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Vaccine-preventable Pediatric Acute Bacterial Meningitis in France: A Time Series Analysis of a 19-Year Prospective
Alexis Rybak1,2,3, Naïm Ouldali1,4,5, Emmanuelle Varon6
1From the ACTIV, Association Clinique et Thérapeutique Infantile du Val-de-Marne, Créteil, Ile-de-France, France.
Insights
The switch to PCV13 vaccines significantly reduced pneumococcal meningitis in France, unlike earlier PCV7 and MenC vaccines. MenB and newer PCVs show promise for preventing future cases.
Area of Science:
- Pediatric infectious diseases
- Vaccinology
- Epidemiology
Background:
- Vaccination campaigns in France target Haemophilus influenzae type b (Hib), pneumococcus (PCV), and Neisseria meningitidis serogroup C (MenC).
- These interventions have altered the incidence of vaccine-preventable acute bacterial meningitis (ABM) due to varying coverage and uptake rates.
Purpose of the Study:
- To evaluate the impact of vaccine implementation on the incidence of acute bacterial meningitis (ABM) in children in France.
- To assess the effectiveness of specific vaccines like PCV7, PCV13, and MenC over time.
Main Methods:
- Analysis of data from a French prospective surveillance network of ABM in children up to 15 years old.
- Utilized segmented linear regression from 2001 to 2020 to estimate vaccine effects on disease incidence.
Main Results:
- MenC ABM incidence decreased post-vaccination, but overall meningococcal ABM trends were unchanged.
- Pneumococcal ABM incidence showed no change after PCV7 but significantly decreased after switching to PCV13.
- A rebound in non-PCV13 serotypes occurred post-2014, and Hib ABM incidence increased after 2017.
Conclusions:
- Early vaccines (PCV7, MenC) had minimal impact due to low uptake; the PCV13 switch at optimal coverage was effective.
- Neisseria meningitidis serogroup B (MenB) and next-generation pneumococcal conjugate vaccines (PCVs) hold potential for reducing future ABM incidence.
Background:
In France, vaccination has been implemented against Hi serotype b (Hib), pneumococcus with pneumococcal conjugate vaccines (PCV), and Neisseria meningitidis serogroup C (MenC). These interventions with different coverage and uptake have disrupted the epidemiology of vaccine-preventable acute bacterial meningitis (ABM).
Methods:
We analyzed data from a French prospective surveillance network of ABM in children ≤15 years old enrolled by 259 pediatric wards (estimated national coverage: 61%). From 2001 to 2020, the effect of vaccine implementation was estimated with segmented linear regression.
Results:
We analyzed 7,186 cases, mainly due to meningococcus (35.0%), pneumococcus (29.8%), and Hi (3.7%). MenC ABM incidence decreased (-0.12%/month, 95% CI: -0.17 to -0.07, P < 0.001) with no change for the overall meningococcal ABM when comparing the pre-MenC vaccination and the post-MenC vaccination trends. Despite a decreasing MenB ABM incidence without a vaccination program (-0.43%/month, 95% CI: -0.53 to -0.34, P < 0.001), 68.3% of meningococcal ABM involved MenB. No change in pneumococcal ABM incidence was observed after the PCV7 recommendation. By contrast, this incidence significantly decreased after the switch to PCV13 (-0.9%/month, 95% CI: -1.6 to -0.2%, P = 0.01). After May 2014, a rebound occurred (0.5%/month, 95% CI: 0.3-0.8%, P < 0.001), with 89.5% of non-PCV13 vaccine serotypes. Hib ABM incidence increased after June 2017.
Conclusions:
PCV7 and MenC vaccine introduction in France, with slow vaccine uptake and low coverage, had no to little impact as compared to the switch from PCV7 to PCV13, which occurred when coverage was optimal. Our data suggest that MenB and next-generation PCVs could prevent a large part of the ABM incidence in France.
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