Epidemiology of bacterial meningitis in the USA from 1997 to 2010: a population-based observational study
Abstract
Background Bacterial meningitis continues to be a substantial cause of morbidity and mortality, but the epidemiological trends after adjunctive dexamethasone recommendations are unknown in the USA. We aimed to describe the changing patterns among the most common bacterial causes in the USA after conjugate vaccination and to assess the association between adjunctive dexamethasone and mortality.Methods For this population-based observational study, we searched information available from hospital discharges about incidence and inpatient mortality for the most important causes of community and nosocomial bacterial meningitis based on International Classification of Diseases coding across all hospitals in the USA between 1997 and 2010 with the HealthCare Cost Utilization Project (HCUP) network database. We calculated incidences according to US Census Bureau data and used a negative binomial regression model to evaluate the significance of changes over time. We assessed mortality from pneumococcus for three periods 1997-2001 (baseline), 2002-04 (transition years), and 2005-08 (after corticosteroid recommendations were available).Findings Streptococcus pneumoniae incidence fell from 0·8 per 100 000 people in 1997, to 0·3 per 100 000 people by the end of 2010 (RR 0·3737, 95% CI 0·1825-0·7656). Mortality from pneumococcal meningitis decreased between 2005 (0·049 per 100 000 people) and 2008 (0·024 per 100 000 people) compared with between 2002 (0·073 per 100 000 people) and 2004 (0·063 per 100 000 people; RR 0·5720, 95% CI 0·4303-0·7582). The incidence of Neisseria meningitidis infection decreased from 0·721 per 100 000 people in 1997, to 0·123 per 100 000 people in 2010 (RR 0·1386, 95% CI 0·048-0·4284), which has placed this pathogen close to common bacterial causes of nosocomial meningitis such as staphylococcus and Gram-negative bacteria and to Haemophilus influenzae.Interpretation S pneumoniae continues to be the leading identifiable cause of bacterial meningitis in the USA, but with a significant decrease in incidence and mortality associated with the introduction of conjugated vaccines and a mortality decrease that is associated with the introduction of recommendations for use of adjunctive dexamethasone for pneumococcal meningitis.Funding National Center for Research Resources.
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Additional meta-analyses of two studies conducted in Northern America demonstrated that S. pneumoniae was the most common pathogen causing bacterial meningitis in 'all ages', with a weighted mean of 43.1%.
“Additional meta-analyses of two studies conducted in Northern America demonstrated that S. pneumoniae was the most common pathogen that caused bacterial meningitis in ‘all ages’, with a weighted mean of 43.1% (S5 Table; [55, 56]).”
From Global etiology of bacterial meningitis: A systematic review and meta-analysis. (2018) · cites this paper as [55]
S. pneumoniae remains an important cause of bacterial meningitis in regions with high vaccine coverage such as Northern America.
“and it remains an important cause of bacterial meningitis in regions with high vaccine coverage such as Northern America. [55, 56]”
From Global etiology of bacterial meningitis: A systematic review and meta-analysis. (2018) · cites this paper as [55]
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- Authors
- Castelblanco, R. L., Lee, M., & Hasbun, R.
- Affiliations
- The University of Texas Health Science Center at Houston (US)
- Corresponding author
- Hasbun, Rodrigo
- Venue
- The Lancet Infectious Diseases
- Publisher
- Elsevier BV
- Published
- 2014-09
- Volume
- 14
- Issue
- 9
- Pages
- 813-819
- ISSN
- 1473-3099 (ISSN-L)
- OpenAlex
- W2100352754
- Cited by
- 245
- References
- 34
- Citations by year
- 2026: 14 · 2025: 13 · 2024: 20 · 2023: 16 · 2022: 11 · 2021: 20 · 2020: 20 · 2019: 24 · 2018: 24 · 2017: 31 · 2016: 22 · 2015: 26 · 2014: 4
- FWCI
- 22.53
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- The Lancet Infectious Diseases (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Center for Research Resources (NIH-1 K23 RR018929-01A2)
- NIH centre for translational Science Award (NIH CTSA) grant (UL RR024148)
- National Center for Research Resources (NCRR) (ULI TR000371)
- Topics
- Life Sciences › Immunology and Microbiology › Microbiology › Bacterial Infections and Vaccines
- Health Sciences › Medicine › Epidemiology › Pneumonia and Respiratory Infections
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Streptococcal Infections and Treatments
- Keywords
- bacterial meningitis, Streptococcus pneumoniae, Neisseria meningitidis, Haemophilus influenzae type b, dexamethasone, adjunctive corticosteroid therapy, meningococcal disease incidence, nosocomial meningitis, community-acquired meningitis, incidence trends, mortality trends
- MeSH terms
- Adolescent, Adult, Aged, Aged, 80 and over, Child, Child, Preschool, Humans, Infant, Infant, Newborn, Meningitis, Haemophilus, Meningitis, Meningococcal, Meningitis, Pneumococcal, Middle Aged, Time Factors, United States, Incidence, Meningitis, Bacterial
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