Bacterial Meningitis in Brazil Baseline Epidemiologic Assessment of the Decade Prior to the Introduction of Pneumococcal and Meningococcal Vaccines.docVIP

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Bacterial Meningitis in Brazil Baseline Epidemiologic Assessment of the Decade Prior to the Introduction of Pneumococcal and Meningococcal Vaccines.doc

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Bacterial Meningitis in Brazil Baseline Epidemiologic Assessment of the Decade Prior to the Introduction of Pneumococcal and Meningococcal Vaccines

BacterialMeningitisinBrazil:BaselineEpidemiologic AssessmentoftheDecadePriortotheIntroductionof PneumococcalandMeningococcalVaccines LucianoCesarPontesAzevedo1,2*,CristianaM.Toscano3,AnaLuizaBierrenbach1,3,4 1Research and Education Institute (IEP), Hospital S?′rio-Libane?s, Sa?o Paulo, Brazil, 2Emergency Medicine Department, University of Sa?o Paulo, Brazil, 3Department of CollectiveHealth,FederalUniversityofGoia′s, Goia?nia, Brazil,4SanasEpidemiologyandResearch,Sa?o Paulo,Brazil Abstract Background: Bacterial meningitis is associated with significant burden in Brazil. In 2010, both 10-valent pneumococcal conjugatevaccineandmeningococcalcapsulargroupCconjugatevaccinewereintroducedintotheroutinevaccination schedule. Haemophilus influenzae type b vaccine was previously introduced in 1999. This study presents trends in demographics,microbiologicalcharacteristicsandseasonalitypatternsofbacterialmeningitiscasesinBrazilfrom2000to 2010. Methods and Findings: All meningitis cases confirmed by clinical and/or laboratory criteria notified to the national informationsystemfornotifiablediseasesbetween2000and2010wereanalyzed.Proportionsofbacterialmeningitiscases bydemographiccharacteristics,criteriausedforconfirmationandetiologywerecalculated.Weestimateddiseaseratesper 100,000 population and trends for the study period, with emphasis on H. influenzae, N. meningitidis and S. pneumoniae cases.Inthedecade,341,805casesofmeningitiswerenotifiedinBrazil.Ofthe251,853caseswithdefinedetiology,110,264 (43.8%) were due to bacterial meningitis (excluding tuberculosis). Of these, 34,997 (31.7%) were due to meningococcal disease.The incidence ofbacterial meningitissignificantly decreased from3.1/100,000 population in2000–2002 to 2.14/ 100,000in2009–2010(p,0.01).Amongcasesofmeningococcaldisease,theproportionofthoseassociatedwithgroupC increasedfrom41%in2007to61.7%in2010,whiletheproportionofgroupBdiseaseprogressivelydeclined.Throughout thestudyperiod,anincreasednumberofcasesoccurredduring