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Children with Bacterial Meningitis Presenting to the Emergency Department during the Pneumococcal Conjugate Vaccine Era

  1. Lise E. Nigrovic MD, MPH,
  2. Nathan Kuppermann MD, MPH,
  3. Richard Malley MD,
  4. for the Bacterial Meningitis Study Group of the Pediatric Emergency Medicine Collaborative Research Committee of the American Academy of Pediatrics

Article first published online: 13 MAY 2008

DOI: 10.1111/j.1553-2712.2008.00117.x

Issue

Academic Emergency Medicine

Academic Emergency Medicine

Volume 15, Issue 6, pages 522–528, June 2008

Additional Information

How to Cite

Nigrovic, L. E., Kuppermann, N., Malley, R. and for the Bacterial Meningitis Study Group of the Pediatric Emergency Medicine Collaborative Research Committee of the American Academy of Pediatrics (2008), Children with Bacterial Meningitis Presenting to the Emergency Department during the Pneumococcal Conjugate Vaccine Era. Academic Emergency Medicine, 15: 522–528. doi: 10.1111/j.1553-2712.2008.00117.x

Author Information

  1. From the Division of Emergency Medicine (LEN, RM) and the Division of Infectious Diseases (RM), Children’s Hospital (LEN, RM), Boston, MA; and the Department of Emergency Medicine, University of California, Davis, Medical Center, and University of California, Davis, School of Medicine (NK), Davis, CA. Bacterial Meningitis Study Group members are listed in †.

*Lise E. Nigrovic, MD, MPH; e-mail: lise.nigrovic@childrens.harvard.edu.

Publication History

  1. Issue published online: 13 MAY 2008
  2. Article first published online: 13 MAY 2008
  3. Received December 17, 2007; revisions received February 15 and February 26, 2008; accepted February 27, 2008.

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Keywords:

  • bacterial meningitis;
  • pneumococcal conjugate vaccination

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 ≥10 cells/mm3) 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.

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