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Increase noted in meningitis caused by non-PCV7 serotypes

Issue: February 2009

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Although rates of pneumococcal meningitis among both children and adults have decreased significantly since the introduction of the pediatric pneumococcal conjugate vaccine 7-valent, researchers noted a recent increase in cases of meningitis caused by nonpneumococcal conjugate vaccine 7-valent serotypes.

Some of these cases have been caused by pneumococcal strains that are nonsusceptible to antibiotics, according to researchers.

The researchers studied pneumococcal meningitis rates from 1998 through 2005; the results for these years were compared with baseline values from the 1998-1999 season. The results showed that PCV7, introduced in 2000, helped to significantly reduce overall rates of pneumococcal meningitis. There were 1,379 cases of pneumococcal meningitis from 1998 through 2005.

The incidence declined from 1.13 cases per 100,000 people in the 1998-1999 season to 0.79 case per 100,000 people in the 2004-2005 season. Among the subpopulation of pediatric patients aged younger than 2 years, the incidence rate significantly decreased 64% during this time. Among adults aged 64 years and older, the rate significantly decreased 54%.

Overall rates of PCV7–serotype meningitis decreased 73.3% and PCV7-related–serotype disease decreased 32.1% during the study period.

However, the results also demonstrated that rates of non-PCV7–serotype disease increased from 0.32 case per 100,000 people to 0.51 case per 100,000 people. The researchers said although this number was small, it represented a significant increase of 60.5%. In particular, the percentages of cases from non-PCV7 serotypes 19A, 22F and 35B increased significantly. The researchers also found that many of these cases were caused by serotypes nonsusceptible to various antibiotics, including penicillin, chloramphenicol, meropenem (Merrem, AstraZeneca) and cefotaxime (Claforan, Sanofi-Aventis).

N Engl J Med. 2009;360:244-256.

This report should alert both pediatricians and adult infectious disease physicians. The non-PCV7 serotypes are still a small minority, to be sure, but close monitoring certainly must continue.

– Theodore C. Eickhoff, MD

Infectious Disease News Chief Medical Editor