{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,24]],"date-time":"2026-10-24T01:42:54Z","timestamp":1792806174930,"version":"4.5.0"},"reference-count":39,"publisher":"Oxford University Press (OUP)","issue":"5","license":[{"start":{"date-parts":[[2020,11,28]],"date-time":"2020-11-28T00:00:00Z","timestamp":1606521600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100001826","name":"Netherlands Organisation for Health Research and Development","doi-asserted-by":"publisher","award":["917.17.308"],"award-info":[{"award-number":["917.17.308"]}],"id":[{"id":"10.13039\/501100001826","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100003180","name":"Academic Medical Center","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100003180","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2021,9,7]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>The epidemiology of acute bacterial meningitis has changed substantially since the introduction of conjugate vaccines.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>We analyzed nationwide surveillance data of all cerebrospinal fluid isolates received by the Netherlands Reference Laboratory for Bacterial Meningitis in the Netherlands. We assessed the impact of conjugate vaccines on incidence (defined as episodes per 100 000 population per year) and for different age groups using incidence rate ratios (IRRs), comparing incidence before and after conjugate vaccine introduction.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>We analyzed 17 393 episodes, of which 5960 episodes (34%) occurred in preschool children (aged 3 months to 4 years). Overall, bacterial meningitis incidence decreased from 6.37 to 1.58 between 1989\u20131993 and 2014\u20132019 (IRR, 0.25 [95% confidence interval {CI}, .23\u2013.26]; P\u2005&amp;lt;\u2005.001). This decrease was most pronounced in preschool and school-aged children (5\u201315 years); IRR, 0.10 [95% CI, .09\u2013.12] and 0.08 [95% CI, .06\u2013.10]; both P\u2005&amp;lt;\u2005.001. The incidence was highest in young infants (&amp;lt;90 days) due to a high incidence of group B Streptococcus and Escherichia coli meningitis (42.48 and 19.49, respectively). Conjugate vaccines effectively reduced the incidence of Haemophilus influenzae type b, Neisseria meningitidis serogroup C, and 10 pneumococcal serotypes (IRRs, .02\u2013.04; P\u2005&amp;lt;\u2005.001). At the end of the observed period, Streptococcus pneumoniae caused the majority of meningitis cases (829\/1616 [51%]), mostly in older adults (aged 45\u201364 years) and elderly adults (aged \u226565 years; incidence of 1.06 and 1.54, respectively).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>Conjugate vaccines reduced the burden of bacterial meningitis, especially in children. The efforts for new measures to prevent bacterial meningitis should be focused on neonates and elderly, as the residual rate of disease is still high in these age groups.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/cid\/ciaa1774","type":"journal-article","created":{"date-parts":[[2020,11,22]],"date-time":"2020-11-22T20:07:13Z","timestamp":1606075633000},"page":"e1099-e1107","source":"Crossref","is-referenced-by-count":81,"title":["Changing Epidemiology of Bacterial Meningitis Since Introduction of Conjugate Vaccines: 3 Decades of National Meningitis Surveillance in The Netherlands"],"prefix":"10.1093","volume":"73","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1451-3010","authenticated-orcid":false,"given":"Diederik L H","family":"Koelman","sequence":"first","affiliation":[{"name":"Department of Neurology, Amsterdam Neuroscience, Amsterdam University Medical Centers, Department of Paediatrics, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6238-7974","authenticated-orcid":false,"given":"Merel N","family":"van Kassel","sequence":"additional","affiliation":[{"name":"Department of Neurology, Amsterdam Neuroscience, Amsterdam University Medical Centers, Department of Paediatrics, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Merijn W","family":"Bijlsma","sequence":"additional","affiliation":[{"name":"Department of Neurology, Amsterdam Neuroscience, Amsterdam University Medical Centers, Department of Paediatrics, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands"},{"name":"Department of Paediatrics, Amsterdam Infection and Immunity, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matthijs C","family":"Brouwer","sequence":"additional","affiliation":[{"name":"Department