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Updated: Dec 29, 2025
Experimental Human Pneumococcal Carriage
Published on: February 15, 2013
New Strategy Is Needed to Prevent Pneumococcal Meningitis
Reshmi Mukerji1, David E Briles2
1From the Department of Microbiology.
Background:
Polysaccharide conjugate vaccines (PCVs) target the pneumococcal capsular types that most commonly cause fatal pneumonia and sepsis. Because these types were eliminated by the vaccines, it became apparent that in immunized populations, most invasive pneumococcal diseases, including bacteremia, sepsis and complicated pneumonia, were greatly reduced. However, the protective effects of PCVs against another invasive disease, meningitis, has shown much less or no decrease in disease incidence.
Methods:
References were identified through searches of PubMed for articles published from January 1930 to the present by use of specific search terms. Relevant articles were also identified through searches in Google and Google Scholar. Relevant references cited in those articles were also reviewed.
Results:
Even in the presence of the PCVs, meningitis rates in children have been reported globally to be as high as 13 per 100,000 annually. Widespread use of vaccines resulted in the emergence of a broad diversity of replacement non-PCV type strains. These strains generally failed to cause sepsis, but caused meningitis of comparable severity and levels similar to, or in excess of, prior pneumococcal meningitis rates. This is probably because these non-PCV type strains do not survive well in the blood, therefore possibly entering the brain through nonhematogenous routes.
Conclusions:
Because virtually all cases of pneumococcal meningitis lead to either permanent neurologic sequelae or death, it would be well worth the effort to develop a new vaccine capable of preventing pneumococcal meningitis regardless of capsular type. Such a vaccine would need to protect against colonization with most, if not all, pneumococci.
Insights
Polysaccharide conjugate vaccines (PCVs) reduced invasive pneumococcal diseases like pneumonia and sepsis, but meningitis rates remain high. New vaccines are needed to prevent pneumococcal meningitis caused by emerging strains.
Area of Science:
- Infectious Diseases
- Vaccinology
- Pediatrics
Background:
- Polysaccharide conjugate vaccines (PCVs) effectively reduced fatal pneumonia and sepsis caused by common pneumococcal types.
- Despite PCV success, a significant incidence of pneumococcal meningitis persists in immunized populations.
- PCVs have not substantially decreased the burden of pneumococcal meningitis.
Purpose of the Study:
- To analyze the impact of PCVs on pneumococcal meningitis incidence.
- To understand the reasons behind the limited effect of PCVs on meningitis rates.
- To highlight the need for novel vaccine strategies against pneumococcal meningitis.
Main Methods:
- Systematic literature review using PubMed, Google, and Google Scholar.
- Analysis of studies published from 1930 to the present.
- Review of cited references for comprehensive data retrieval.
Main Results:
- Meningitis rates remain high globally, up to 13 per 100,000 children annually, even with PCVs.
- Emergence of diverse non-PCV type strains has replaced vaccine targets.
- These replacement strains cause meningitis with severity comparable to or exceeding pre-vaccine levels, potentially via non-hematogenous routes.
Conclusions:
- Pneumococcal meningitis leads to severe neurologic sequelae or death in nearly all cases.
- Development of a new vaccine is crucial to prevent pneumococcal meningitis irrespective of capsular type.
- A future vaccine must protect against colonization by a broad spectrum of pneumococcal strains.
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