European Journal of Pediatrics

, Volume 173, Issue 7, pp 871–878

The burden of pneumococcal meningitis in Austrian children between 2001 and 2008

  • D. S. Klobassa
  • B. Zoehrer
  • M. Paulke-Korinek
  • U. Gruber-Sedlmayr
  • K. Pfurtscheller
  • V. Strenger
  • A. Sonnleitner
  • R. Kerbl
  • B. Ausserer
  • W. Arocker
  • W. Kaulfersch
  • B. Hausberger
  • B. Covi
  • F. Eitelberger
  • A. Vécsei
  • B. Simma
  • R. Birnbacher
  • H. Kurz
  • K. Zwiauer
  • D. Weghuber
  • S. Heuberger
  • F. Quehenberger
  • H. Kollaritsch
  • W. Zenz
Original Article


The present study was conducted to evaluate the burden of pneumococcal meningitis in Austrian children between 2001 and 2008. Clinical outcome was retrospectively analyzed both on discharge and on follow-up investigations. This study was based on a prospective multicentre surveillance study on hospitalized invasive pneumococcal infections in Austrian children with a total annual “study population” of about 399,000 children aged below 5 years per year. Between 2001 and 2008, 74 cases of pneumococcal meningitis were identified in children aged below 5 years. The mean annual incidence rate for pneumococcal meningitis was 2.3 per 100,000 children in this age group. In 57/74 children (mean age on admission 14.5 ± 13.3 months), outcome data on hospital discharge were available: 5 deaths (8.8 %), 20 children (35.1 %) with sequelae and 32 children (56.1 %) without sequelae were observed. Sequelae on discharge included motor impairment in 8 children (14.0 %), hearing impairment in 9 children (15.8 %) and/or other complications in 14 children (24.6 %). In 7/8 children with motor deficits, matching cerebral lesions were identified by neuroimaging: cerebral infarction in five children, cerebral vasculitis and cerebral abscess in one child each. In 40/57 children, long-term outcome (18.9 ± 20.2 months after discharge) could be assessed: 1 child (2.5 %) died 9 months after hospital discharge, 11 children (27.5 %) had one or two long-term sequelae and 28 children (70.0 %) had no sequelae. Long-term sequelae included motor impairment in three children (7.5 %), hearing impairment in nine children (22.5 %) and other deficits in two children (5.0 %). Conclusion: Our study confirms that pneumococcal meningitis causes high mortality and severe long-term sequelae. On long-term follow-up, we observed improvements of motor impairment, but not of hearing impairment.


Bacterial meningitis Streptococcus pneumoniae Pneumococcal disease Children Long-term outcome Long-term sequelae 

Supplementary material

431_2013_2260_MOESM1_ESM.pdf (15 kb)
Table 2Cerebral lesions with focal neurological deficits as complication of pneumococcal meningitis (PDF 14 kb)


