title: Impact of the 13-Valent Pneumococcal Conjugate Vaccine on Pneumococcal Meningitis in US Children.
abstract: BACKGROUND
  The impact of 13-valent pneumococcal conjugate vaccine (PCV13) on pneumococcal meningitis (PM) in US children is unknown. We compared the serotype distribution, antibiotic susceptibility, hospital course, and outcomes of children with PM 3 years before and 3 years after the introduction of PCV13.
  
  
  METHODS
  We identified patients ≤ 18 years of age with PM at 8 children's hospitals in the United States. Pneumococcal isolates were collected prospectively. Serotyping and antibiotic susceptibility were performed in a central laboratory. Clinical data were abstracted from medical records. Patients were divided into 3 subgroups: pre-PCV13 (2007-2009), transitional year (2010), and post-PCV13 (2011-2013). Categorical variables were analyzed by the χ(2) test and continuous variables by the Mann--Whitney U test.
  
  
  RESULTS
  During the study period, 173 of 1207 episodes (14%) of invasive pneumococcal disease were identified as PM; 76 of 645 (12%) were during 2007-2009 and 69 of 394 (18%) during 2011-2013 (50% increase; P = .03). The proportion of PCV13 serotype cases decreased from 54% in 2007-2009 to 27% in 2011-2013 (P = .001). Non-PCV13 serotype cases represented 73% of the isolates in 2011-2013. Isolates with ceftriaxone minimum inhibitory concentration ≥ 1 µg/mL decreased (13% to 3%) from 2007-2009 to 2011-2013 (P = .03). No significant differences were identified for hospital course or outcome, with the exception that a greater proportion of patients had subdural empyema and hemiparesis in 2011-2013.
  
  
  CONCLUSIONS
  After the introduction of PCV13, the number of cases of PM in children remained unchanged compared with 2007-2009, although the proportion of PCV13 serotypes decreased significantly. Serotype 19A continued to be the most common serotype in 2011-2013. Antibiotic resistance decreased significantly. Morbidity and case-fatality rate due to PM remain substantial.
authors.affiliation: Department of Pediatrics, Baylor College of Medicine, Houston, Texas.
authors.forename: Liset
authors.initials: L
authors.lastname: Olarte
authors.affiliation: Department of Pediatrics, Ohio State University College of Medicine, Columbus.
authors.forename: William J
authors.initials: WJ
authors.lastname: Barson
authors.affiliation: Department of Pediatrics, Ohio State University College of Medicine, Columbus.
authors.forename: Ryan M
authors.initials: RM
authors.lastname: Barson
authors.affiliation: Department of Pediatrics, Children's Hospital of Pittsburgh of the University of Pittsburgh Medical Center, Pennsylvania.
authors.forename: Philana Ling
authors.initials: PL
authors.lastname: Lin
authors.affiliation: Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock.
authors.forename: José R
authors.initials: JR
authors.lastname: Romero
authors.affiliation: Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois.
authors.forename: Tina Q
authors.initials: TQ
authors.lastname: Tan
authors.affiliation: Department of Pediatrics, Wake Forest School of Medicine, Winston-Salem, North Carolina.
authors.forename: Laurence B
authors.initials: LB
authors.lastname: Givner
authors.affiliation: Department of Pediatrics, Rady Children's Hospital-San Diego, California.
authors.forename: John S
authors.initials: JS
authors.lastname: Bradley
authors.affiliation: Department of Pediatrics, University of Southern California School of Medicine, Los Angeles.
authors.forename: Jill A
authors.initials: JA
authors.lastname: Hoffman
authors.affiliation: Department of Pediatrics, Baylor College of Medicine, Houston, Texas.
authors.forename: Kristina G
authors.initials: KG
authors.lastname: Hultén
authors.affiliation: Department of Pediatrics, Baylor College of Medicine, Houston, Texas.
authors.forename: Edward O
authors.initials: EO
authors.lastname: Mason
authors.affiliation: Department of Pediatrics, Baylor College of Medicine, Houston, Texas.
authors.forename: Sheldon L
authors.initials: SL
authors.lastname: Kaplan
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000494:pharmacology; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D008297:Male; D008586:Meningitis, Pneumococcal / Q000453:epidemiology / Q000382:microbiology / Q000517:prevention & control; D008875:Middle Aged; D022242:Pneumococcal Vaccines / Q000008:administration & dosage / Q000276:immunology*; D011446:Prospective Studies; D013296:Streptococcus pneumoniae / Q000145:classification* / Q000187:drug effects / Q000276:immunology*; D014481:United States / Q000453:epidemiology; D055815:Young Adult
chemical_list: C538862:13-valent pneumococcal vaccine; D000900:Anti-Bacterial Agents; D022242:Pneumococcal Vaccines
keywords: Streptococcus pneumoniae; conjugate vaccine; meningitis; pneumococcal disease