Effect of pneumococcal conjugate vaccine on pneumococcal meningitis

Heather E. Hsu, Kathleen A. Shutt, Matthew R. Moore, Bernard W. Beall, Nancy M. Bennett, Allen S. Craig, Monica M. Farley, James H. Jorgensen, Catherine A. Lexau, Susan Petit, Arthur Reingold, William Schaffner, Ann Thomas, Cynthia G. Whitney, Lee H. Harrison

Research output: Contribution to journalArticle

360 Citations (Scopus)

Abstract

BACKGROUND: Invasive pneumococcal disease declined among children and adults after the introduction of the pediatric heptavalent pneumococcal conjugate vaccine (PCV7) in 2000, but its effect on pneumococcal meningitis is unclear. METHODS: We examined trends in pneumococcal meningitis from 1998 through 2005 using active, population-based surveillance data from eight sites in the United States. Isolates were grouped into PCV7 serotypes (4, 6B, 9V, 14, 18C, 19F, and 23F), PCV7-related serotypes (6A, 9A, 9L, 9N, 18A, 18B, 18F, 19B, 19C, 23A, and 23B), and non-PCV7 serotypes (all others). Changes in the incidence of pneumococcal meningitis were assessed against baseline values from 1998-1999. RESULTS: We identified 1379 cases of pneumococcal meningitis. The incidence declined from 1.13 cases to 0.79 case per 100,000 persons between 1998-1999 and 2004-2005 (a 30.1% decline, P<0.001). Among persons younger than 2 years of age and those 65 years of age or older, the incidence decreased during the study period by 64.0% and 54.0%, respectively (P<0.001 for both groups). Rates of PCV7-serotype meningitis declined from 0.66 case to 0.18 case (a 73.3% decline, P<0.001) among patients of all ages. Although rates of PCV7-related-serotype disease decreased by 32.1% (P = 0.08), rates of non-PCV7-serotype disease increased from 0.32 to 0.51 (an increase of 60.5%, P<0.001). The percentages of cases from non-PCV7 serotypes 19A, 22F, and 35B each increased significantly during the study period. On average, 27.8% of isolates were nonsusceptible to penicillin, but fewer isolates were nonsusceptible to chloramphenicol (5.7%), meropenem (16.6%), and cefotaxime (11.8%). The proportion of penicillinnon-susceptible isolates decreased between 1998 and 2003 (from 32.0% to 19.4%, P = 0.01) but increased between 2003 and 2005 (from 19.4% to 30.1%, P = 0.03). CONCLUSIONS: Rates of pneumococcal meningitis have decreased among children and adults since PCV7 was introduced. Although the overall effect of the vaccine remains substantial, a recent increase in meningitis caused by non-PCV7 serotypes, including strains non-susceptible to antibiotics, is a concern.

Original languageEnglish (US)
Pages (from-to)244-256
Number of pages13
JournalNew England Journal of Medicine
Volume360
Issue number3
DOIs
StatePublished - Jan 15 2009

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Pneumococcal Meningitis
Conjugate Vaccines
Pneumococcal Vaccines
meropenem
Meningitis
Incidence
Population Surveillance
Cefotaxime
Serogroup
Chloramphenicol
Penicillins
Vaccines
Pediatrics
Anti-Bacterial Agents

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Hsu, H. E., Shutt, K. A., Moore, M. R., Beall, B. W., Bennett, N. M., Craig, A. S., ... Harrison, L. H. (2009). Effect of pneumococcal conjugate vaccine on pneumococcal meningitis. New England Journal of Medicine, 360(3), 244-256. https://doi.org/10.1056/NEJMoa0800836

Effect of pneumococcal conjugate vaccine on pneumococcal meningitis. / Hsu, Heather E.; Shutt, Kathleen A.; Moore, Matthew R.; Beall, Bernard W.; Bennett, Nancy M.; Craig, Allen S.; Farley, Monica M.; Jorgensen, James H.; Lexau, Catherine A.; Petit, Susan; Reingold, Arthur; Schaffner, William; Thomas, Ann; Whitney, Cynthia G.; Harrison, Lee H.

In: New England Journal of Medicine, Vol. 360, No. 3, 15.01.2009, p. 244-256.