of Neurology, Amsterdam Neuroscience, Amsterdam University Medical Centers, Department of Paediatrics, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4571-044X","authenticated-orcid":false,"given":"Diederik","family":"van de Beek","sequence":"additional","affiliation":[{"name":"Department of Neurology, Amsterdam Neuroscience, Amsterdam University Medical Centers, Department of Paediatrics, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Arie","family":"van der Ende","sequence":"additional","affiliation":[{"name":"Department of Medical Microbiology and Infection Prevention, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands"},{"name":"Netherlands Reference Laboratory for Bacterial Meningitis, Amsterdam University Medical Centers, National Institute for Public Health and the Environment, Amsterdam, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2020,11,28]]},"reference":[{"key":"2021090721130072500_CIT0001","doi-asserted-by":"crossref","first-page":"1693","DOI":"10.1016\/S0140-6736(12)61186-6","article-title":"Advances in treatment of bacterial meningitis","volume":"380","author":"van de Beek","year":"2012","journal-title":"Lancet"},{"key":"2021090721130072500_CIT0002","doi-asserted-by":"crossref","first-page":"16074","DOI":"10.1038\/nrdp.2016.74","article-title":"Community-acquired bacterial meningitis","volume":"2","author":"van de Beek","year":"2016","journal-title":"Nat Rev Dis Primers"},{"key":"2021090721130072500_CIT0003","doi-asserted-by":"crossref","first-page":"1703","DOI":"10.1016\/S0140-6736(12)61187-8","article-title":"Effect of vaccines on bacterial meningitis worldwide","volume":"380","author":"McIntyre","year":"2012","journal-title":"Lancet"},{"key":"2021090721130072500_CIT0004","doi-asserted-by":"crossref","first-page":"970","DOI":"10.1056\/NEJM199710023371404","article-title":"Bacterial meningitis in the United States in 1995. Active Surveillance Team","volume":"337","author":"Schuchat","year":"1997","journal-title":"N Engl J Med"},{"key":"2021090721130072500_CIT0005","doi-asserted-by":"crossref","first-page":"2016","DOI":"10.1056\/NEJMoa1005384","article-title":"Bacterial meningitis in the United States, 1998\u20132007","volume":"364","author":"Thigpen","year":"2011","journal-title":"N Engl J Med"},{"key":"2021090721130072500_CIT0006","doi-asserted-by":"crossref","first-page":"339","DOI":"10.1016\/S1473-3099(15)00430-2","article-title":"Community-acquired bacterial meningitis in adults in the Netherlands, 2006-14: a prospective cohort study","volume":"16","author":"Bijlsma","year":"2016","journal-title":"Lancet Infect Dis"},{"key":"2021090721130072500_CIT0007","volume-title":"Bacterial meningitis in the Netherlands: annual report 2016","author":"Netherlands Reference Laboratory for Bacterial Meningitis (AMC\/RIVM)","year":"2017"},{"key":"2021090721130072500_CIT0008","doi-asserted-by":"crossref","first-page":"805","DOI":"10.1016\/S1473-3099(14)70806-0","article-title":"Epidemiology of invasive meningococcal disease in the Netherlands, 1960\u20132012: an analysis of national surveillance data","volume":"14","author":"Bijlsma","year":"2014","journal-title":"Lancet Infect Dis"},{"key":"2021090721130072500_CIT0009","doi-asserted-by":"crossref","first-page":"749","DOI":"10.1016\/S1473-3099(18)30166-X","article-title":"Effectiveness of the DTPa-HBV-IPV\/Hib vaccine against invasive Haemophilus influenzae type b disease in the Netherlands (2003-16): a case-control study","volume":"18","author":"Monge","year":"2018","journal-title":"Lancet Infect Dis"},{"key":"2021090721130072500_CIT0010","doi-asserted-by":"crossref","first-page":"e473","DOI":"10.1016\/S2468-2667(17)30157-3","article-title":"Temporal associations between national outbreaks of meningococcal serogroup W and C disease in the Netherlands and England: an observational cohort study","volume":"2","author":"Knol","year":"2017","journal-title":"Lancet Public Health"},{"key":"2021090721130072500_CIT0011","doi-asserted-by":"crossref","first-page":"1077","DOI":"10.1016\/j.vaccine.2015.12.066","article-title":"Invasive pneumococcal disease: clinical outcomes and patient characteristics 2\u20136 years after introduction of 7-valent pneumococcal conjugate vaccine compared to the pre-vaccine period, the Netherlands","volume":"34","author":"Wagenvoort","year":"2016","journal-title":"Vaccine"},{"key":"2021090721130072500_CIT0012","author":"Statistics Netherlands"},{"key":"2021090721130072500_CIT0013","first-page":"1132","article-title":"The first