  1. 1.
    Arditi M, Mason EO Jr, Bradley JS et al (1998) Three-year multicenter surveillance of pneumococcal meningitis in children: clinical characteristics, and outcome related to penicillin susceptibility and dexamethasone use. Paediatrics 102:1087–1097CrossRefGoogle Scholar
  2. 2.
    Baraff LJ, Lee SI, Schriger DL (1993) Outcomes of bacterial meningitis in children: a meta-analysis. Pediatr Infect Dis J 12:389–394PubMedCrossRefGoogle Scholar
  3. 3.
    Bedford H, de Louvois J, Halket S, Peckham C, Hurley R, Harvey D (2001) Meningitis in infancy in England and Wales: follow up at age 5 years. BMJ 323:533–536PubMedCentralPubMedCrossRefGoogle Scholar
  4. 4.
    BMGF. Oberster Sanitätsrat. Österreichischer Impfplan 2006 [BMGF web site] Available at: Accessed 16 Oct 2013
  5. 5.
    Boardman JP, Ganesan V, Rutherford MA, Saunders DE, Mercuri E, Cowan F (2005) Magnetic resonance image correlates of hemiparesis after neonatal and childhood middle cerebral artery stroke. Paediatrics 115:321–326CrossRefGoogle Scholar
  6. 6.
    Cabral DA, Flodmark O, Farrell K, Speert DP (1987) Prospective study of computed tomography in acute bacterial meningitis. J Pediatr 111:201–205PubMedCrossRefGoogle Scholar
  7. 7.
    Casado-Flores J, Rodrigo C, Arístegui J, Martínón JM, Fenoll A, Mendez C (2008) Decline in pneumococcal meningitis in Spain after introduction of the heptavalent pneumococcal conjugate vaccine. Pediatr Infect Dis J 27:1020–1022PubMedCrossRefGoogle Scholar
  8. 8.
    Chandran A, Herbert H, Misurski D, Santosham M (2011) Long-term sequelae of childhood bacterial meningitis: an underappreciated problem. Pediatr Infect Dis J 30:3–6PubMedCrossRefGoogle Scholar
  9. 9.
    Chang CJ, Chang WN, Huang et al (2003) Cerebral infarction in perinatal and childhood bacterial meningitis. QJM 96:755–762PubMedCrossRefGoogle Scholar
  10. 10.
    Chao YN, Chiu NC, Huang FY (2008) Clinical features and prognostic factors in childhood pneumococcal meningitis. J Microbiol Immunol Infect 41:48–53PubMedGoogle Scholar
  11. 11.
    Christie D, Viner RM, Knox K et al (2011) Long-term outcomes of pneumococcal meningitis in childhood and adolescence. Eur J Pediatr 170:997–1006PubMedCrossRefGoogle Scholar
  12. 12.
    De Jonge RC, van Furth AM, Wassenaar M, Gemke RJ, Terwee CB (2010) Predicting sequelae and death after bacterial meningitis in childhood: a systematic review of prognostic studies. BMC Infect Dis 10:232PubMedCentralPubMedCrossRefGoogle Scholar
  13. 13.
    Feigin RD (2009) Bacterial meningitis beyond the neonatal period. In: Feigin RD, Cherry JD (eds) Textbooks of pediatric infectious diseases, 6th edn. WB Saunders, Philadelphia, p 439Google Scholar
  14. 14.
    Floret D, Delmas MC, Cochat P (1989) Cerebellar infarction as a complication of pneumococcus meningitis. Pediatr Infect Dis J 8:57–58PubMedCrossRefGoogle Scholar
  15. 15.
    Fortnum HM (1992) Hearing impairment after bacterial meningitis: a review. Arch Dis Child 67:1128–1133PubMedCentralPubMedCrossRefGoogle Scholar
  16. 16.
    Gil Prieto R, San Román Montero J, Gómez Alejandre C, Alvaro Meca LA, Alvaro Meca A, Gil de Miguel A (2009) Epidemiology of pneumococcal meningitis hospitalizations in pediatric population in Spain (1998-2006). Vaccine 27:2669–2673PubMedCrossRefGoogle Scholar
  17. 17.
    Gray BM, Dillon HC Jr (1988) Epidemiological studies of Streptococcus pneumoniae in infants: antibody to types 3, 6, 14, and 23 in the first two years of life. J Infect Dis 158:948–955PubMedCrossRefGoogle Scholar
  18. 18.
    Hsu HE, Shutt KA, Moore MR et al (2009) Effect of pneumococcal conjugate vaccine on pneumococcal meningitis. N Engl J Med 360:244–256PubMedCrossRefGoogle Scholar
  19. 19.
