma Foundation (grant to M. W. B. and D.v.d.B.); and Pfizer (investigatorinitiated research grant number WI173197 to A. v. d. E.). The NRLBM is partially financed by the National Institute for Public Health and the Environment, Bilthoven. This work was partly supported by a grant from the Meningitis Research Foundation (project number 1502.0, Group B Streptococcal Genome Library) awarded to A. v. d. E. Publisher Copyright: © 2020 The Author(s). Published by Oxford University Press for the Infectious Diseases Society of America.
PY - 2021/9/1
Y1 - 2021/9/1
N2 - Background: The epidemiology of acute bacterial meningitis has changed substantially since the introduction of conjugate vaccines. Methods: We analyzed nationwide surveillance data of all cerebrospinal fluid isolates received by the Netherlands Reference Laboratory for Bacterial Meningitis in the Netherlands. We assessed the impact of conjugate vaccines on incidence (defined as episodes per 100 000 population per year) and for different age groups using incidence rate ratios (IRRs), comparing incidence before and after conjugate vaccine introduction. Results: We analyzed 17 393 episodes, of which 5960 episodes (34%) occurred in preschool children (aged 3 months to 4 years). Overall, bacterial meningitis incidence decreased from 6.37 to 1.58 between 1989-1993 and 2014-2019 (IRR, 0.25 [95% confidence interval {CI},. 23-.26]; P<.001). This decrease was most pronounced in preschool and school-aged children (5-15 years); IRR, 0.10 [95% CI,. 09-.12] and 0.08 [95% CI,. 06-.10]; both P<.001. The incidence was highest in young infants (<90 days) due to a high incidence of group B Streptococcus and Escherichia coli meningitis (42.48 and 19.49, respectively). Conjugate vaccines effectively reduced the incidence of Haemophilus influenzae type b, Neisseria meningitidis serogroup C, and 10 pneumococcal serotypes (IRRs,. 02-.04; P<.001). At the end of the observed period, Streptococcus pneumoniae caused the majority of meningitis cases (829/1616 [51%]), mostly in older adults (aged 45-64 years) and elderly adults (aged ≥65 years; incidence of 1.06 and 1.54, respectively). Conclusions: Conjugate vaccines reduced the burden of bacterial meningitis, especially in children. The efforts for new measures to prevent bacterial meningitis should be focused on neonates and elderly, as the residual rate of disease is still high in these age groups.
AB - Background: The epidemiology of acute bacterial meningitis has changed substantially since the introduction of conjugate vaccines. Methods: We analyzed nationwide surveillance data of all cerebrospinal fluid isolates received by the Netherlands Reference Laboratory for Bacterial Meningitis in the Netherlands. We assessed the impact of conjugate vaccines on incidence (defined as episodes per 100 000 population per year) and for different age groups using incidence rate ratios (IRRs), comparing incidence before and after conjugate vaccine introduction. Results: We analyzed 17 393 episodes, of which 5960 episodes (34%) occurred in preschool children (aged 3 months to 4 years). Overall, bacterial meningitis incidence decreased from 6.37 to 1.58 between 1989-1993 and 2014-2019 (IRR, 0.25 [95% confidence interval {CI},. 23-.26]; P<.001). This decrease was most pronounced in preschool and school-aged children (5-15 years); IRR, 0.10 [95% CI,. 09-.12] and 0.08 [95% CI,. 06-.10]; both P<.001. The incidence was highest in young infants (<90 days) due to a high incidence of group B Streptococcus and Escherichia coli meningitis (42.48 and 19.49, respectively). Conjugate vaccines effectively reduced the incidence of Haemophilus influenzae type b, Neisseria meningitidis serogroup C, and 10 pneumococcal serotypes (IRRs,. 02-.04; P<.001). At the end of the observed period, Streptococcus pneumoniae caused the majority of meningitis cases (829/1616 [51%]), mostly in older adults (aged 45-64 years) and elderly adults (aged ≥65 years; incidence of 1.06 and 1.54, respectively). Conclusions: Conjugate vaccines reduced the burden of bacterial meningitis, especially in children. The efforts for new measures to prevent bacterial meningitis should be focused on neonates and elderly, as the residual rate of disease is still high in these age groups.
KW - bacterial meningitis
KW - conjugate vaccines
KW - epidemiology
KW - surveillance study
UR - http://www.scopus.com/inward/record.url?scp=85099383768&partnerID=8YFLogxK
U2 - https://doi.org/10.1093/cid/ciaa1774
DO - https://doi.org/10.1093/cid/ciaa1774
M3 - Article
C2 - 33247582
SN - 1058-4838
VL - 73
SP - E1099-E1107
JO - Clinical Infectious Diseases
JF - Clinical Infectious Diseases
IS - 5
ER -