title: Burden of group A streptococcal meningitis in Salvador, Brazil: report of 11 years of population-based surveillance.
abstract: BACKGROUND
  Over recent decades, a resurgence of invasive group A streptococcal (GAS) infections has been observed; GAS remains a rare cause of pyogenic meningitis. We report herein population-based findings of long-term surveillance for GAS meningitis in Salvador, Brazil, and estimate the overall burden of invasive GAS infections.
  
  
  METHODS
  From February 1996 to February 2007 we conducted active surveillance for GAS meningitis in the state reference hospital for infectious diseases in Salvador, Brazil. Data on clinical presentation, laboratory records, and outcome were collected through interviews and chart review. GAS isolates were evaluated for antimicrobial susceptibility and emm type.
  
  
  RESULTS
  We identified 20 cases of GAS meningitis, which accounted for 0.9% of all culture-proven bacterial meningitis in the study period. The mean annual incidence of GAS meningitis was 0.03 cases per 100,000 population in metropolitan Salvador and peaked in children <1 year of age (0.67 cases per 100,000 population). Among 17 cases with clinical information available, 41% required intensive care unit support and 25% died. Tested isolates were susceptible to penicillin and exhibited large emm type diversity. Based on the incidence of GAS meningitis, we estimate that the annual incidence of GAS infection is 3 cases per 100,000 population in metropolitan Salvador.
  
  
  CONCLUSIONS
  Although rare, GAS is a life-threatening cause of bacterial meningitis. Knowledge of the incidence and emm type variability of the disease is necessary for planning immunization strategies.
authors.affiliation: Centro de Pesquisas Gonçalo Moniz, Fundação Oswaldo Cruz/MS, Rua Waldemar Falcão, 121, Ministério da Saúde, Salvador, Bahia 40296-710, Brazil.
authors.forename: Milena Soares
authors.initials: MS
authors.lastname: Santos
authors.forename: Guilherme de Sousa
authors.initials: GS
authors.lastname: Ribeiro
authors.forename: Tainara Queiroz
authors.initials: TQ
authors.lastname: Oliveira
authors.forename: Renan Cardoso Nery
authors.initials: RC
authors.lastname: Santos
authors.forename: Edilane
authors.initials: E
authors.lastname: Gouveia
authors.forename: Kátia
authors.initials: K
authors.lastname: Salgado
authors.forename: Daniele
authors.initials: D
authors.lastname: Takahashi
authors.forename: Cleuber
authors.initials: C
authors.lastname: Fontes
authors.forename: Leila Carvalho
authors.initials: LC
authors.lastname: Campos
authors.forename: Mitermayer Galvão
authors.initials: MG
authors.lastname: Reis
authors.forename: Albert Icksang
authors.initials: AI
authors.lastname: Ko
authors.forename: Joice Neves
authors.initials: JN
authors.lastname: Reis
mesh_terms: D000293:Adolescent; D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001938:Brazil / Q000453:epidemiology; D002648:Child; D017281:Cost of Illness; D005260:Female; D006801:Humans; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D016920:Meningitis, Bacterial / Q000453:epidemiology* / Q000276:immunology / Q000401:mortality; D008875:Middle Aged; D013290:Streptococcal Infections / Q000191:economics / Q000453:epidemiology* / Q000276:immunology / Q000401:mortality; D013292:Streptococcus agalactiae
chemical_list: D000900:Anti-Bacterial Agents