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Children with bacterial meningitis presenting to the emergency department during the pneumococcal conjugate vaccine era.
Acad Emerg Med. 2008 Jun; 15(6):522-8.AE

Abstract

BACKGROUND

The epidemiology of bacterial meningitis in children in the era of widespread heptavalent conjugate pneumococcal vaccination (PCV7) is unknown.

OBJECTIVES

The objective was to describe the epidemiology of bacterial meningitis in children presenting to the emergency department (ED) during the era of widespread PCV7 vaccination.

METHODS

The authors retrospectively reviewed the medical records of all children aged 1 month to 19 years with bacterial meningitis who presented to the EDs of 20 U.S. pediatric centers (2001-2004). Bacterial meningitis was defined by a positive cerebrospinal fluid (CSF) culture for a bacterial pathogen or CSF pleocytosis (CSF white blood cell [WBC] count >or=10 cells/mm(3)) in association with either a positive blood culture or a CSF latex agglutination study.

RESULTS

A total of 231 children with bacterial meningitis were identified. The median age was 0.6 years (interquartile range [IQR] = 0.2-4.2). Eight patients (3% of all patients) died. The following bacterial pathogens were identified: Streptococcus pneumoniae (n = 77; 33.3%), Neisseria meningitidis (67; 29.0%), Group B Streptococcus (42; 18.2%), Escherichia coli (17; 7.4%), nontypeable Haemophilus influenzae (10; 4.3%), other Gram-negative bacilli (7; 3.0%), Listeria monocytogenes (5; 2.2%), Group A Streptococcus (5; 2.2%), and Moraxella catarrhalis (1; 0.4%). S. pneumoniae serotypes were determined in 37 of 77 patients; of these, 62% were due to nonvaccine serotypes (including 19A).

CONCLUSIONS

Although now a rare infectious disease in United States, bacterial meningitis still causes substantial morbidity in affected children. Despite the introduction of PCV7, S. pneumoniae remains the most common cause of bacterial meningitis in U.S. children, with approximately half of cases due to nonvaccine serotypes.

Authors+Show Affiliations

Division of Emergency Medicine, Children's Hospital, Boston, MA, USA. lise.nigrovic@childrens.harvard.eduNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Multicenter Study
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

18616437

Citation

Nigrovic, Lise E., et al. "Children With Bacterial Meningitis Presenting to the Emergency Department During the Pneumococcal Conjugate Vaccine Era." Academic Emergency Medicine : Official Journal of the Society for Academic Emergency Medicine, vol. 15, no. 6, 2008, pp. 522-8.
Nigrovic LE, Kuppermann N, Malley R, et al. Children with bacterial meningitis presenting to the emergency department during the pneumococcal conjugate vaccine era. Acad Emerg Med. 2008;15(6):522-8.
Nigrovic, L. E., Kuppermann, N., & Malley, R. (2008). Children with bacterial meningitis presenting to the emergency department during the pneumococcal conjugate vaccine era. Academic Emergency Medicine : Official Journal of the Society for Academic Emergency Medicine, 15(6), 522-8. https://doi.org/10.1111/j.1553-2712.2008.00117.x
Nigrovic LE, et al. Children With Bacterial Meningitis Presenting to the Emergency Department During the Pneumococcal Conjugate Vaccine Era. Acad Emerg Med. 2008;15(6):522-8. PubMed PMID: 18616437.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Children with bacterial meningitis presenting to the emergency department during the pneumococcal conjugate vaccine era. AU - Nigrovic,Lise E, AU - Kuppermann,Nathan, AU - Malley,Richard, AU - ,, PY - 2008/7/12/pubmed PY - 2008/9/24/medline PY - 2008/7/12/entrez SP - 522 EP - 8 JF - Academic emergency medicine : official journal of the Society for Academic Emergency Medicine JO - Acad Emerg Med VL - 15 IS - 6 N2 - BACKGROUND: The epidemiology of bacterial meningitis in children in the era of widespread heptavalent conjugate pneumococcal vaccination (PCV7) is unknown. OBJECTIVES: The objective was to describe the epidemiology of bacterial meningitis in children presenting to the emergency department (ED) during the era of widespread PCV7 vaccination. METHODS: The authors retrospectively reviewed the medical records of all children aged 1 month to 19 years with bacterial meningitis who presented to the EDs of 20 U.S. pediatric centers (2001-2004). Bacterial meningitis was defined by a positive cerebrospinal fluid (CSF) culture for a bacterial pathogen or CSF pleocytosis (CSF white blood cell [WBC] count >or=10 cells/mm(3)) in association with either a positive blood culture or a CSF latex agglutination study. RESULTS: A total of 231 children with bacterial meningitis were identified. The median age was 0.6 years (interquartile range [IQR] = 0.2-4.2). Eight patients (3% of all patients) died. The following bacterial pathogens were identified: Streptococcus pneumoniae (n = 77; 33.3%), Neisseria meningitidis (67; 29.0%), Group B Streptococcus (42; 18.2%), Escherichia coli (17; 7.4%), nontypeable Haemophilus influenzae (10; 4.3%), other Gram-negative bacilli (7; 3.0%), Listeria monocytogenes (5; 2.2%), Group A Streptococcus (5; 2.2%), and Moraxella catarrhalis (1; 0.4%). S. pneumoniae serotypes were determined in 37 of 77 patients; of these, 62% were due to nonvaccine serotypes (including 19A). CONCLUSIONS: Although now a rare infectious disease in United States, bacterial meningitis still causes substantial morbidity in affected children. Despite the introduction of PCV7, S. pneumoniae remains the most common cause of bacterial meningitis in U.S. children, with approximately half of cases due to nonvaccine serotypes. SN - 1553-2712 UR - https://www.unboundmedicine.com/medline/citation/18616437/Children_with_bacterial_meningitis_presenting_to_the_emergency_department_during_the_pneumococcal_conjugate_vaccine_era_ L2 - https://doi.org/10.1111/j.1553-2712.2008.00117.x DB - PRIME DP - Unbound Medicine ER -