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Pneumococcal meningitis in the era of pneumococcal conjugate vaccine implementation

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Abstract

The French Pediatric Infectious Diseases Group set up an active surveillance network to analyze the clinical and biological features of pneumococcal meningitis and the impact of the seven-valent pneumococcal conjugate vaccine (PCV7). From 2001 to 2005, 234 pediatric wards working with 166 microbiology laboratories enrolled all children with pneumococcal meningitis. Risk factors, signs and symptoms, vaccination status, cerebrospinal fluid analysis, treatments and case fatality rates were recorded. One hundred and sixty-nine centers (169/234) reported 616 cases, median age was 0.9 years and 67.2% of children were ≤2 years old. Underlying conditions were present in 13.1% of cases. The proportion of penicillin non-susceptible strains was 48.7%. Vancomycin plus a third-generation cephalosporin was prescribed in 92.7% of cases, and steroids were given before antibiotic treatment in 16.5% of cases. The case fatality rate was 10.8% overall and was not related to age, antibiotic susceptibility or steroid use. In children 2 to 24 months old compared to the prevaccinal period (2001–2002) a decrease of 28.4% of the number of cases was observed in 2005 (P < 0.05). Among children 2 to 24 months old, the proportion of serotypes covered by the PCV7 fell from 39/57 (68.4%) in 2001–2002 to 19/45 (42.2%) in 2005, while the proportion of non-vaccine serotypes and related serotypes increased respectively from 9/57 (15.8%) and 9/57 (15.8%) in 2001–2002 to 14/45 (31.1%) and 12/45 (26.7%) in 2005. Among 52 cases of pneumococcal meningitis that have occurred in vaccinated children (≥1 dose) with PCV7, 7 were due by vaccine serotypes. This study provides data on underlying conditions, penicillin susceptibility, serotype evolution according to vaccination status and risk factors for mortality for pneumococcal meningitis in children from 2001–2005 in France.

