Burden of group A streptococcal meningitis in Salvador, Brazil: report of 11 years of population-based surveillance.
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.
Santos
Milena Soares
MS
Centro de Pesquisas Gonçalo Moniz, Fundação Oswaldo Cruz/MS, Rua Waldemar Falcão, 121, Ministério da Saúde, Salvador, Bahia 40296-710, Brazil.
Ribeiro
Guilherme de Sousa
GS
Oliveira
Tainara Queiroz
TQ
Santos
Renan Cardoso Nery
RC
Gouveia
Edilane
E
Salgado
Kátia
K
Takahashi
Daniele
D
Fontes
Cleuber
C
Campos
Leila Carvalho
LC
Reis
Mitermayer Galvão
MG
Ko
Albert Icksang
AI
Reis
Joice Neves
JN
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
D000900:Anti-Bacterial Agents