Prevalencia de meningitis neumocócica en niños españoles

Bacterial meningitis and living conditions

INTRODUCTION

Bacterial meningitis has great social relevance due to its ability to produce sequelae and cause death. It is most frequently found in developing countries, especially among children. Meningococcal meningitis occurs at a high frequency in populations with poor living conditions. This study describes the temporal evolution of bacterial meningitis in Salvador, Brazil, 1995-2009, and verifies the association between its spatial variation and the living conditions of the population.

METHODS

This was an ecological study in which the areas of information were classified by an index of living conditions. It examined fluctuations using a trend curve, and the relationship between this index and the spatial distribution of meningitis was verified using simple linear regression.

RESULTS

From 1995-2009, there were 3,456 confirmed cases of bacterial meningitis in Salvador. We observed a downward trend during this period, with a yearly incidence of 9.1 cases/100,000 population and fatality of 16.7%. Children aged <5 years old and male were more affected. There was no significant spatial autocorrelation or pattern in the spatial distribution of the disease. The areas with the worst living conditions had higher fatality from meningococcal disease (β = 0.0078117, p < 0.005).

CONCLUSIONS

Bacterial meningitis reaches all social strata; however, areas with poor living conditions have a greater proportion of cases that progress to death. This finding reflects the difficulties for ready access and poor quality of medical care faced by these populations.

Reduction in pediatric invasive pneumococcal disease in the Basque Country and Navarre, Spain, after introduction of the heptavalent pneumococcal conjugate vaccine

This study evaluated the incidence of invasive pneumococcal disease, identified the causal serotypes, and tracked the evolution of the antibiotic susceptibility of Streptococcus pneumoniae isolates in the regions of the Basque Country and Navarre, Spain, before and after the introduction of the heptavalent pneumococcal conjugate vaccine. The study included all children aged between birth and 5 years diagnosed with bacteremia, meningitis, or bacteremic pneumonia caused by pneumococci. By the second year after introduction of the heptavalent pneumococcal conjugate vaccine, compared with the period 1998-2001, the incidence of invasive disease decreased by 64.3% in children less than 12 months of age, by 39.7% in children less than 24 months of age, and by 37.5% in children less than 60 months of age. The prevalence of clinical isolates of S. pneumoniae that lacked susceptibility to penicillin decreased by 58.2% among children less than 60 months of age. With an estimated coverage by four-dose heptavalent pneumococcal conjugate vaccine of 28-45% in 2003, the number of invasive pneumococcal infections in the Basque Country and in Navarre fell significantly after just 2 years of immunization, underscoring the importance of improving vaccination coverage under a universal childhood immunization program.

Clinical data and factors associated with poor outcome in pneumococcal meningitis

We carried out a 4-year study of 159 children (ages 1 month-14 years) with pneumococcal meningitis. The study was divided into two periods: the retrospective period (1998-2000: 107 patients), and the prospective period (2001-2002: 52 patients). About 2/3 of the children were under 2 years of age: 72 (45%) were under 1 year of age and 38 (24%) had meningitis during the second year of life. One-third of the patients had signs of otitis media; convulsions were more frequent in patients under 1 year compared with older patients (34.7 vs. 14.9%; P=0.004); 13/159 children (8.2%) died; 93/159 (58.5%) recovered completely, 12.6% had motor sequelae, 6.9% hydrocephalus, 29.8% sensorineural hearing loss; 140/159 (88%) were treated with third generation cephalosporins, yet only 8.7% of the pneumococci identified were completely penicillin-resistant (> or =1 microg/ml); 119/159 were treated with dexamethasone. Four patients had received an injection of heptavalent vaccine. Antibiotics for 1 week prior to admission, shock, abnormal pupils, leukocytes count <6,000 mm(3), and CSF glucose < or =8.5 mg/dl were significantly associated with poor outcome and/or death in the univariate analysis. No patient with leukocytosis >16,000/mm(3) died. Conclusion. Sequelae are very common in pneumococcal meningitis. Poor outcome was associated with pupillary abnormality and a leukocyte count <6,000/mm(3) on admission. Leukocytosis was protective against poor outcome.