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Acknowledgments

We thank all pediatricians and microbiologists who participated in the study: Drs. Adam, Agoli, Akitani, Akli, Alba-Sauviat, Albertini, Aljazayri, Alonso, Amira, Amirault, Amsallem, Andlauer, Andriantahina, Arlet, Armengaud, Arnault, Artigou, Asensi, Aubert, Aucher, Aufrant, Aujard, Auvray, Avignon, Bachelier, Badinand, Banerjee, Barbier, Barbut, Barnaud, Barrans, Barraud, Barré, Bassil, Bataille, Beaufils, Bebear, Bellegra Nourrine, Benezech, Berardi-Grassias, Berche, Berger, Bernard, Berrahma, Berthelot, Berthier, Bessis, Besson-Leaud, Biessy, Bigirimawa, Bineau, Bingen, Terki, Blanc, Blanchard, Bland, Blezel, Retali, Blin, Blondel, Blondin, Boisivon, Bompard, Bonafoux, Bonardi, Bonnin, Boquet, Borde, Born, Bost-Bru, Boudard, Bouillié, Bour, Bourrillon, Boutte, Bouygues, Bouziges, Bowete, Boyer, Branca, Branger, Briand, Brizard, Brocard, Brotslhi, Brouard, Broussine, Brunoni, Bruyas, Budniok, Burel, Lina, Burnichon, Cahiez, Caillaux, Callamand, Calvez, Fellouse, Camboulives, Camenen, Canarelli, Canonne, Cantagrel, Canzi, Carbonnelle, Carre-Cavellier, Carriere, Carriere, Carroger, Castelnau, Barthez, Cattoen, Cau, Caveriviere, Chabrol, Chalvon Demersay, Chami, Chamouilli, Chamoux, Chantelat, Chantepie, Chappet, Charachon, Charara, Chardon, Charras, Chassevent, Chavet, Chenaud, Cheraïtia, Cheron, Chevallier, Chopard, Choulot, Claris, Clergeau, Colin-Gorski, Collignon, Combe, Cometdidierjean, Gury, Cordier, Cormier, Costa, Cottancin, Cottin, Couchot, Coumenges, Courcol, Cousinard, Crepet, Landrot, Croix, Croizé, Crost, Cuntz-Shadfar, Cuvelier, Cuzzi, Dabernat, Dagorne, D’albignac, Dalmon, Daltroff, Danjean-Deguin, Danjoux, Daoudi, Darras, Darviau, Dassieu, David, De Champs, De La Rocque, De Lumley, De Montclos, De Montgolfier, De Preville, De Prunele, De Ricaud, Debray, Decoster, Decoux, Deforche, Dehan, Delacour, Delahaye, Delamare, Delarbre, Delbeke, Deligne, Delisle, Delubac, Demachy, Demarcq, Demarque, Demarquez, Denavit, Denis, Despert, Desprez, Desson, Devictor, Deville, Dib, Dieckmann, Doeuvre, Dolhem, Dommergues, Douard, Douchain, Douillet, Drugeon, Dublanchet, Dubois, Dubourdieu, Duchaine, Poirot, Duhamel, Dulucq, Dumont, Dupic, Dupre, Durand, Duval Arnould, Dzukou, Eb, Eicher, Elchardus, Eloy, Emerique, Enchery, Escarguel, Estournet-Mathiaud, Estrangin, Etienne, Evrard, Faibis, Farges, Faye, Feit, Ferre, Ferroni, Fevre, Fieschi, Fischbach, Floret, Flurin, Forget, Fortier, Fortin,Foucaud, Fournet, Fournier, Francoise, Fremaux, Freysz, Fromont, Fruchart-Flamenbaum, Furioli, Gagliardone, Gaillard, Galanti-Cuyeu, Gallou, Ganivala, Garbarg-Chenon, Garcera, Garnier, Gaudeau-Toussaint, Gaudelus, Gautry, Gavignet, Gbadamassi, Geffroy, Gendrel, Geraudel, Gevaudan, Ghnassia, Ginies, Giudicelli, Glastre, Gold, Goldstein, Goudeau, Gougeon, Goumy, Gouraud, Gout, Goux, Graff, Grancher, Gras-Le Guen, Grasmik, Grelier, Gremillet, Gressier, Grimprel, Grise, Gros, Guesnu, Guibert, Guichard, Guilhaume, Guillaume Bodet, Guillois, Guillot, Guyon, Guyot, Haas, Hachani, Hage, Hallalel, Halna, Hamza, Haouari, Hefteh, Heidt, Hernandorena, Herve, Heusse, Hidri, Hoffmann, Holler, Hubert, Hudebine, Huet, Huin, Huon, Hureaux, Husson, Ikunga, Imbs, Ingrand, Jacob, Jalloul, Jan, Janaud, Jeannoel, Jeannot, Jeny, Jomaa, Joron, Joubert, Joussein, Julien, Jullien, Kaid, Kaiffer, Kermad, Khazaal, Kirch, Kremp, Kretz, Kuntzel, Kurtz, Laboureau, Labrune, Lacomme, Lafargue, Lagier, Laisney, Lajarrige, Laluque, Lambert, Landragin, Langs, Lanotte, Lansiaux, Larroque, Larrouy, Laugier, Launay, Laurens, Laurent, Le Bideau, Le Bouar, Le Gall, Le Loc’h, Le Lorier, Le Luyer, Le Turdu, Lebas, Leblanc, Lecaillon-Thibon, Lecine, Leclerc, Leclercq, Leflon-Guibout, Lefrand-Crepin, Lehnert, Lejeune, Lelioux, Leluan, Lemaitre, Lemble, Lemeland, Lenclen, Lenoir, Lenthel, Leotard, Leraillez, Lesage, Lesbros, Lescanne, Letouzey, Levy, Lhermitte, Cahuzac, Lorotte, Luc, Lucet, Lureau, Lusina, Magny, Maillotte, Mallet, Mancini, Mandelcwajg, Mangeol, Marchand, Marcou, Marie Cardine, Marie Dit Dinard, Marret, Martha Le Gall, Martin, Martinot, Mas, Massard, Masutti, Mathieu, Mattei, Maugard, Mazataud, M’bamba, Megraud, Lehours, Melon, Menetrey, Menget, Menouni-Foray, Merlin, Mettey, Metton, Meunier, Meyer, Michalick, Mikail, Milesi, Milleret-Proyart, Milou, Minery, Mokhtari, Mondaud, Monier, Monin, Monteil, Morales-Gineste, Moreau, Morègne, Moretti, Morice, Moriette, Morin, Morisot, Morville, Motte, Moulene, Moulie, Mounzer, Mselati, Mucignat, Muller, Nardou, Naudion, Nelson, Nerl Schiavini, Netter, Nicolas-Chanoine, Noir, Nordmann, Nouvellon, Orzechowski, Otterbein, Oules, Paget, Pangon, Doucet Populaire, Pannecouck, Paris, Pateyron, Pauchard, Paul, Pautard, Pellerin, Poilly, Pelloux, Penaud, Peralta, Perrin, Peter, Peyrard, Peyraud, Philippe, Philippon, Picaud, Picherot, Pierre, Pierrejean, Pignol, Pinard, Pincemaille, Pincet, Pinquier, Plasse, Ploton, Freydiere, Poilane, Poisson, Pollet, Popelard, Porcheret, Poulain, Pradeaux, Prere, Puech, Queinnec, Quinet, Raber, Raoult, Ravussin, Raymond, Raynaud, Rebaud, Reguet, Reinert, Renaud, Renolleau, Retbi, Reveil, Richardin, Rimet, Rivaux, Riviere, Robin, Rodiere, Rolland, Romanet, Ropert, Rossignol, Rougier, Roussellier, Roybet, Roze, Rudler, Russo, Ryckewaert, Sachs, Sadki, Saf, Saillant, Saliba, Sanchez, Santerne, Sanyas, Sardet, Sarlangue, Sarran, Sartelet, Savoy, Sayegh, Scanvic, Scart, Scat, Schaefer, Schnebelen, Schneider, Schweitzer, Sebag, Secher, Seguin, Semon, Sep-Hieng, Sermet-Gaudelus, Sfez, Sibille, Sicard, Siegel, Smati, Sommabere, Spicq, Stach, Tahiri, Taillebois, Talon, Tchanga, Tessier, Thevenieau, Thibaud, Thibault, Thierry, Thore, Tillier, Tiry, Tixier Ou Vray, Tommasi, Tourrand, Tous, Trioche, Tronc, Turchini, Uzan, Vachee, Valayer, Vallee, Van De Perre, Vandenesch, Vanlaeys, Vasselon-Raina, Vaucel, Vergerond, Vergnaud, Vergne, Vernet-Garnier, Vic, Vidailhet, Vigne, Vigneron, Villemain, Villeneuve, Voyer, Vrillon, Vu Thien, Weil-Olivier, Weisse, Wemeau, Yang Ting, Ygout, Ythier, Zaoui, Zelinsky-Gurung, Zimmermann, Zumbo, Zupan Simunek and Zyka.

