Pneumococcal Meningitis in the PCV13 Era

Pneumococcal meningitis is a rare but serious disease in infants and young children. In 2010, the Advisory Committee on Immunization Practices recommended the use of PCV13 (13-valent pneumococcal conjugate vaccine) in place of PCV7 for routine use in children. This occurred after a rise in invasive pneumococcal disease (IPD), including meningitis, caused by nonvaccine serotypes of Streptococcus pneumoniae. It was predicted that the inclusion of an additional 6 serotypes would decrease the incidence of IPD including meningitis in both immunized and underimmunized children as it did after PCV7. In the state of Wisconsin, rates of pneumococcal meningitis have been consistently low since 2003 with 1 to 5 reported cases per year (personal communication: Jeffrey Davis, MD; Chief Medical Officer and State Epidemiologist). Our children’s hospital, which serves a large geographic area of both rural and urban patients in Wisconsin and northern Illinois, had infrequent admissions of children with pneumococcal meningitis over the past ten years. However, we observed a cluster of cases within a 17-month period during 2013 and 2014 with a severe degree of morbidity and 2 fatalities. The purpose of this case series is to alert health care providers who care for children to the ongoing and perhaps increasing need for a high degree of clinical suspicion for pneumococcal meningitis in infants and young children due to serotype replacement.