Research output: Contribution to journalArticle

Hsu, HE, Shutt, KA, Moore, MR, Beall, BW, Bennett, NM, Craig, AS, Farley, MM, Jorgensen, JH, Lexau, CA, Petit, S, Reingold, A, Schaffner, W, Thomas, A, Whitney, CG & Harrison, LH 2009, 'Effect of pneumococcal conjugate vaccine on pneumococcal meningitis', New England Journal of Medicine, vol. 360, no. 3, pp. 244-256. https://doi.org/10.1056/NEJMoa0800836
Hsu HE, Shutt KA, Moore MR, Beall BW, Bennett NM, Craig AS et al. Effect of pneumococcal conjugate vaccine on pneumococcal meningitis. New England Journal of Medicine. 2009 Jan 15;360(3):244-256. https://doi.org/10.1056/NEJMoa0800836
Hsu, Heather E. ; Shutt, Kathleen A. ; Moore, Matthew R. ; Beall, Bernard W. ; Bennett, Nancy M. ; Craig, Allen S. ; Farley, Monica M. ; Jorgensen, James H. ; Lexau, Catherine A. ; Petit, Susan ; Reingold, Arthur ; Schaffner, William ; Thomas, Ann ; Whitney, Cynthia G. ; Harrison, Lee H. / Effect of pneumococcal conjugate vaccine on pneumococcal meningitis. In: New England Journal of Medicine. 2009 ; Vol. 360, No. 3. pp. 244-256.
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abstract = "BACKGROUND: Invasive pneumococcal disease declined among children and adults after the introduction of the pediatric heptavalent pneumococcal conjugate vaccine (PCV7) in 2000, but its effect on pneumococcal meningitis is unclear. METHODS: We examined trends in pneumococcal meningitis from 1998 through 2005 using active, population-based surveillance data from eight sites in the United States. Isolates were grouped into PCV7 serotypes (4, 6B, 9V, 14, 18C, 19F, and 23F), PCV7-related serotypes (6A, 9A, 9L, 9N, 18A, 18B, 18F, 19B, 19C, 23A, and 23B), and non-PCV7 serotypes (all others). Changes in the incidence of pneumococcal meningitis were assessed against baseline values from 1998-1999. RESULTS: We identified 1379 cases of pneumococcal meningitis. The incidence declined from 1.13 cases to 0.79 case per 100,000 persons between 1998-1999 and 2004-2005 (a 30.1{\%} decline, P<0.001). Among persons younger than 2 years of age and those 65 years of age or older, the incidence decreased during the study period by 64.0{\%} and 54.0{\%}, respectively (P<0.001 for both groups). Rates of PCV7-serotype meningitis declined from 0.66 case to 0.18 case (a 73.3{\%} decline, P<0.001) among patients of all ages. Although rates of PCV7-related-serotype disease decreased by 32.1{\%} (P = 0.08), rates of non-PCV7-serotype disease increased from 0.32 to 0.51 (an increase of 60.5{\%}, P<0.001). The percentages of cases from non-PCV7 serotypes 19A, 22F, and 35B each increased significantly during the study period. On average, 27.8{\%} of isolates were nonsusceptible to penicillin, but fewer isolates were nonsusceptible to chloramphenicol (5.7{\%}), meropenem (16.6{\%}), and cefotaxime (11.8{\%}). The proportion of penicillinnon-susceptible isolates decreased between 1998 and 2003 (from 32.0{\%} to 19.4{\%}, P = 0.01) but increased between 2003 and 2005 (from 19.4{\%} to 30.1{\%}, P = 0.03). CONCLUSIONS: Rates of pneumococcal meningitis have decreased among children and adults since PCV7 was introduced. Although the overall effect of the vaccine remains substantial, a recent increase in meningitis caused by non-PCV7 serotypes, including strains non-susceptible to antibiotics, is a concern.",
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T1 - Effect of pneumococcal conjugate vaccine on pneumococcal meningitis

AU - Hsu, Heather E.

AU - Shutt, Kathleen A.

AU - Moore, Matthew R.

AU - Beall, Bernard W.

AU - Bennett, Nancy M.

AU - Craig, Allen S.

AU - Farley, Monica M.

AU - Jorgensen, James H.

AU - Lexau, Catherine A.

AU - Petit, Susan

AU - Reingold, Arthur

AU - Schaffner, William

AU - Thomas, Ann

AU - Whitney, Cynthia G.

AU - Harrison, Lee H.

