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Pneumococcal meningitis in children and adults before and after implementation of PCV13 into national pediatric
Ching-Min Tang1, Hsin-Chieh Li2, Lin-Hui Su2
1Division of Pediatric Neurology, Chang Gung Memorial Hospital, Taoyuan, Taiwan; Division of Pediatric Critical Care and Pediatric Neurocritical Care Center, Chang Gung Memorial Hospital, Taoyuan, Taiwan.
Insights
Pneumococcal meningitis in Taiwan shows a shift towards non-vaccine serotypes after PCV13 use, with emerging multidrug-resistant strains. Continuous surveillance and higher-valency vaccines are crucial for control.
Area of Science:
- Infectious Diseases
- Microbiology
- Epidemiology
Background:
- Streptococcus pneumoniae is a major cause of bacterial meningitis globally.
- Pneumococcal conjugate vaccines (PCVs) have reduced invasive pneumococcal disease but raised concerns about non-vaccine serotypes (NVTs).
- Limited data exist on pneumococcal meningitis characteristics post-PCV13 introduction.
Purpose of the Study:
- To describe clinical and microbiological features of pneumococcal meningitis.
- To compare pediatric and adult cases after PCV13 introduction in Taiwan.
- To analyze serotype distribution and antimicrobial susceptibility.
Main Methods:
- Retrospective study of culture-confirmed pneumococcal meningitis cases (2009-2025) at Chang Gung Memorial Hospital, Taiwan.
- Review of clinical data, antimicrobial susceptibility, outcomes, and serotypes.
- Comparison between pediatric and adult patient groups.
Main Results:
- 23 cases identified: 11 pediatric, 12 adult.
- Pediatric cases predominantly caused by NVTs (35B, 23A, 15B); 2 VT cases occurred in unvaccinated children.
- Adult cases also showed NVT predominance; 37.5% of adult VT cases were in unvaccinated individuals before 2015. Antibiotic resistance to penicillin and ceftriaxone was noted, with vancomycin susceptibility. In-hospital mortality was 18% in children, with complications like empyema and vasculitis.
Conclusions:
- A clear serotype replacement pattern towards NVTs is evident in Taiwanese children post-PCV13.
- The rise of multidrug-resistant NVTs necessitates ongoing surveillance.
- Higher-valency pneumococcal conjugate vaccines are supported by these findings.
Background:
Streptococcus pneumoniae remains a leading cause of bacterial meningitis worldwide. Although pneumococcal conjugate vaccines (PCVs) have markedly reduced vaccine serotypes (VTs) invasive pneumococcal disease, the emergence of non-vaccine serotypes (NVTs) has become an increasing concern. Data describing the clinical and microbiological characteristics of pneumococcal meningitis after the introduction of PCV13 remain limited.
Methods:
We conducted a retrospective study of culture-confirmed pneumococcal meningitis at Chang Gung Memorial Hospital, Taiwan, from 2009 to 2025. Clinical characteristics, antimicrobial susceptibility profiles, outcomes, and serotype distributions were reviewed and compared between pediatric and adult patients with pneumococcal meningitis.
Results:
A total of 23 patients with pneumococcal meningitis were identified between 2009 and 2025, including 11 pediatric and 12 adult patients. In children, the mean age was 4.8 years. Majority of the isolates are NVTs (35B, 23 A, and 15B). Two patients had meningitis caused by VTs; however, neither of them received PCV13. Clinical characteristics at admission included fever, productive cough, headache, and decreased consciousness (mean Glasgow Coma Scale:11). Susceptibility to antibiotics were similar, with most of the isolates being resistant to penicillin and ceftriaxone but susceptible to vancomycin. The in-hospital mortality rate was 18% (2/11). Most survivors suffered from complications, including empyema and multiple infarctions following vasculitis. In adults, the mean age was 48.6 years old, and majority of the serotypes were NVTs. Most had comorbidities, and the complications following meningitis were diverse. Overall, 37.5% of the patients (6/16) had meningitis attributed to VTs; all were non-immunized and occurred before 2015.
Conclusions:
This study demonstrated a clear serotype replacement pattern in pneumococcal meningitis in Taiwan following PCV13 implementation in children. The emergence of multidrug-resistant NVTs underscores the importance of continuous surveillance and supports the use of higher-valency pneumococcal conjugate vaccines.
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