Nationwide multisite data on pyogenic meningitis in children

PLoS One. 2018; 13(5): e0197198

Contributed by Dr Kiran Kumar, Dr Abi Manesh

This seminal paper describes the changing epidemiology of bacterial meningitis among children less than 2 years of age in India. This data is particularly important as it follows the introduction of the Pentavalent vaccine in India (which included HiB vaccine) .It is also of significance as the government is considering the introduction of the pneumococcal conjugate vaccines.

Haemophilus influenzae type b (Hib), Streptococcus pneumoniae, and Neisseria meningitidis were the commonest causes for bacterial meningitis in India before the introduction of the HiB vaccine. A total of 3104 suspected meningitis cases were enrolled from 19,670 children admitted with fever at the surveillance hospitals. Of these, 257 cases were confirmed as cases of meningitis. S. pneumoniae (82.9%), H. influenzae type b (14.4%) and N. meningitidis (2.7%) were the commonest etiologies. Highest prevalence (55.3%) was observed among children 1 to 11 months. Antimicrobial susceptibility testing revealed considerable resistance among S. pneumoniae isolates against commonly used antibiotics such as cotrimoxazole, erythromycin, penicillin, and cefotaxime. More commonly prevalent serotypes of S. pneumoniae in circulation included 6B, 14, 6A and 19F. More than 90% of serotypes identified were covered by Pneumococcal Conjugate Vaccine 13.

This data highlights the value of the 13 valent pneumococcal conjugate vaccine in the Indian scenario. Vancomycin with ceftriaxone should be our empirical antibiotic choice for acute bacterial meningitis.