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Hearing outcomes in children with pneumococcal meningitis in the PCV13 era
Nam K Lee1, Suhong Tong2, Kaitlyn Tholen3
1University of Colorado Anschutz School of Medicine, Aurora, CO 80045, USA.
Insights
Pediatric sensorineural hearing loss (SNHL) from pneumococcal meningitis remains common, even with PCV-13 vaccination. Non-PCV-13 serotypes are linked to severe SNHL, suggesting a need for broader vaccine coverage.
Area of Science:
- Pediatrics
- Infectious Diseases
- Audiology
Background:
- Streptococcus pneumoniae causes the highest incidence of post-meningitic sensorineural hearing loss (SNHL).
- The impact of 13-valent pneumococcal conjugate vaccine (PCV) on pediatric SNHL from pneumococcal meningitis requires further investigation.
Purpose of the Study:
- To identify clinical factors associated with post-meningitic SNHL (pmSNHL) in children.
- To describe the rates of pmSNHL across pre-PCV, PCV-7, and PCV-13 vaccination eras.
Main Methods:
- Retrospective case-control study of pediatric patients (≤18 years) with pneumococcal meningitis.
- Comparison of demographic and clinical risk factors in patients with and without SNHL.
- Detailed audiologic evaluation of patients with resulting SNHL.
Main Results:
- Six of twenty patients with pneumococcal meningitis developed pmSNHL, with 50% bilateral.
- The rate of pmSNHL in the PCV-13 era was similar to pre-PCV and PCV-7 eras.
- Non-PCV-13 serotypes were more prevalent in patients with pmSNHL (83%) compared to those without (57%).
Conclusions:
- Post-meningitic SNHL remains a significant concern despite high PCV-13 uptake.
- Non-PCV-13 serotypes are associated with the persistent high rates and severity of pmSNHL.
- Vaccines with expanded serotype coverage may reduce SNHL incidence and severity.
Introduction:
Streptococcus pneumoniae, is associated with the highest incidence of post-meningitic SNHL. The exact impact of 13-valent pneumococcal conjugate vaccine (PCV) on pediatric SNHL from pneumococcal meningitis is unknown. We aimed to identify clinical factors associated with post-meningitic SNHL (pmSNHL) from pneumococcal meningitis and describe its rates based on three time periods: pre-PCV, PCV-7 and PCV13 eras.
Methods:
A retrospective case-control study was performed for patients 18 years and younger diagnosed with pneumococcal meningitis from January 1, 2010 to December 31, 2020 at Children's Hospital Colorado. Demographic and clinical risk factors between those with or without SNHL were compared. Detailed hearing outcomes of those with resulting SNHL are described.
Results:
23 patients with CSF cultures or Meningitis/Encephalitis Panel positive for pneumococcal meningitis were identified. Twenty patients both survived the infection and had audiologic evaluation. Six patients had pmSNHL, with 50 % affected bilaterally. The rate of pmSNHL from S. pneumoniae in the PCV-13 era at our institution was similar to historical rates from the pre-PCV and PCV-7 eras. Similar proportions of patients with pmSNHL completed PCV vaccination (66.7 %) compared to those without (71.4 %). Non-PCV-13 serotypes were responsible 83 % of patients with pmSNHL versus 57 % of patients without pmSNHL.
Conclusions:
Despite high rates of PCV-13 uptake in our cohort, pmSNHL was still common, severe, and commonly associated with non-PCV-13 serotypes. Non-PCV-13 serotypes may be contributing to the persistently high rate of post-meningitic SNHL and the severity of SNHL. Newer pneumococcal conjugate vaccines with expanded serotypes may help mitigate the SNHL associated with pneumococcal meningitis.
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