title: Streptococcus pneumoniae meningitis in Alberta pre- and postintroduction of the 7-valent pneumococcal conjugate vaccine.
abstract: OBJECTIVE
  To describe the epidemiology, clinical characteristics, microbiology and outcomes of patients of all ages with Streptococcus pneumoniae meningitis two years pre- and postintroduction of a S pneumoniae 7-valent conjugate vaccine program in Alberta in children <2 years of age.
  
  
  METHODS
  Between 2000 and 2004, all cases of invasive pneumococcal disease in Alberta were identified. From this cohort, patients with S pneumoniae meningitis were identified by chart review. Clinical data, laboratory data and in-hospital outcomes were collected.
  
  
  RESULTS
  Of the 1768 cases of invasive pneumococcal disease identified between 2000 and 2004, 110 (6.2%) had S pneumoniae meningitis. The overall incidence was 0.7 per 100,000 persons and remained unchanged over the study period. The rate in children <2 years of age appeared to fall over time, from 10.5 per 100,000 persons in 2000 to five per 100,000 persons in 2004, although there was insufficient evidence of a statistically significant time trend within any age group. Overall, the mean age was 30 years and 47% were male. In-hospital mortality was 20%, ranging from 6% in those ≤2 years of age to 31% for those ≥18 years of age, despite appropriate antimicrobial therapy.
  
  
  CONCLUSIONS
  The high mortality rate associated with S pneumoniae meningitis suggests that prevention by vaccination is critical. In children <2 years of age, there was a downward trend in the rate of S pneumoniae meningitis after implementation of the S pneumoniae 7-valent conjugate vaccine program, but rates were still high.
authors.affiliation: Department of Medicine; ; Institute for Infectious Disease Research, McMaster University, Hamilton, Ontario;
authors.forename: Jennie
authors.initials: J
authors.lastname: Johnstone
authors.forename: Gregory J
authors.initials: GJ
authors.lastname: Tyrrell
authors.forename: Thomas J
authors.initials: TJ
authors.lastname: Marrie
authors.forename: Sipi
authors.initials: S
authors.lastname: Garg
authors.forename: James D
authors.initials: JD
authors.lastname: Kellner