Bacterial meningitis in the United States, 1998-2007.

BACKGROUND The rate of bacterial meningitis declined by 55% in the United States in the early 1990s, when the Haemophilus influenzae type b (Hib) conjugate vaccine for infants was introduced. More recent prevention measures such as the pneumococcal conjugate vaccine and universal screening of pregnant women for group B streptococcus (GBS) have further changed the epidemiology of bacterial meningitis. METHODS We analyzed data on cases of bacterial meningitis reported among residents in eight surveillance areas of the Emerging Infections Programs Network, consisting of approximately 17.4 million persons, during 1998-2007. We defined bacterial meningitis as the presence of H. influenzae, Streptococcus pneumoniae, GBS, Listeria monocytogenes, or Neisseria meningitidis in cerebrospinal fluid or other normally sterile site in association with a clinical diagnosis of meningitis. RESULTS We identified 3188 patients with bacterial meningitis; of 3155 patients for whom outcome data were available, 466 (14.8%) died. The incidence of meningitis changed by -31% (95% confidence interval [CI], -33 to -29) during the surveillance period, from 2.00 cases per 100,000 population (95% CI, 1.85 to 2.15) in 1998-1999 to 1.38 cases per 100,000 population (95% CI 1.27 to 1.50) in 2006-2007. The median age of patients increased from 30.3 years in 1998-1999 to 41.9 years in 2006-2007 (P<0.001 by the Wilcoxon rank-sum test). The case fatality rate did not change significantly: it was 15.7% in 1998-1999 and 14.3% in 2006-2007 (P=0.50). Of the 1670 cases reported during 2003-2007, S. pneumoniae was the predominant infective species (58.0%), followed by GBS (18.1%), N. meningitidis (13.9%), H. influenzae (6.7%), and L. monocytogenes (3.4%). An estimated 4100 cases and 500 deaths from bacterial meningitis occurred annually in the United States during 2003-2007. CONCLUSIONS The rates of bacterial meningitis have decreased since 1998, but the disease still often results in death. With the success of pneumococcal and Hib conjugate vaccines in reducing the risk of meningitis among young children, the burden of bacterial meningitis is now borne more by older adults. (Funded by the Emerging Infections Programs, Centers for Disease Control and Prevention.).

[1]  D. Swerdlow,et al.  Pregnancy-associated listeriosis , 2010, Epidemiology and Infection.

[2]  W. Schaffner,et al.  Changes in Neisseria meningitidis disease epidemiology in the United States, 1998-2007: implications for prevention of meningococcal disease. , 2010, Clinical infectious diseases : an official publication of the Infectious Diseases Society of America.

[3]  D. Beek.  Effect of Pneumococcal Conjugate Vaccine on Pneumococcal Meningitis , 2010 .

[4]  Lisa M. Lee,et al.  Estimation of HIV incidence in the United States. , 2008, JAMA.

[5]  Carlos G. Grijalva,et al.  Changing epidemiology of pneumococcal meningitis after the introduction of pneumococcal conjugate vaccine in the United States. , 2008, Clinical infectious diseases : an official publication of the Infectious Diseases Society of America.

[6]  N. Khardori.  Epidemiology of Invasive Group B Streptococcal Disease in the United States, 1999-2005 , 2008 .

[7]  L. Graves,et al.  Listeria monocytogenes infection from foods prepared in a commercial establishment: a case-control study of potential sources of sporadic illness in the United States. , 2007, Clinical infectious diseases : an official publication of the Infectious Diseases Society of America.

[8]  Matthew R Moore,et al.  Reduction in the incidence of invasive listeriosis in foodborne diseases active surveillance network sites, 1996-2003. , 2007, Clinical infectious diseases : an official publication of the Infectious Diseases Society of America.

[9]  W. Schaffner,et al.  Changes in Invasive Pneumococcal Disease among HIV-Infected Adults Living in the Era of Childhood Pneumococcal Immunization , 2006, Annals of Internal Medicine.

[10]  L. Graves,et al.  Multistate outbreak of Listeriosis linked to turkey deli meat and subsequent changes in US regulatory policy. , 2006, Clinical infectious diseases : an official publication of the Infectious Diseases Society of America.

[11]  J. Gerberding,et al.  Direct and indirect effects of routine vaccination of children with 7-valent pneumococcal conjugate vaccine on incidence of invasive pneumococcal disease--United States, 1998-2003. , 2005, MMWR. Morbidity and mortality weekly report.

[12]  Allan R Tunkel,et al.  Practice guidelines for the management of bacterial meningitis. , 2004, Clinical infectious diseases : an official publication of the Infectious Diseases Society of America.

[13]  L. Charles,et al.  Epidemiologic issues in study design and data analysis related to FoodNet activities. , 2004, Clinical infectious diseases : an official publication of the Infectious Diseases Society of America.

[14]  A. Schuchat,et al.  Decline in invasive pneumococcal disease after the introduction of protein-polysaccharide conjugate vaccine. , 2003, The New England journal of medicine.

[15]  L. Harrison,et al.  Active bacterial core surveillance of the emerging infections program network. , 2001, Emerging infectious diseases.

[16]  Oleg O. Bilukha,et al.  Prevention and control of meningococcal disease. Recommendations of the Advisory Committee on Immunization Practices (ACIP). , 2000, MMWR. Recommendations and reports : Morbidity and mortality weekly report. Recommendations and reports.

[17]  L. McCaig,et al.  Food-related illness and death in the United States. , 1999, Emerging infectious diseases.

[18]  A. Schuchat,et al.  Bacterial Meningitis in the United States in 1995 , 1997 .

[19]  R. Lucena,et al.  2-04-10 Acute bacterial meningitis in adults , 1997, Journal of the Neurological Sciences.

[20]  V. Caviness,et al.  Acute bacterial meningitis in adults. A review of 493 episodes. , 1993, The New England journal of medicine.

[21]  A. Hightower,et al.  Bacterial meningitis in the United States, 1986: report of a multistate surveillance study. The Bacterial Meningitis Study Group. , 1990, The Journal of infectious diseases.

[22]  J. Gruber.  Bacterial meningitis in the United States, 1978 through 1981: The national bacterial meningitis surveillance study , 1985 .

[23]  L. Silverman,et al.  Undiagnosed bacterial meningitis in Vermont children. , 1975, American journal of epidemiology.

[24]  R. Feldman,et al.  Bacterial meningitis in Bernalillo County, New Mexico: a comparison with three other American populations. , 1974, American journal of epidemiology.