We are grateful to A. Lécuyer, N. Kohn and S. Tortorreli for their technical assistance.

We are grateful to C. Picart for the patients’ immunological exploration from the Centre d’Etudes et déficit Immunitaire, Necker Hospital, Paris, France.

We thank David Young for editorial assistance.

Financial support

Pediatric Infectious Diseases Group of the French Pediatrics Society (GPIP) and the Association Clinique et Therapeutique Infantile du Val de Marne (ACTIV).

Potential conflicts of interest

All authors have no conflicts.

Ethical approval

Not needed.

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Authors and Affiliations

  1. Service de Microbiologie, Hôpital Robert Debré, 48 Bvd Serurier, F75019, Paris, France

    E. Bingen

  2. The Pediatric Infectious Diseases Group of the French Pediatrics Society, Paris, France

    E. Bingen, C. Levy, F. de La Rocque, Y. Aujard & R. Cohen

  3. ACTIV (Association Clinique et Thérapeutique Infantile du Val de Marne), Saint Maur des Fossés, France

    C. Levy, F. de La Rocque, M. Boucherat & R. Cohen

  4. National Reference Center for Streptococcus pneumoniae, Hôpital Georges Pompidou, Paris, France

    E. Varon

  5. Département de biostatistique du Centre Hospitalier Universitaire de Dijon, Dijon, France

    P. d’Athis

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Bingen, E., Levy, C., Varon, E. et al. Pneumococcal meningitis in the era of pneumococcal conjugate vaccine implementation. Eur J Clin Microbiol Infect Dis 27, 191–199 (2008). https://doi.org/10.1007/s10096-007-0417-y

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