title: Pneumococcal meningitis and vaccine effects in the era of conjugate vaccination: results of 20 years of nationwide surveillance in Germany.
abstract: BACKGROUND
  Long-term complications and a case mortality rate of 7.5% make meningitis caused by Streptococcus pneumoniae a serious clinical threat. In 2006, a general pneumococcal conjugate vaccination (PCV) recommendation was issued for all children under 2 years in Germany. Here, we investigate serotype changes in meningitis cases after this vaccine recommendation.
  
  
  METHODS
  The German National Reference Center for Streptococci (NRCS) has conducted surveillance for invasive pneumococcal disease (IPD) in Germany since 1992. Pneumococcal isolates were serotyped by the Neufeld's Quellung reaction and antibiotic susceptibility was tested using the broth microdilution method.
  
  
  RESULTS
  Of 22,204 IPD isolates sent to the NRCS from July 1992 to June 2013, 3,086 were meningitis cases. Microbiological and statistical investigations were performed to characterize and quantify all meningitis cases, focusing on changes reflecting implementation of the national PCV recommendation. 1,766 isolates (57.2% of meningitis cases) were from adults (≥16 years) and 1,320 isolates (42.8%) originated from children (<16 years). Overall, the leading serotypes were 14 (9.7%), 7F (7.8%), 3 (6.9%), 19F (5.7%) and 23F (5.0%). Among children, serotypes 14 (16.2%), 7F (8.9%) and 19F (7.1%) were most common, whereas among adults, serotypes 3 (9.6%), 7F (6.9%), 22F (5.0%), 23F (4.9%) and 14 (4.8%) were most prevalent. After the introduction of general PCV7/10/13 vaccination a significant decrease for most vaccine serotypes was observed. Generally, the differences in antibiotic nonsusceptibility between children <16 years and adults ≥16 were low. For macrolides in the pre-PCV7 period, a significantly higher proportion of resistant isolates was found in children (25.1%), compared to the post-vaccination period (9.7%; p<0.0001).
  
  
  CONCLUSIONS
  Implementation of the pneumococcal conjugate vaccines broadly reduced vaccine-type meningitis cases. Changes in serotype prevalence must be continuously monitored to observe future trends concerning pneumococcal meningitis.
authors.affiliation: Institute of Medical Microbiology and National Reference Center for Streptococci, University Hospital (RWTH), Pauwelsstr. 30, Aachen, Germany. mimoehl@ukaachen.de.
authors.forename: Matthias
authors.initials: M
authors.lastname: Imöhl
authors.affiliation: Institute of Medical Microbiology and National Reference Center for Streptococci, University Hospital (RWTH), Pauwelsstr. 30, Aachen, Germany. drjensmoeller@gmail.com.
authors.forename: Jens
authors.initials: J
authors.lastname: Möller
authors.affiliation: Institute of Medical Microbiology and National Reference Center for Streptococci, University Hospital (RWTH), Pauwelsstr. 30, Aachen, Germany. RalfRene.Reinert@pfizer.com.
authors.forename: Ralf René
authors.initials: RR
authors.lastname: Reinert
authors.affiliation: Institute of Medical Microbiology and National Reference Center for Streptococci, University Hospital (RWTH), Pauwelsstr. 30, Aachen, Germany. stephanie.perniciaro@gmail.com.
authors.forename: Stephanie
authors.initials: S
authors.lastname: Perniciaro
authors.affiliation: Institute of Medical Microbiology and National Reference Center for Streptococci, University Hospital (RWTH), Pauwelsstr. 30, Aachen, Germany. mlinden@ukaachen.de.
authors.forename: Mark
authors.initials: M
authors.lastname: van der Linden
authors.affiliation: Department of Neurology, Medical Faculty, Heinrich-Heine-University, Düsseldorf, Germany. Orhan.Aktas@uni-duesseldorf.de.
authors.forename: Orhan
authors.initials: O
authors.lastname: Aktas
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D062665:Epidemiological Monitoring; D005260:Female; D005858:Germany / Q000453:epidemiology; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008586:Meningitis, Pneumococcal / Q000453:epidemiology* / Q000382:microbiology / Q000517:prevention & control*; D008875:Middle Aged; D022242:Pneumococcal Vaccines / Q000276:immunology / Q000627:therapeutic use*; D015995:Prevalence; D012703:Serotyping; D013296:Streptococcus pneumoniae / Q000145:classification / Q000276:immunology; D014611:Vaccination / Q000379:methods* / Q000706:statistics & numerical data; D018074:Vaccines, Conjugate / Q000276:immunology / Q000627:therapeutic use*; D055815:Young Adult
chemical_list: D022242:Pneumococcal Vaccines; D018074:Vaccines, Conjugate