effect of the national vaccination campaign against meningococcal-C disease: a rapid and sharp decrease in the number of patients [in Dutch]","volume":"147","author":"de Greeff","year":"2003","journal-title":"Ned Tijdschr Geneeskd"},{"key":"2021090721130072500_CIT0014","author":"National Institute for Public Health and the Environment.","year":"2019"},{"key":"2021090721130072500_CIT0015","author":"Aragon","year":"2020"},{"key":"2021090721130072500_CIT0016","doi-asserted-by":"crossref","first-page":"467","DOI":"10.1128\/CMR.00070-09","article-title":"Epidemiology, diagnosis, and antimicrobial treatment of acute bacterial meningitis","volume":"23","author":"Brouwer","year":"2010","journal-title":"Clin Microbiol Rev"},{"key":"2021090721130072500_CIT0017","doi-asserted-by":"crossref","first-page":"439","DOI":"10.1111\/j.1469-0691.2006.01670.x","article-title":"Community-acquired Haemophilus influenzae meningitis in adults","volume":"13","author":"Brouwer","year":"2007","journal-title":"Clin Microbiol Infect"},{"key":"2021090721130072500_CIT0018","doi-asserted-by":"crossref","first-page":"524","DOI":"10.1128\/JCM.42.2.524-529.2004","article-title":"Analysis of invasive Haemophilus influenzae infections after extensive vaccination against H. influenzae type b","volume":"42","author":"Campos","year":"2004","journal-title":"J Clin Microbiol"},{"key":"2021090721130072500_CIT0019","doi-asserted-by":"crossref","first-page":"2256","DOI":"10.1093\/cid\/ciz649","article-title":"Community-acquired bacterial meningitis in adults with cerebrospinal fluid leakage","volume":"70","author":"Ter Horst","year":"2020","journal-title":"Clin Infect Dis"},{"key":"2021090721130072500_CIT0020","doi-asserted-by":"crossref","first-page":"515","DOI":"10.1093\/clinids\/14.2.515","article-title":"Meningococcal meningitis in sub-Saharan Africa: a model for the epidemic process","volume":"14","author":"Moore","year":"1992","journal-title":"Clin Infect Dis"},{"key":"2021090721130072500_CIT0021","doi-asserted-by":"crossref","first-page":"S225","DOI":"10.1093\/infdis\/jiz355","article-title":"Meningococcal meningitis outbreaks in the African meningitis belt after meningococcal serogroup a conjugate vaccine introduction, 2011\u20132017","volume":"220","author":"Fernandez","year":"2019","journal-title":"J Infect Dis"},{"key":"2021090721130072500_CIT0022","doi-asserted-by":"crossref","first-page":"341","DOI":"10.1016\/S0035-9203(99)90106-2","article-title":"Manson lecture. Meningococcal meningitis in Africa","volume":"93","author":"Greenwood","year":"1999","journal-title":"Trans R Soc Trop Med Hyg"},{"key":"2021090721130072500_CIT0023","doi-asserted-by":"crossref","first-page":"313","DOI":"10.1080\/14760584.2017.1258308","article-title":"The Global Meningococcal Initiative: global epidemiology, the impact of vaccines on meningococcal disease and the importance of herd protection","volume":"16","author":"Borrow","year":"2017","journal-title":"Expert Rev Vaccines"},{"key":"2021090721130072500_CIT0024","doi-asserted-by":"crossref","first-page":"B26","DOI":"10.1016\/j.vaccine.2011.12.032","article-title":"The changing and dynamic epidemiology of meningococcal disease","volume":"30(Suppl 2)","author":"Halperin","year":"2012","journal-title":"Vaccine"},{"key":"2021090721130072500_CIT0025","doi-asserted-by":"crossref","first-page":"e65043","DOI":"10.1371\/journal.pone.0065043","article-title":"An analysis of the sequence variability of meningococcal fHbp, NadA and NHBA over a 50-year period in the Netherlands","volume":"8","author":"Bambini","year":"2013","journal-title":"PLoS One"},{"key":"2021090721130072500_CIT0026","first-page":"mgen000422","article-title":"Diversification in immunogenicity genes caused by selective pressures in invasive meningococci","volume":"6","author":"Kremer","year":"2020","journal-title":"Microb Genom"},{"key":"2021090721130072500_CIT0027","doi-asserted-by":"crossref","first-page":"829","DOI":"10.1097\/01.inf.0000136868.91756.80","article-title":"Community-wide vaccination with the heptavalent pneumococcal conjugate significantly alters the microbiology of acute otitis media","volume":"23","author":"Block","year":"2004","journal-title":"Pediatr Infect Dis J"},{"key":"2021090721130072500_CIT0028","doi-asserted-by":"crossref","first-page":"e39730","DOI":"10.1371\/journal.pone.0039730","article-title":"Long-term effects of pneumococcal conjugate vaccine on nasopharyngeal carriage of S. pneumoniae, S. aureus, H. influenzae and