Enfermedad invasiva por Streptococcus pneumoniae y Haemophilus influenzae serotipo b. Estudio retrospectivo de 12 años

BACKGROUND

Streptococcus pneumoniae and Haemophilus influenzae serotype b (Hib) are two of the most common causes of invasive bacterial disease in children. The introduction of a successful Hib vaccine and the emergence of penicillin-resistant pneumococci have changed the epidemiology of these bacteria over the last few years.

OBJECTIVES

To evaluate the incidence of S. pneumoniae and Hib invasive disease in children (0-15 years) admitted to our hospital during a 12-year period (January 1991-December 2002).

METHODS

We retrospectively reviewed the medical records of 101 children with isolation of S. pneumoniae and Hib in blood, cerebrospinal fluid (CSF) or synovial fluid samples during the study period.

RESULTS

SP was isolated in 81 samples (72 in blood and nine in CSF) from 73 children (72.6 % were aged < 2 years). The annual incidence per 100,000 children aged 0-2 years was 53.76 cases (95 % CI: 40.7-70.9). The most common clinical diagnosis was bacteremia (67 %). The percentage of penicillin-resistant strains was 44 %. Hib was isolated in 38 samples (26 in blood, 10 in CSF and two in synovial fluid) from 28 children (82.1 % were aged < 2 years). The most common clinical diagnosis was meningitis (35.7 %). The annual incidence per 100,000 children aged between 0-5 years dropped from 21.52 cases (95 % CI: 14.4-32) to 1.7 cases (95 % CI: 0.1-10.8) after systematic vaccination. The percentage of ampicillin-resistant strains was 63.1 %.

CONCLUSIONS

The incidence of invasive pneumococcal disease and the increased antimicrobial resistance rates of pneumococcus are two major reasons to support the routine use of pneumococcal conjugate vaccination in children. Systematic Hib vaccination since October 1998 has dramatically reduced the incidence of this disease.

Enfermedad neumocócica invasiva en la población infantil de la Comunidad Valenciana

OBJECTIVE

Pneumococcal disease is an important cause of morbidity and mortality in children. The recent authorization of the heptavalent conjugate vaccine has increased interest in this disease. The objective of this study was to identify the epidemiological and clinical characteristics of this disease, as well as its outcome in the pediatric population of the Autonomous Community of Valencia.

METHOD

Data were obtained from the medical records of children aged less than 15 years who were positive for pneumococcus isolation on admission to hospital between 1996 and 2000. All the public hospitals of the Autonomous Community of Valencia were included. Changes in incidence were evaluated by comparing rates and outcomes (sequelae and lethality) through frequency and age distribution.

RESULTS

One hundred twenty-seven cases were registered, giving a mean annual rate of 3.89/105 inhabitants aged less than 15 years. The rate was 20.14 in children aged less than 2 years. A total of 29.1% of the children had previous health problems. The main clinical manifestations included sepsis/bacteremia (38%), pneumonia (31%) and meningitis (24%). At discharge sequelae were present in 10 children, 75% of whom were aged less than 2 years. Eight children died (6.3% lethality).

CONCLUSIONS

In the period and region studied, pneumococcal infection was present mainly in children aged less than 2 years and in those with previous health problems. In the last few years, mortality has increased. Thus, inclusion of pneumococcal disease in the epidemiological surveillance system would be appropriate to achieve more precise estimations of its epidemiological patterns and to determine whether the conjugate vaccine represents a solution to the problems currently associated with this bacteria.

Incidencia de enfermedad neumocócica invasiva en Cantabria (1995-2001) e implicaciones para el calendario vacunal

OBJECTIVE

To describe the incidence of invasive pneumococcal disease in Cantabria (Spain) between 1995 and 2001.

METHOD

We reviewed the records of the Minimum Data Set (MDS) of public hospitals in Cantabria, discharges from private hospitals and the registry of diseases of mandatory reporting, as well as the microbiologic diagnoses and medical records of children discharged from the Pediatric Service of the Cantabria Hospital (the tertiary care hospital in our autonomous community).

RESULTS

We obtained a meningitis incidence of 5.55, 5.03 and 0.76/100,000 in children < 2 years, > or = 2 and < 5 years, and > or = 5 years respectively, and an incidence of invasive disease of 11.11, 11.32 and 1.49/100,000 in the same age groups.

CONCLUSIONS

The incidence of meningitis and invasive pneumococcal disease in Cantabria is low. We discuss factors that should be taken into account when introducing the pneumococcal conjugate vaccine in the childhood immunization schedule of Cantabria.