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Epidemiology of meningitis and bacteraemia due to Streptococcus pneumoniae in The Netherlands
L Spanjaard1, A van der Ende, H Rümke
1The Netherlands Reference Laboratory for Bacterial Meningitis (AMC/RIVM), Department of Medical Microbiology, Academic Medical Center, Amsterdam. l.spanjaard@amc.uva.nl
Abstract:
In The Netherlands, accurate data on the epidemiology of pneumococcal meningitis are available through a clinical microbiology laboratory-based national surveillance of cerebrospinal fluid isolates. The Netherlands Reference Laboratory for Bacterial Meningitis receives isolates of about 80% of all meningitis cases and about 40% of bacteraemic cases. The incidence of pneumococcal meningitis has increased slowly from 1.0/100,000 in 1990 to 1.5/100,000 since 1996. The highest age-specific incidence of meningitis was observed in children < 5 y of age (8.2/100,000 in 1999). Of all isolates, 35% were from children < 5 y of age. The number of isolates from non-meningitis patients with bacteraemia increased considerably since the early 1990s, especially among the elderly. The highest incidence was found in 1996, probably owing to a relatively severe winter. During 1995-1999, pneumococcal meningitis in The Netherlands was caused mainly by serotypes 3, 6B, 7F, 9V, 14, 18C, 19F, and 23F. Of the cases in children < 15 y, almost half were caused by serotypes 6B, 14, 18C, and 19F. The serotypes present in the 23-valent polysaccharide and 7-valent conjugate vaccines accounted for 87% and 47% of all meningitis cases, respectively. Pneumococcal resistance to penicillin in The Netherlands is still low, at about 1%. Genotypically, resistant strains belong to many clones. Horizontal transfer of capsular genes occurs among these isolates. In The Netherlands, 45% of cases of pneumococcal meningitis have severe predisposing factors. The case-fatality rate was significantly higher among patients with impaired immunity than among those with a break in the integrity of the dura.
Insights
Pneumococcal meningitis incidence in The Netherlands is slowly rising, particularly in young children. Surveillance data show common serotypes and low penicillin resistance, with vaccines covering a significant proportion of cases.
Area of Science:
- Bacteriology
- Epidemiology
- Public Health
Background:
- Pneumococcal meningitis remains a significant public health concern.
- Accurate epidemiological data are crucial for effective prevention and control strategies.
Purpose of the Study:
- To analyze the epidemiology of pneumococcal meningitis in The Netherlands using national surveillance data.
- To identify prevalent serotypes, incidence trends, and risk factors associated with the disease.
Main Methods:
- Laboratory-based national surveillance of cerebrospinal fluid isolates.
- Analysis of data from The Netherlands Reference Laboratory for Bacterial Meningitis.
- Incidence calculation by age group and serotype identification.
Main Results:
- Slowly increasing incidence of pneumococcal meningitis from 1.0 to 1.5 per 100,000 population.
- Highest incidence observed in children under 5 years old.
- Serotypes 3, 6B, 7F, 9V, 14, 18C, 19F, and 23F were dominant; vaccines covered 87% (polysaccharide) and 47% (conjugate) of cases.
- Low penicillin resistance (1%) and increased bacteraemia cases in the elderly.
Conclusions:
- Pneumococcal meningitis epidemiology in The Netherlands shows a slight increase, with young children being most affected.
- Key serotypes are covered by existing vaccines, but a substantial proportion of cases are not.
- Low antibiotic resistance and high prevalence of predisposing factors highlight the need for continued surveillance and vaccination efforts.