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Epidemiological analysis on two decades of hospitalisations for meningitis in the United States

European Journal of Clinical Microbiology & Infectious Diseases volume 33, pages 1519–1524 (2014)Cite this article

Abstract

Bacterial meningitis is an important source of mortality and morbidity worldwide. Data exist on specific vaccines against Streptococcus pneumoniae and Neisseria meningitidis indicating that they reduce the incidence of meningitis, yet comprehensive information on the trend of bacterial meningitis is still lacking. We analysed the Kids’ Inpatient Database and the National Inpatient Database considering all bacterial meningitides in the United States, excluding cases of tuberculosis and sexually transmitted diseases. We analysed the trend of meningitis incidence from 1993 to 2011 and in specific age groups before and after the introduction of the pneumococcal conjugate vaccine 7 (PCV-7) and the meningococcal conjugate vaccine 4 (MCV-4). Moreover, we analysed the prevalence of aetiological agents to assess their changes. We estimated 295,706 cases of meningitis having occurred in the United States and a reduction of the discharge rate of 21 %. We observed a significant reduction in cases of meningitis in children and elderly patients following the introduction of the PCV-7. We also found a reduction in subjects aged 10–14 years, an age span consistent with the introduction of MCV-4, although further analyses based on serotypes data are required to confirm this observation. By contrast, we observed an increased prevalence of cases of staphylococcal and streptococcal meningitides. The introduction of PCV-7 has reduced the incidence and changed significantly the aetiology of bacterial meningitis in the United States during the last two decades.

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References

  1. Nudelman Y, Tunkel AR (2009) Bacterial meningitis: epidemiology, pathogenesis and management update. Drugs 69:2577–2596

    CAS  PubMed  Article  Google Scholar 

  2. Wenger JD, Hightower AW, Facklam RR, Gaventa S, Broome CV (1990) Bacterial meningitis in the United States, 1986: report of a multistate surveillance study. The Bacterial Meningitis Study Group. J Infect Dis 162:1316–1323

    CAS  PubMed  Article  Google Scholar 

  3. Schuchat A, Robinson K, Wenger JD, Harrison LH, Farley M, Reingold AL, Lefkowitz L, Perkins BA (1997) Bacterial meningitis in the United States in 1995. Active Surveillance Team. N Engl J Med 337:970–976

    CAS  PubMed  Article  Google Scholar 

  4. Thigpen MC, Whitney CG, Messonnier NE, Zell ER, Lynfield R, Hadler JL, Harrison LH, Farley MM, Reingold A, Bennett NM, Craig AS, Schaffner W, Thomas A, Lewis MM, Scallan E, Schuchat A; Emerging Infections Programs Network (2011) Bacterial meningitis in the United States, 1998–2007. N Engl J Med 364:2016–2025

    CAS  PubMed  Article  Google Scholar 

  5. von Gottberg A, Cohen C, Whitelaw A, Chhagan M, Flannery B, Cohen AL, de Gouveia L, Plessis Md, Madhi SA, Klugman KP; Group for Enteric, Respiratory, Meningeal Disease Surveillance in South Africa (GERMS-SA) (2012) Invasive disease due to Haemophilus influenzae serotype b ten years after routine vaccination, South Africa, 2003–2009. Vaccine 30:565–571

    Article  Google Scholar 

  6. Musher DM (2006) Pneumococcal vaccine—direct and indirect (“herd”) effects. N Engl J Med 354:1522–1524

    CAS  PubMed  Article  Google Scholar 

  7. Hsu HE, Shutt KA, Moore MR, Beall BW, Bennett NM, Craig AS, Farley MM, Jorgensen JH, Lexau CA, Petit S, Reingold A, Schaffner W, Thomas A, Whitney CG, Harrison LH (2009) Effect of pneumococcal conjugate vaccine on pneumococcal meningitis. N Engl J Med 360:244–256

    CAS  PubMed  Article  Google Scholar 

  8. Duggan ST (2010) Pneumococcal polysaccharide conjugate vaccine (13-valent, adsorbed) [prevenar 13®]. Drugs 70:1973–1986

    CAS  PubMed  Article  Google Scholar 

  9. Centers for Disease Control and Prevention (CDC) Immunization schedules. Available online at: http://www.cdc.gov/vaccines/schedules/hcp/imz/child-adolescent.html. Last accessed 3 March 2014

  10. Cohn AC, MacNeil JR, Harrison LH, Hatcher C, Theodore J, Schmidt M, Pondo T, Arnold KE, Baumbach J, Bennett N, Craig AS, Farley M, Gershman K, Petit S, Lynfield R, Reingold A, Schaffner W, Shutt KA, Zell ER, Mayer LW, Clark T, Stephens D, Messonnier NE (2010) Changes in Neisseria meningitidis disease epidemiology in the United States, 1998–2007: implications for prevention of meningococcal disease. Clin Infect Dis 50:184–191

