Seen a Case of Childhood Meningitis Lately?

This article originally appeared online at Dr.Pullen.com

In my residency and in the first few years in practice I would diagnose one or two cases of bacterial meningitis annually. It seemed like every month or two I’d have to do a lumbar puncture on a baby or young child to see if they had meningitis. The causative bacteria were usually either H. influenza type B or S. pneumonia (pneumococcus) . These days thanks primarily to vaccinations against H. influenza type b (HIB vaccination) and the most invasive strains of pneumococcus (PCV-7 vaccine) have made meningitis from these germs quite unusual. We still see cases, and need to keep our diagnostic index of suspicion high, but the incidence of bacterial meningitis has pummeted . I don’t recall the last case of bacterial meningitis in a young child in my practice. Data shows that since the introduction of the HIB vaccination in the UK in 1992 the incidence of H. influenza type B meningitis has dropped by >90%, and in the US the incidence of S. pneumonia meningitis has dropped by over 59% since use of the pneumococcal vaccination became routine.

Meningitis is an infection of the spinal fluid and meninges (tissues covering the brain and spinal cord) that. prior to the development of antibiotics, nearly always caused death. Even with aggressive antibiotic treatment many patients still died or had brain injury. Prior to the PCV-7 vaccination there were about 6000 cases of pneumococcal meningitis in children annually in the US, now there are about 2000 cases annually. There is strong evidence that other infections with the HIB and pneumococcal germs, like bacteremia and pneumonia, have become less common since vaccinations were introduced. Although you may feel like your child is a pincushion at some early well child visits it is well worth the injection discomfort.

As early as 2005 we learned of an added benefit of the universal use of the PCV-7 vaccination. An article in JAMA reported a reduced incidence of pneumococcal pneumonia in older adults. This is felt to be an example of herd immunity, and has been a nice additional public health benefit.

Ed Pullen, MD, is a board-certified family physician practicing in Puyallup, WA. He blogs at DrPullen.com — A Medical Bog for the Informed Patient.