    Isaacman DJ, McIntosh ED, Reinert RR (2010) Burden of invasive pneumococcal disease and serotype distribution among Streptococcus pneumoniae isolates in young children in Europe: impact of the 7-valent pneumococcal conjugate vaccine and considerations for future conjugate vaccines. Int J Infect Dis 14:e197–e209PubMedCrossRefGoogle Scholar
  20. 20.
    Isenberg H (1998) Pneumokokken-Meningitis. In: Isenberg H (ed) Meningitis im Kindesalter und Neugeborenensepsis, 4th edn. Steinkopff Verlag, Darmstadt, pp 139–141CrossRefGoogle Scholar
  21. 21.
    Johnston MV (2009) Plasticity in the developing brain: implications for rehabilitation. Dev Disabil Res Rev 15:94–101PubMedCrossRefGoogle Scholar
  22. 22.
    Kaplan SL, Catlin FI, Weaver T, Feigin RD (1984) Onset of hearing loss in children with bacterial meningitis. Pediatrics 73:575–578PubMedGoogle Scholar
  23. 23.
    Kastenbauer S, Pfister HW (2003) Pneumococcal meningitis in adults: spectrum of complications and prognostic factors in a series of 87 cases. Brain 126:1015–1025PubMedCrossRefGoogle Scholar
  24. 24.
    Kihara M, de Haan M, Were EO, Garrashi HH, Neville BG, Newton CR (2012) Cognitive deficits following exposure to pneumococcal meningitis: an event-related potential study. BMC Infect Dis 12:79PubMedCentralPubMedCrossRefGoogle Scholar
  25. 25.
    King BA, Richmond P (2004) Pneumococcal meningitis: clinical course and resource use in Western Australian children. J Paediatr Child Health 40:606–610PubMedCrossRefGoogle Scholar
  26. 26.
    Klein M, Koedel U, Kastenbauer S, Pfister HW (2008) Nitrogen and oxygen molecules in meningitis-associated labyrinthitis and hearing impairment. Infection 36:2–14PubMedCrossRefGoogle Scholar
  27. 27.
    Kornelisse RF, Westerbeek CM, Spoor AB et al (1995) Pneumococcal meningitis in children: prognostic indicators and outcome. Clin Infect Dis 21:1390–1397PubMedCrossRefGoogle Scholar
  28. 28.
    Kutz JW, Simon LM, Chennupati SK, Giannoni CM, Manolidis S (2006) Clinical predictors for hearing loss in children with bacterial meningitis. Arch Otolaryngol Head Neck Surg 132:941–945PubMedCrossRefGoogle Scholar
  29. 29.
    Launes C, de-Sevilla MF, Selva L, Garcia-Garcia JJ, Pallares R, Muñoz-Almagro C (2012) Viral coinfection in children less than five years old with invasive pneumococcal disease. Pediatr Infect Dis J 31:650–653PubMedCrossRefGoogle Scholar
  30. 30.
    Laxer RM, Marks MI (1977) Pneumococcal meningitis in children. Am J Dis Child 131:850–853PubMedGoogle Scholar
  31. 31.
    Lovera D, Arbo A (2005) Risk factors for mortality in Paraguayan children with pneumococcal bacterial meningitis. Trop Med Int Health 10:1235–1241PubMedCrossRefGoogle Scholar
  32. 32.
    O’Brien KL, Wolfson LJ, Watt JP et al (2009) Burden of disease caused by Streptococcus pneumoniae in children younger than 5 years: global estimates. Lancet 374:893–902PubMedCrossRefGoogle Scholar
  33. 33.
    Østergaard C, Konradsen HB, Samuelsson S (2005) Clinical presentation and prognostic factors of Streptococcus pneumoniae meningitis according to the focus of infection. BMC Infect Dis 5:93PubMedCentralPubMedCrossRefGoogle Scholar
  34. 34.
    Pagliano P, Fusco U, Attanasio V et al (2007) Pneumococcal meningitis in childhood: a longitudinal prospective study. FEMS Immunol Med Microbiol 51:488–495PubMedCrossRefGoogle Scholar
  35. 35.
    Pikis A, Kavaliotis J, Tsikoulas J, Andrianopoulos P, Venzon D, Manios S (1996) Long-term sequelae of pneumococcal meningitis in children. Clin Pediatr (Phila) 35:72–78CrossRefGoogle Scholar
  36. 36.
    Pomeroy SL, Holmes SJ, Dodge PR, Feigin RD (1990) Seizures and other neurologic sequelae of bacterial meningitis in children. N Engl J Med 323:1651–1657PubMedCrossRefGoogle Scholar
  37. 37.
