ArticlesCommunity-acquired bacterial meningitis in adults in the Netherlands, 2006–14: a prospective cohort study
Introduction
Bacterial meningitis is associated with substantial mortality and morbidity.1 The epidemiology and treatment of bacterial meningitis has changed over the past 15 years.2, 3 The routine use of protein–polysaccharide conjugate vaccines in childhood against common causative pathogens of bacterial meningitis has reduced the overall incidence, affecting the distributions of causative pathogens and the age groups most often affected.2, 4 The introduction of new treatments, such as dexamethasone as adjunctive treatment, might have affected national outcomes of bacterial meningitis.5, 6 In 2006, we started a prospective cohort study to identify and characterise host genetic traits and bacterial genetic factors controlling occurrence and outcome of bacterial meningitis (MeninGene).7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19 Here, we report data from this study, including the incidence, causative pathogens, clinical features, and prognostic factors in adults with community-acquired bacterial meningitis in the Netherlands from 2006 to 2014.
Section snippets
Study population
We identified adults (patients older than age 16 years) who had bacterial meningitis in the Netherlands between Jan 1, 2006, and July 1, 2014, and who were listed in the database of the Netherlands Reference Laboratory for Bacterial Meningitis. This laboratory receives cerebrospinal fluid and blood samples from roughly 85% of all patients with bacterial meningitis in the Netherlands (population 16·9 million).20, 21 The laboratory provided daily updates of the names of hospitals where patients
Results
1887 episodes of bacterial meningitis were identified, 1736 (92%) by the reference laboratory and 151 (8%) by physicians (figure 1). 240 (13%) of 1887 episodes were excluded from the cohort and 235 (12%) met exclusion criteria, resulting in 1412 (75%) episodes in 1391 patients (figure 1).
Median age was 61 years (table 1). A history of splenectomy or cerebrospinal fluid leak was present in 71 (5%) of 1374 episodes. For 457 (33%) of 1380 episodes, the patient had used immunosuppressive drugs or
Discussion
Our findings show that the incidence of adult bacterial meningitis has decreased since the introduction of conjugate vaccines, primarily because of falls in pneumococcal and meningococcal meningitis. Incidence decreased most sharply among pneumococcal serotypes included in the seven-valent and ten-valent conjugate vaccines; these vaccines were introduced in the Netherlands in 2006 and 2011. A surveillance study4 of 17·4 million people in the USA during 1998–2007, showed a similar effect of herd
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