{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,24]],"date-time":"2026-09-24T08:28:54Z","timestamp":1790238534895,"version":"4.1.0"},"reference-count":47,"publisher":"MDPI AG","issue":"8","license":[{"start":{"date-parts":[[2023,7,25]],"date-time":"2023-07-25T00:00:00Z","timestamp":1690243200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Merck Sharp &amp; Dohme LLC"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Vaccines"],"abstract":"<jats:p>The pneumococcal conjugate vaccination (PCV) was introduced into the Brazilian Childhood National Immunization Program in 2010; however, universal pneumococcal vaccination for older adults has not been implemented yet. Our aim is to evaluate the trends in pneumococcal meningitis incidence and case fatality rate (CFR) across all age groups from 2007 to 2019 using data from the National Surveillance System. The pre-PCV (2007\u20132009) and post-PCV (2011\u20132019) periods were compared; changes in incidence and CFR were assessed by joinpoint regression. Additional analyses of bacterial meningitis were performed to compare the patterns and trends. Over the 13-year period, 81,203 and 13,837 cases were classified as bacterial and pneumococcal meningitis, respectively. S. pneumoniae was the main etiological agent of bacterial meningitis in adults aged \u226550 years and the most lethal in all age groups. In the post-PCV period, a 56.5% reduction in the average incidence was seen in pneumococcal meningitis in the pediatric population. In contrast, there was an increasing trend among adults. The CFR for pneumococcal and bacterial meningitis remained stable in most age groups during the study period. These findings highlight the value of expanding pneumococcal vaccination policies, including vaccines that provide better indirect protection from children to adults and broadening vaccination to older adults.<\/jats:p>","DOI":"10.3390\/vaccines11081279","type":"journal-article","created":{"date-parts":[[2023,7,26]],"date-time":"2023-07-26T00:45:02Z","timestamp":1690332302000},"page":"1279","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":13,"title":["Trends in Pneumococcal and Bacterial Meningitis in Brazil from 2007 to 2019"],"prefix":"10.3390","volume":"11","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8536-9274","authenticated-orcid":false,"given":"Cintia Irene","family":"Parellada","sequence":"first","affiliation":[{"name":"MSD Brazil, S\u00e3o Paulo 04583-110, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5599-0991","authenticated-orcid":false,"given":"Ariane de Jesus Lopes de","family":"Abreu","sequence":"additional","affiliation":[{"name":"IQVIA Brazil, S\u00e3o Paulo 04719-002, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marina G.","family":"Birck","sequence":"additional","affiliation":[{"name":"IQVIA Brazil, S\u00e3o Paulo 04719-002, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carolina Zampirolli","family":"Dias","sequence":"additional","affiliation":[{"name":"IQVIA Brazil, S\u00e3o Paulo 04719-002, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thais das Neves Fraga","family":"Moreira","sequence":"additional","affiliation":[{"name":"MSD Brazil, S\u00e3o Paulo 04583-110, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Guilherme Silva","family":"Julian","sequence":"additional","affiliation":[{"name":"IQVIA Brazil, S\u00e3o Paulo 04719-002, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6860-1740","authenticated-orcid":false,"given":"Paula de Mendon\u00e7a","family":"Batista","sequence":"additional","affiliation":[{"name":"MSD Brazil, S\u00e3o Paulo 