    Rendi-Wagner P, Georgopoulos A, Kundi M et al (2004) Prospective surveillance of incidence, serotypes and antimicrobial susceptibility of invasive Streptococcus pneumoniae among hospitalized children in Austria. J Antimicrob Chemother 53:826–831PubMedCrossRefGoogle Scholar
  38. 38.
    Rendi-Wagner P, Paulke-Korinek M, Kundi M et al (2009) National paediatric immunization program of high risk groups: no effect on the incidence of invasive pneumococcal diseases. Vaccine 27:3963–3968PubMedCrossRefGoogle Scholar
  39. 39.
    Rückinger S, von Kries R, Siedler A, van der Linden M (2009) Association of serotype of Streptococcus pneumoniae with risk of severe and fatal outcome. Pediatr Infect Dis J 28:118–122PubMedCrossRefGoogle Scholar
  40. 40.
    Sáez-Llorens X, McCracken GH Jr (2003) Bacterial meningitis in children. Lancet 361:2139–2148PubMedCrossRefGoogle Scholar
  41. 41.
    Salih MA, Abdel-Gader AG, Al-Jarallah AA, et al. (2006) Infectious and inflammatory disorders of the circulatory system as risk factors for stroke in Saudi children. Saudi Med J, Suppl.1:41–52Google Scholar
  42. 42.
    Snyder RD, Stovring J, Cushing AH et al (1981) Cerebral infarction in childhood bacterial meningitis. J Neurol Neurosurg Psychiatry 44:581–585PubMedCentralPubMedCrossRefGoogle Scholar
  43. 43.
    Statistik Austria. Demographisches Jahrbuch 2006. 11/2007 ed.Wien: Statistik Austria, Die Informationsmanager; 2007Google Scholar
  44. 44.
    Takeoka M, Takahashi T (2002) Infectious and inflammatory disorders of the circulatory system and stroke in childhood. Curr Opin Neurol 15:159–164PubMedCrossRefGoogle Scholar
  45. 45.
    Techasaensiri B, Techasaensiri C, Mejías A, McCracken GH Jr, Ramilo O (2010) Viral coinfections in children with invasive pneumococcal disease. Pediatr Infect Dis J 29:519–523PubMedGoogle Scholar
  46. 46.
    Theodoridou MN, Vasilopoulou VA, Atsali EE et al (2007) Meningitis registry of hospitalized cases in children: epidemiological patterns of acute bacterial meningitis throughout a 32-year period. BMC Infect Dis 7:101PubMedCentralPubMedCrossRefGoogle Scholar
  47. 47.
    Tuomanen EI (1996) Molecular and cellular mechanisms of pneumococcal meningitis. Ann N Y Acad Sci 797:42–52PubMedCrossRefGoogle Scholar
  48. 48.
    Van der Linden M, Weiß S, Falkenhorst G, Siedler A, Imöhl M, von Kries R (2012) Four years of universal pneumococcal conjugate infant vaccination in Germany: impact on incidence of invasive pneumococcal disease and serotype distribution in children. Vaccine 30:5880–5885PubMedCrossRefGoogle Scholar
  49. 49.
    Wasier AP, Chevret L, Essouri S, Durand P, Chevret S, Devictor D (2005) Pneumococcal meningitis in a pediatric intensive care unit: prognostic factors in a series of 49 children. Pediatr Crit Care Med 6:568–572PubMedCrossRefGoogle Scholar
  50. 50.
    Weisfelt M, de Gans J, van der Poll T, van de Beek D (2006) Pneumococcal meningitis in adults: new approaches to management and prevention. Lancet Neurol 5:332–342PubMedCrossRefGoogle Scholar
  51. 51.
    Winther TN, Kristensen TD, Kaltoft MS, Konradsen HB, Knudsen JD, Høgh B (2009) Invasive pneumococcal disease in Danish children, 1996-2007, prior to the introduction of heptavalent pneumococcal conjugate vaccine. Acta Paediatr 98:328–331PubMedCrossRefGoogle Scholar
  52. 52.
    Worsøe L, Cayé-Thomasen P, Brandt CT, Thomsen J, Østergaard C (2010) Factors associated with the occurrence of hearing loss after pneumococcal meningitis. Clin Infect Dis 51:917–924PubMedCrossRefGoogle Scholar
  53. 53.
    Zenz W, Bodó Z, Plotho J et al (1998) Factor V Leiden and prothrombin gene G 20210 A variant in children with ischemic stroke. Thromb Haemost 80:763–766PubMedGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2014