PY - 2009/1/15

Y1 - 2009/1/15

N2 - BACKGROUND: Invasive pneumococcal disease declined among children and adults after the introduction of the pediatric heptavalent pneumococcal conjugate vaccine (PCV7) in 2000, but its effect on pneumococcal meningitis is unclear. METHODS: We examined trends in pneumococcal meningitis from 1998 through 2005 using active, population-based surveillance data from eight sites in the United States. Isolates were grouped into PCV7 serotypes (4, 6B, 9V, 14, 18C, 19F, and 23F), PCV7-related serotypes (6A, 9A, 9L, 9N, 18A, 18B, 18F, 19B, 19C, 23A, and 23B), and non-PCV7 serotypes (all others). Changes in the incidence of pneumococcal meningitis were assessed against baseline values from 1998-1999. RESULTS: We identified 1379 cases of pneumococcal meningitis. The incidence declined from 1.13 cases to 0.79 case per 100,000 persons between 1998-1999 and 2004-2005 (a 30.1% decline, P<0.001). Among persons younger than 2 years of age and those 65 years of age or older, the incidence decreased during the study period by 64.0% and 54.0%, respectively (P<0.001 for both groups). Rates of PCV7-serotype meningitis declined from 0.66 case to 0.18 case (a 73.3% decline, P<0.001) among patients of all ages. Although rates of PCV7-related-serotype disease decreased by 32.1% (P = 0.08), rates of non-PCV7-serotype disease increased from 0.32 to 0.51 (an increase of 60.5%, P<0.001). The percentages of cases from non-PCV7 serotypes 19A, 22F, and 35B each increased significantly during the study period. On average, 27.8% of isolates were nonsusceptible to penicillin, but fewer isolates were nonsusceptible to chloramphenicol (5.7%), meropenem (16.6%), and cefotaxime (11.8%). The proportion of penicillinnon-susceptible isolates decreased between 1998 and 2003 (from 32.0% to 19.4%, P = 0.01) but increased between 2003 and 2005 (from 19.4% to 30.1%, P = 0.03). CONCLUSIONS: Rates of pneumococcal meningitis have decreased among children and adults since PCV7 was introduced. Although the overall effect of the vaccine remains substantial, a recent increase in meningitis caused by non-PCV7 serotypes, including strains non-susceptible to antibiotics, is a concern.

AB - BACKGROUND: Invasive pneumococcal disease declined among children and adults after the introduction of the pediatric heptavalent pneumococcal conjugate vaccine (PCV7) in 2000, but its effect on pneumococcal meningitis is unclear. METHODS: We examined trends in pneumococcal meningitis from 1998 through 2005 using active, population-based surveillance data from eight sites in the United States. Isolates were grouped into PCV7 serotypes (4, 6B, 9V, 14, 18C, 19F, and 23F), PCV7-related serotypes (6A, 9A, 9L, 9N, 18A, 18B, 18F, 19B, 19C, 23A, and 23B), and non-PCV7 serotypes (all others). Changes in the incidence of pneumococcal meningitis were assessed against baseline values from 1998-1999. RESULTS: We identified 1379 cases of pneumococcal meningitis. The incidence declined from 1.13 cases to 0.79 case per 100,000 persons between 1998-1999 and 2004-2005 (a 30.1% decline, P<0.001). Among persons younger than 2 years of age and those 65 years of age or older, the incidence decreased during the study period by 64.0% and 54.0%, respectively (P<0.001 for both groups). Rates of PCV7-serotype meningitis declined from 0.66 case to 0.18 case (a 73.3% decline, P<0.001) among patients of all ages. Although rates of PCV7-related-serotype disease decreased by 32.1% (P = 0.08), rates of non-PCV7-serotype disease increased from 0.32 to 0.51 (an increase of 60.5%, P<0.001). The percentages of cases from non-PCV7 serotypes 19A, 22F, and 35B each increased significantly during the study period. On average, 27.8% of isolates were nonsusceptible to penicillin, but fewer isolates were nonsusceptible to chloramphenicol (5.7%), meropenem (16.6%), and cefotaxime (11.8%). The proportion of penicillinnon-susceptible isolates decreased between 1998 and 2003 (from 32.0% to 19.4%, P = 0.01) but increased between 2003 and 2005 (from 19.4% to 30.1%, P = 0.03). CONCLUSIONS: Rates of pneumococcal meningitis have decreased among children and adults since PCV7 was introduced. Although the overall effect of the vaccine remains substantial, a recent increase in meningitis caused by non-PCV7 serotypes, including strains non-susceptible to antibiotics, is a concern.

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