04583-110, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3998-4743","authenticated-orcid":false,"given":"Juan Carlos","family":"Orengo","sequence":"additional","affiliation":[{"name":"MSD (IA) LLC, Guaynabo 00966, Puerto Rico"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6837-0636","authenticated-orcid":false,"given":"Ana Luiza","family":"Bierrenbach","sequence":"additional","affiliation":[{"name":"Instituto de Ensino e Pesquisa, Hospital S\u00edrio-Liban\u00eas, S\u00e3o Paulo 01308-050, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2023,7,25]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"78","DOI":"10.1097\/QCO.0000000000000417","article-title":"Epidemiology of community-acquired bacterial meningitis","volume":"31","author":"Brouwer","year":"2018","journal-title":"Curr. Opin. Infect. Dis."},{"key":"ref_2","doi-asserted-by":"crossref","unstructured":"Schiess, N., Groce, N.E., and Dua, T. (2021). The Impact and Burden of Neurological Sequelae Following Bacterial Meningitis: A Narrative Review. Microorganisms, 9.","DOI":"10.3390\/microorganisms9050900"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"219","DOI":"10.1016\/j.ijid.2021.04.070","article-title":"World Meningitis Day and the World Health Organization\u2032s roadmap to defeat bacterial meningitis in the COVID-19 pandemic era","volume":"107","author":"Pinto","year":"2021","journal-title":"Int. J. Infect. Dis."},{"key":"ref_4","unstructured":"GBD 2016 Meningitis Collaborators (2018). Global, regional, and national burden of meningitis, 1990\u20132016: A systematic analysis for the Global Burden of Disease Study 2016. Lancet Neurol., 17, 1061\u20131082."},{"key":"ref_5","unstructured":"GBD 2019 Antimicrobial Resistance Collaborators (2022). Global mortality associated with 33 bacterial pathogens in 2019: A systematic analysis for the Global Burden of Disease Study 2019. Lancet, 400, 2221\u20132248."},{"key":"ref_6","unstructured":"Brasil. Minist\u00e9rio da Sa\u00fade (2023, June 25). Notifica\u00e7\u00e3o Compuls\u00f3ria, Available online: https:\/\/www.gov.br\/saude\/pt-br\/composicao\/svsa\/notificacao-compulsoria."},{"key":"ref_7","unstructured":"Brasil. Minist\u00e9rio da Sa\u00fade (2019). Secretaria de Vigil\u00e2ncia em Sa\u00fade, Guia de Vigil\u00e2ncia em Sa\u00fade: Volume \u00danico."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"285","DOI":"10.1080\/21645515.2015.1117713","article-title":"Evaluating the impact of PCV-10 on invasive pneumococcal disease in Brazil: A time-series analysis","volume":"12","author":"Andrade","year":"2016","journal-title":"Hum. Vaccin. Immunother."},{"key":"ref_9","doi-asserted-by":"crossref","unstructured":"Azevedo, L.C., Toscano, C.M., and Bierrenbach, A.L. (2013). Bacterial Meningitis in Brazil: Baseline Epidemiologic Assessment of the Decade Prior to the Introduction of Pneumococcal and Meningococcal Vaccines. PLoS ONE, 8.","DOI":"10.1371\/journal.pone.0064524"},{"key":"ref_10","unstructured":"DATASUS (2023, June 25). Informa\u00e7\u00f5es de Sa\u00fade: Immuniza\u00e7\u00f5es-Cobertura-Brasil, Available online: http:\/\/tabnet.datasus.gov.br\/cgi\/tabcgi.exe?pni\/cnv\/cpniuf.def."},{"key":"ref_11","unstructured":"Brasil. Minist\u00e9rio da Sa\u00fade (2023, June 23). Manual dos Centros de Refer\u00eancia para Imunobiol\u00f3gicos Especiais, Available online: https:\/\/bvsms.saude.gov.br\/bvs\/publicacoes\/manual_centros_imunobiologicos_especiais_5ed.pdf."},{"key":"ref_12","unstructured":"Brasil. Minist\u00e9rio da Sa\u00fade (2023, June 23). Informe T\u00e9cnico Para Implanta\u00e7\u00e3o da Vacina Pneumoc\u00f3cica Conjugada 13-Valente em Pacientes de Risco \u2265 de 5 Anos de Idade. Available online: https:\/\/sbim.org.br\/images\/files\/notas-tecnicas\/informe-tecnico-pneumo13-pacientesderisco-menoresde5anos.pdf."