Pneumococcal bacteraemia and meningitis in England and Wales, 1993 to 1995

A total of 10,346 blood and 682 cerebrospinal fluid (CSF) isolates of Streptococcus pneumoniae were reported to the PHLS Communicable Disease Surveillance Centre from laboratories in England and Wales from 1 January 1993 to 31 December 1995. This corresponds to a mean annual incidence of 6.7 per 100,000 episodes of bacteraemia and 0.44/100,000 of meningitis. Absolute numbers of pneumococcal bacteraemia were similar to levels reported between 1990 and 1992, but fewer isolates of pneumococci were made from CSF. There was no discernible overall trend between 1993 and 1995, but age specific incidence suggested a slight increase in bacteraemia in older age groups. Estimated case fatality rates were 20% for pneumococcal bacteraemia and 22% for meningitis. The proportion of pneumococcal strains resistant to penicillin and erythromycin rose between 1989 and 1995 from 0.3% to 2.9% and 3.3% to 10.9%, respectively. The persistent threat of invasive pneumococcal infections highlights the need for continuing laboratory surveillance (including serotyping), appropriate use of antibiotics, and immunisation of groups at risk. The development of conjugate vaccines offers new prospects for prevention.