M. catarrhalis","volume":"7","author":"Spijkerman","year":"2012","journal-title":"PLoS One"},{"key":"2021090721130072500_CIT0029","doi-asserted-by":"crossref","first-page":"766","DOI":"10.1128\/CVI.05675-11","article-title":"Risk of invasive Haemophilus influenzae type b (Hib) disease in adults with secondary immunodeficiency in the post-Hib vaccine era","volume":"19","author":"Nix","year":"2012","journal-title":"Clin Vaccine Immunol"},{"key":"2021090721130072500_CIT0030","doi-asserted-by":"crossref","first-page":"113","DOI":"10.1186\/s12916-017-0882-9","article-title":"Assessing the efficiency of catch-up campaigns for the introduction of pneumococcal conjugate vaccine: a modelling study based on data from PCV10 introduction in Kilifi, Kenya","volume":"15","author":"Flasche","year":"2017","journal-title":"BMC Med"},{"key":"2021090721130072500_CIT0031","volume-title":"Guideline of national coordination of infectious disease control, part of the Netherlands National Institute for Public Health and the Environment\u2014pneumococcal vaccine","author":"National Institute for Public Health and the Environment.","year":"2020"},{"key":"2021090721130072500_CIT0032","author":"Netherlands Association for Obstetrics and Gynecology","year":"1998"},{"key":"2021090721130072500_CIT0033","doi-asserted-by":"crossref","first-page":"D7","DOI":"10.1016\/j.vaccine.2013.01.009","article-title":"An overview of global GBS epidemiology","volume":"31(Suppl 4)","author":"Le Doare","year":"2013","journal-title":"Vaccine"},{"key":"2021090721130072500_CIT0034","first-page":"CD007467","article-title":"Intrapartum antibiotics for known maternal group B streptococcal colonization","volume":"1","author":"Ohlsson","year":"2014","journal-title":"Cochrane Database Syst Rev"},{"key":"2021090721130072500_CIT0035","doi-asserted-by":"crossref","first-page":"753","DOI":"10.1056\/NEJM197604012941404","article-title":"Correlation of maternal antibody deficiency with susceptibility to neonatal group B streptococcal infection","volume":"294","author":"Baker","year":"1976","journal-title":"N Engl J Med"},{"key":"2021090721130072500_CIT0036","doi-asserted-by":"crossref","first-page":"76","DOI":"10.1177\/2051013615579869","article-title":"Group B Streptococcus vaccine: state of the art","volume":"3","author":"Nuccitelli","year":"2015","journal-title":"Ther Adv Vaccines"},{"key":"2021090721130072500_CIT0037","doi-asserted-by":"crossref","first-page":"919","DOI":"10.1016\/j.tim.2017.05.013","article-title":"Perinatal group B streptococcal infections: virulence factors, immunity, and prevention strategies","volume":"25","author":"Vornhagen","year":"2017","journal-title":"Trends Microbiol"},{"key":"2021090721130072500_CIT0038","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/j.jinf.2016.09.007","article-title":"Adults with suspected central nervous system infection: a prospective study of diagnostic accuracy","volume":"74","author":"Khatib","year":"2017","journal-title":"J Infect"},{"key":"2021090721130072500_CIT0039","doi-asserted-by":"crossref","first-page":"860","DOI":"10.1186\/s12879-019-4513-2","article-title":"Evaluation of the surveillance system for invasive meningococcal disease (IMD) in the Netherlands, 2004\u20132016","volume":"19","author":"Brandwagt","year":"2019","journal-title":"BMC Infect Dis"}],"container-title":["Clinical Infectious Diseases"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/academic.oup.com\/cid\/advance-article-pdf\/doi\/10.1093\/cid\/ciaa1774\/38132936\/ciaa1774.pdf","content-type":"application\/pdf","content-version":"am","intended-application":"syndication"},{"URL":"http:\/\/academic.oup.com\/cid\/article-pdf\/73\/5\/e1099\/40326549\/ciaa1774.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"http:\/\/academic.oup.com\/cid\/article-pdf\/73\/5\/e1099\/40326549\/ciaa1774.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,9,7]],"date-time":"2021-09-07T21:13:29Z","timestamp":1631049209000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/cid\/article\/73\/5\/e1099\/6008501"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,11,28]]},"references-count":39,"journal-issue":{"issue":"5","published-online":{"date-parts":[[2020,11,28]]},"published-print":{"date-parts":[[2021,9,7]]}},"URL":"https:\/\/doi.org\/10.1093\/cid\/ciaa1774","relation":{},"ISSN":["1058-4838","1537-6591"],"issn-type":[{"value":"1058-4838","type":"print"},{"value":"1537-6591","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2021,9,1]]},"published":{"date-parts":[[2020,11,28]]}}}