Authors and Affiliations

  • D. S. Klobassa
    • 1
  • B. Zoehrer
    • 1
  • M. Paulke-Korinek
    • 2
  • U. Gruber-Sedlmayr
    • 1
  • K. Pfurtscheller
    • 3
  • V. Strenger
    • 1
  • A. Sonnleitner
    • 1
  • R. Kerbl
    • 4
  • B. Ausserer
    • 5
  • W. Arocker
    • 6
  • W. Kaulfersch
    • 7
  • B. Hausberger
    • 8
  • B. Covi
    • 9
  • F. Eitelberger
    • 10
  • A. Vécsei
    • 11
  • B. Simma
    • 12
  • R. Birnbacher
    • 13
  • H. Kurz
    • 14
  • K. Zwiauer
    • 15
  • D. Weghuber
    • 16
  • S. Heuberger
    • 17
  • F. Quehenberger
    • 18
  • H. Kollaritsch
    • 2
  • W. Zenz
    • 1
    • 19
  1. 1.Department of General Paediatrics, University Clinic of Paediatrics and Adolescent MedicineMedical University GrazGrazAustria
  2. 2.Institute of Specific Prophylaxis and Tropical Medicine, Center for Pathophysiology, Infectiology and ImmunologyMedical University ViennaViennaAustria
  3. 3.University Clinic of Paediatrics and Adolescent MedicineMedical University GrazGrazAustria
  4. 4.Department of Paediatrics and Adolescent MedicineGeneral Hospital of LeobenLeobenAustria
  5. 5.Department of Paediatrics and Adolescent MedicineGeneral Hospital of DornbirnDornbirnAustria
  6. 6.Department of Paediatrics and Adolescent MedicineRudolfstiftung Hospital ViennaViennaAustria
  7. 7.Department of Paediatrics and Adolescent MedicineGeneral Hospital of KlagenfurtKlagenfurtAustria
  8. 8.Department of Paediatrics and Adolescent MedicineGeneral Hospital of Wiener NeustadtWiener NeustadtAustria
  9. 9.Department of Paediatrics and Adolescent MedicineMedical University InnsbruckInnsbruckAustria
  10. 10.Department of PaediatricsKlinikum Wels GrieskirchenWelsAustria
  11. 11.St. Anna Children’s Hospital, Department of PaediatricsMedical University ViennaViennaAustria
  12. 12.Department of PaediatricsAcademic Teaching Hospital FeldkirchFeldkirchAustria
  13. 13.Department of Paediatrics and Adolescent MedicineGeneral Hospital of VillachVillachAustria
  14. 14.Department of Paediatrics and Adolescent MedicineDanube HospitalViennaAustria
  15. 15.Department of Paediatric and Adolescent MedicineClinicum St. PöltenSt. PöltenAustria
  16. 16.Department of Paediatrics, Salzburger LandesklinikenParacelsus Medical UniversitySalzburgAustria
  17. 17.Austrian Agency for Health and Food SafetyGrazAustria
  18. 18.Institute of Medical Informatics, Statistics and DocumentationMedical University GrazGrazAustria
  19. 19.Research Unit Infectiology and Vaccinology, Department of General PaediatricsMedical University GrazGrazAustria

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