Emerg Infect Dis. 2018 Jul;24(7):1275-1284. doi: 10.3201/eid2407.170721.
The indirect effect of pneumococcal conjugate vaccine on adult pneumococcal meningitis has not been thoroughly investigated. We present data from active surveillance on pneumococcal meningitis in adults in Israel occurring during July 2009-June 2015. Pneumococcal meningitis was diagnosed for 221 patients, 9.4% of all invasive pneumococcal disease (IPD) cases. Although overall IPD incidence decreased during the study period, meningitis increased nonsignificantly from 0.66 to 0.85 cases/100,000 population. Incidence of vaccine type (VT) pneumococcal meningitis (VT13) decreased by 70%, but non-VT13 pneumococcal meningitis increased from 0.32 to 0.75 cases/100,000 population (incident rate ratio 2.35, 95% CI 1.27-4.35). Pneumococcal meningitis patients were younger and healthier than nonmeningitis IPD patients, and 20.2% had a history of previous head surgery or cerebrospinal fluid leak compared with <2.0% of nonmeningitis patients (p<0.0001). Non-VT13 types that rarely cause IPD (15B/C, 6C, 23A, 23B, 24F) seem to be emerging as common causes of meningitis.
肺炎球菌结合疫苗对成人肺炎球菌性脑膜炎的间接影响尚未得到彻底研究。我们报告了 2009 年 7 月至 2015 年 6 月期间在以色列进行的成人侵袭性肺炎球菌病（IPD）主动监测中肺炎球菌性脑膜炎的数据。共诊断出 221 例肺炎球菌性脑膜炎患者，占所有 IPD 病例的 9.4%。尽管研究期间 IPD 总发病率有所下降，但脑膜炎的发病率从 0.66 例/100,000 人上升至 0.85 例/100,000 人，无显著性差异。疫苗型（VT）肺炎球菌性脑膜炎（VT13）的发病率下降了 70%，而非 VT13 型肺炎球菌性脑膜炎的发病率从 0.32 例/100,000 人上升至 0.75 例/100,000 人（发病率比 2.35，95%CI 1.27-4.35）。肺炎球菌性脑膜炎患者比非脑膜炎 IPD 患者年轻且健康，20.2%的患者有既往头颈部手术或脑脊液漏病史，而非脑膜炎患者中这一比例<2.0%（p<0.0001）。不太可能引起 IPD 的非 VT13 型（15B/C、6C、23A、23B、24F）似乎正成为脑膜炎的常见原因。
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