Children with bacterial meningitis presenting to the emergency department during the pneumococcal conjugate vaccine era.
BACKGROUND
The epidemiology of bacterial meningitis in children in the era of widespread heptavalent conjugate pneumococcal vaccination (PCV7) is unknown.


OBJECTIVE
The objective was to describe the epidemiology of bacterial meningitis in children presenting to the emergency department (ED) during the era of widespread PCV7 vaccination.


METHODS
The authors retrospectively reviewed the medical records of all children aged 1 month to 19 years with bacterial meningitis who presented to the EDs of 20 U.S. pediatric centers (2001-2004). Bacterial meningitis was defined by a positive cerebrospinal fluid (CSF) culture for a bacterial pathogen or CSF pleocytosis (CSF white blood cell [WBC] count >or=10 cells/mm(3)) in association with either a positive blood culture or a CSF latex agglutination study.


RESULTS
A total of 231 children with bacterial meningitis were identified. The median age was 0.6 years (interquartile range [IQR] = 0.2-4.2). Eight patients (3% of all patients) died. The following bacterial pathogens were identified: Streptococcus pneumoniae (n = 77; 33.3%), Neisseria meningitidis (67; 29.0%), Group B Streptococcus (42; 18.2%), Escherichia coli (17; 7.4%), nontypeable Haemophilus influenzae (10; 4.3%), other Gram-negative bacilli (7; 3.0%), Listeria monocytogenes (5; 2.2%), Group A Streptococcus (5; 2.2%), and Moraxella catarrhalis (1; 0.4%). S. pneumoniae serotypes were determined in 37 of 77 patients; of these, 62% were due to nonvaccine serotypes (including 19A).


CONCLUSIONS
Although now a rare infectious disease in United States, bacterial meningitis still causes substantial morbidity in affected children. Despite the introduction of PCV7, S. pneumoniae remains the most common cause of bacterial meningitis in U.S. children, with approximately half of cases due to nonvaccine serotypes.
Nigrovic
Lise E
LE
Division of Emergency Medicine, Children's Hospital, Boston, MA, USA. lise.nigrovic@childrens.harvard.edu
Kuppermann
Nathan
N
Malley
Richard
R
D000293:Adolescent; D000328:Adult; D002555:Cerebrospinal Fluid / Q000382:microbiology; D002648:Child; D002675:Child, Preschool; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D004926:Escherichia coli / Q000276:immunology / Q000302:isolation & purification; D006192:Haemophilus Infections / Q000453:epidemiology; D019741:Haemophilus influenzae type b / Q000276:immunology / Q000302:isolation & purification; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D016920:Meningitis, Bacterial / Q000453:epidemiology* / Q000382:microbiology; D008585:Meningitis, Meningococcal / Q000453:epidemiology / Q000517:prevention & control; D009345:Neisseria meningitidis / Q000302:isolation & purification; D011008:Pneumococcal Infections / Q000453:epidemiology / Q000517:prevention & control*; D022242:Pneumococcal Vaccines / Q000276:immunology*; D012189:Retrospective Studies; D018709:Statistics, Nonparametric; D013296:Streptococcus pneumoniae / Q000276:immunology / Q000302:isolation & purification; D014481:United States / Q000453:epidemiology
D022242:Pneumococcal Vaccines