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Recent trends in pediatric bacterial meningitis in Japan, 2016-2018 - S. agalactiae has been the most common pathogen
Masayoshi Shinjoh1, Yoshio Yamaguchi2, Munehiro Furuichi1
1Department of Pediatrics, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan.
Background:
Haemophilus influenzae type b (Hib) vaccine and pneumococcal conjugated vaccine (PCV) have been widely used since 2010 in Japan. The overall incidence of bacterial meningitis decreased thereafter. Streptococcus agalactiae has become the main organism.
Objectives:
The purpose of the present study was to investigate the incidence rate per 1000 admissions of bacterial meningitis and the change in causative organisms in subsequent years.
Methods:
A cross-sectional, multicenter, non-interventional retrospective study regarding pediatric bacterial meningitis was conducted in Japan in 2019. We analyzed the epidemiological and clinical data for 2016-2018, and compared the information obtained in our previous nationwide survey database. We also investigated the risk factors for disease outcome.
Results:
In the 2016-2018 surveys, 197 patients from 153 hospitals from all prefectures were evaluated. S. agalactiae (0-3 months, 39%), Streptococcus pneumoniae (2-112 months, 20%), and E. coli (0-136 months, 13%) were the main organisms. The total number of patients hospitalized with bacterial meningitis per 1000 admissions decreased from 1.00 to 1.68 in 2000-2010 to 0.38 in 2013-2015, bu remained stable thereafter (0.35-0.40 in 2016-2018). Only one case with Neisseria meningitidis was reported. Nine cases with death were reported, including four cases with S. agalactiae. Risk factors for death and sequelae were consciousness disturbance, duration of convulsion, low CSF glucose levels, and disuse of dexamethasone (p < 0.05).
Conclusions:
The incidence in pediatric bacterial meningitis remained low, and S. agalactiae remains the most common cause of bacterial meningitis in Japan since 2012. S. pneumoniae is the most common cause after 3 months of age.
Insights
Pediatric bacterial meningitis incidence remains low in Japan, with Streptococcus agalactiae being the primary cause in infants. Streptococcus pneumoniae is the leading cause in older children, highlighting evolving epidemiology post-vaccination.
Area of Science:
- Pediatrics
- Infectious Diseases
- Epidemiology
Background:
- Widespread use of Haemophilus influenzae type b (Hib) and pneumococcal conjugated vaccines (PCV) since 2010 in Japan has led to a decrease in overall bacterial meningitis incidence.
- Streptococcus agalactiae has emerged as the predominant causative organism in pediatric bacterial meningitis.
Purpose of the Study:
- To investigate the incidence rate of bacterial meningitis per 1000 admissions in pediatric patients.
- To analyze the changes in causative organisms responsible for bacterial meningitis over recent years in Japan.
Main Methods:
- A retrospective, multicenter, non-interventional study was conducted in Japan in 2019.
- Epidemiological and clinical data from 2016-2018 were analyzed and compared with previous nationwide survey data.
- Risk factors associated with disease outcomes were investigated.
Main Results:
- Streptococcus agalactiae (39%), Streptococcus pneumoniae (20%), and Escherichia coli (13%) were the primary causative organisms identified in pediatric bacterial meningitis cases from 2016-2018.
- The incidence of bacterial meningitis per 1000 admissions remained stable between 2016-2018 (0.35-0.40), following a significant decrease from 2000-2010.
- Risk factors for mortality and sequelae included impaired consciousness, prolonged seizures, low cerebrospinal fluid glucose levels, and lack of dexamethasone use.
Conclusions:
- Pediatric bacterial meningitis incidence in Japan remains low, with Streptococcus agalactiae consistently being the most common cause since 2012.
- Streptococcus pneumoniae is identified as the leading cause of bacterial meningitis in children older than 3 months.
- The study underscores the evolving landscape of bacterial meningitis pathogens in a post-vaccination era.
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