Meningitis Update

Monday, May 30, 2011 // Uncategorized

Bacterial Meningitis in the U.S.: An Update

Although immunization programs have reduced the incidence of this disease, the case fatality rate has not declined.   THIS MEANS THAT IF YOU GET THE DISEASE, THE LIKELIHOOD THAT YOU WILL DIE OF IT IS UNCHANGED.

Pediatric immunization programs that include the Haemophilus influenzaetype B and heptavalent protein-polysaccharide pneumococcal conjugate vaccines have substantially reduced the incidence of bacterial meningitis. Now, using data from two surveillance systems of the Emerging Infections Programs Network (Active Bacterial Core surveillance and Foodborne Diseases Active Surveillance Network), researchers have studied trends in bacterial meningitis incidence and epidemiology in the U.S. from 1998 through 2007.

Data from eight surveillance areas (~17.4 million people) were analyzed. Bacterial meningitis was defined as the presence of H. influenzae, Streptococcus pneumoniae, group B Streptococcus, Listeria monocytogenes, or Neisseria meningitidisin cerebrospinal fluid or another normally sterile site in conjunction with a clinical diagnosis of meningitis. These five pathogens were selected because they collectively account for most bacterial meningitis cases in the U.S.

Over the entire study period, 3188 meningitis cases were identified, of which 14.8% were fatal. From 2003 through 2007, 1670 cases were identified, with a 13.0% fatality rate. On the basis of these data, the researchers estimated that 4100 cases and 500 deaths occurred annually in the U.S. during these latter years.

Between 1998 and 2007, the incidence of bacterial meningitis caused by these five pathogens decreased by 31% (95% confidence interval, –33 to –29). The median age of patients increased from 30.3 to 41.9 (P<0.001). The case fatality rate did not change during the surveillance period (15.7% in 1998–1999 and 14.3% in 2006–2007; P=0.51). S. pneumoniae was the predominant pathogen identified (56.9% of cases overall).

Comment: The success of vaccination programs in children is laudable and provides impetus for additional vaccine development, as well as for initiation of such programs in developing countries, where they are often lacking. In addition, novel interventions for the management of bacterial meningitis are desperately needed: The case fatality rate has not improved in years. Until that happens, however, empirical antibiotic therapy that includes coverage for resistant strains of S. pneumoniae should be initiated as early as possible in an effort to reduce morbidity and mortality.

Larry M. Baddour, MD

Published in Journal Watch Infectious Diseases May 25, 2011


Thigpen MC et al. Bacterial meningitis in the United States, 1998–2007. N Engl J Med 2011 May 26; 364:2016.

ACIP Recommends Meningitis Booster for Teens, Pertussis Booster for Adults

The CDC’s Advisory Committee on Immunization Practices has recommended that teens receive an additional shot of the meningitis vaccine at age 16 and that those between 11 and 64 receive a pertussis booster, the New York Times reports.

The vaccine, which was thought to have been effective for 10 years, is only effective for 5, according to the Times‘s account. In a close vote, the ACIP recommended giving the additional shot, rather than moving the age at first vaccination up to 14 or 15 from the currently recommended age of 11 or 12.

Later yesterday, Reuters reported that the committee recommended that people aged 11 to 64 — as well as people aged 65 and older who are regularly around infants — receive a booster vaccine for diphtheria, tetanus, and pertussis because of an outbreak of nearly 6300 pertussis cases in California. Pertussis is also on the rise elsewhere in the nation. Previously, older adults were not in the target group for vaccination.


New York Times story (Free)


Leave a Reply

Your email address will not be published. Required fields are marked *