    PubMed  Article  Google Scholar 

  11. Centers for Disease Control and Prevention (CDC) Meningococcal vaccine for preteens and teens. Available online at: http://www.cdc.gov/vaccines/who/teens/vaccines/mcv.html. Last accessed 3 March 2014

  12. HCUPnet. Home page at: http://hcupnet.ahrq.gov/HCUPnet.jsp. Last accessed 24 September 2013

  13. Griffin MR, Zhu Y, Moore MR, Whitney CG, Grijalva CG (2013) U.S. hospitalizations for pneumonia after a decade of pneumococcal vaccination. N Engl J Med 369(2):155–163

    CAS  PubMed  Article  Google Scholar 

  14. Lindenauer PK, Lagu T, Shieh MS, Pekow PS, Rothberg MB (2012) Association of diagnostic coding with trends in hospitalizations and mortality of patients with pneumonia, 2003–2009. JAMA 307:1405–1413

    CAS  PubMed  Article  Google Scholar 

  15. Bogaert D, Hermans PW, Boelens H, Sluijter M, Luijendijk A, Rumke HC, Koppen S, van Belkum A, de Groot R, Verbrugh HA (2005) Epidemiology of nasopharyngeal carriage of Neisseria meningitidis in healthy Dutch children. Clin Infect Dis 40:899–902

    CAS  PubMed  Article  Google Scholar 

  16. Gallup. U.S. smoking rate still coming down. Available online at: http://www.gallup.com/poll/109048/us-smoking-rate-still-coming-down.aspx. Last accessed 24 September 2013

  17. Harrison LH (2010) Epidemiological profile of meningococcal disease in the United States. Clin Infect Dis 50(Suppl 2):S37–S44

    PubMed Central  PubMed  Article  Google Scholar 

  18. Schlech WF 3rd, Ward JI, Band JD, Hightower A, Fraser DW, Broome CV (1985) Bacterial meningitis in the United States, 1978 through 1981. The National Bacterial Meningitis Surveillance Study. JAMA 253:1749–1754

    PubMed  Article  Google Scholar 

  19. Marom T, Tan A, Wilkinson GS, Pierson KS, Freeman JL, Chonmaitree T (2014) Trends in otitis media-related health care use in the United States, 2001–2011. JAMA Pediatr 168(1):68–75

    PubMed Central  PubMed  Article  Google Scholar 

  20. Tan TQ (2012) Pediatric invasive pneumococcal disease in the United States in the era of pneumococcal conjugate vaccines. Clin Microbiol Rev 25(3):409–419

    PubMed Central  PubMed  Article  Google Scholar 

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Acknowledgements

The financial support by the Italian Medicines Agency, AIFA, and the Italian Ministry of Health (RC 2014 to E.C.) is gratefully acknowledged.

Conflict of interest

The authors declare that they have no conflict of interest.

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Affiliations

  1. Unit of Clinical Pharmacology, Department of Biomedical and Clinical Sciences, University Hospital “Luigi Sacco”, Università di Milano, Via GB Grassi 74, 20157, Milan, Italy

    P. Pellegrino, C. Carnovale, V. Perrone, D. Salvati, M. Gentili, T. Brusadelli, S. Radice & E. Clementi

  2. Scientific Institute, IRCCS E. Medea, 23842, Bosisio Parini, Lecco, Italy

    M. Pozzi & E. Clementi

  3. IRCCS Foundation Ca’ Granda Ospedale Maggiore Policlinico, Milan, 20122, Italy

    S. Antoniazzi

Authors
  1. P. Pellegrino
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  2. C. Carnovale
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  3. V. Perrone
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  4. D. Salvati
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  5. M. Gentili
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  6. T. Brusadelli
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  7. S. Antoniazzi
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  8. M. Pozzi
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  9. S. Radice
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  10. E. Clementi
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Corresponding author

Correspondence to S. Radice.

Additional information

Paolo Pellegrino and Carla Carnovale contributed equally to the work.

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Pellegrino, P., Carnovale, C., Perrone, V. et al. Epidemiological analysis on two decades of hospitalisations for meningitis in the United States. Eur J Clin Microbiol Infect Dis 33, 1519–1524 (2014). https://doi.org/10.1007/s10096-014-2102-2

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  • DOI: https://doi.org/10.1007/s10096-014-2102-2

Keywords

  • Meningitis
  • Bacterial Meningitis
  • Conjugate Vaccine
  • Nationwide Inpatient Sample
  • Pneumococcal Meningitis