},{"key":"ref_13","unstructured":"Brasil. Minist\u00e9rio da Sa\u00fade (2023, June 23). Calend\u00e1rio Nacional de Vacina\u00e7\u00e3o 2022-Adulto e Idoso, Available online: https:\/\/www.gov.br\/saude\/pt-br\/assuntos\/saude-de-a-a-z\/c\/calendario-nacional-de-vacinacao\/calendario-vacinal-2022\/calendario-nacional-de-vacinacao-2022-adulto-e-idoso\/view."},{"key":"ref_14","first-page":"S1","article-title":"Budget Impact Analysis of Implementing a 23-Valent Pneumococcal Polysaccharide Vaccine in the Brazilian National Immunization Program for Adults 60 Year Old","volume":"25","author":"Moreira","year":"2022","journal-title":"Value Health"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"1962","DOI":"10.1016\/S0140-6736(10)62225-8","article-title":"Serotype replacement in disease after pneumococcal vaccination","volume":"378","author":"Weinberger","year":"2011","journal-title":"Lancet"},{"key":"ref_16","doi-asserted-by":"crossref","unstructured":"Almeida, S.C.G., Lo, S.W., Hawkins, P.A., Gladstone, R.A., Cassiolato, A.P., Klugman, K.P., Breiman, R.F., Bentley, S.D., McGee, L., and Brandileone, M.C. (2021). Genomic surveillance of invasive Streptococcus pneumoniae isolates in the period pre-PCV10 and post-PCV10 introduction in Brazil. Microb. Genom., 7.","DOI":"10.1099\/mgen.0.000635"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"e213","DOI":"10.1016\/S1473-3099(18)30660-1","article-title":"Making sense of differences in pneumococcal serotype replacement","volume":"19","author":"Lewnard","year":"2019","journal-title":"Lancet Infect. Dis."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"3207","DOI":"10.1016\/j.vaccine.2021.02.063","article-title":"Dynamics of antimicrobial resistance of Streptococcus pneumoniae following PCV10 introduction in Brazil: Nationwide surveillance from 2007 to 2019","volume":"39","author":"Brandileone","year":"2021","journal-title":"Vaccine"},{"key":"ref_19","doi-asserted-by":"crossref","unstructured":"Pan American Health Organization (2023, June 23). Surveillance of Bacterial Pneumonia and Meningitis in Children Aged Under 5 Years: Field Guide. Available online: https:\/\/doi.org\/10.37774\/9789275121894.","DOI":"10.37774\/9789275121894"},{"key":"ref_20","unstructured":"Brasil. Minist\u00e9rio da Sa\u00fade (2023, June 20). Doen\u00e7as e Agravos de Notifica\u00e7\u00e3o\u20132007 em Diante (SINAN): Meningite, Available online: https:\/\/datasus.saude.gov.br\/informacoes-de-saude-tabnet\/."},{"key":"ref_21","unstructured":"(2023, March 23). Instituto Brasileiro de Geografia e Estat\u00edstica, Available online: https:\/\/www.ibge.gov.br\/estatisticas\/sociais\/populacao\/9109-projecao-da-populacao.html?=&t=resultados."},{"key":"ref_22","unstructured":"Brasil. Minist\u00e9rio da Sa\u00fade (2023, June 25). Pol\u00edtica Nacional do Idoso, Available online: https:\/\/bvsms.saude.gov.br\/bvs\/saudelegis\/gm\/2006\/prt2528_19_10_2006.html."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"e02515","DOI":"10.1016\/j.heliyon.2019.e02515","article-title":"The utility of joinpoint regression for estimating population parameters given changes in population structure","volume":"5","author":"Gillis","year":"2019","journal-title":"Heliyon"},{"key":"ref_24","doi-asserted-by":"crossref","unstructured":"Garcia Quesada, M., Yang, Y., Bennett, J.C., Hayford, K., Zeger, S.L., Feikin, D.R., Peterson, M.E., Cohen, A.L., Almeida, S.C.G., and Ampofo, K. (2021). Serotype Distribution of Remaining Pneumococcal Meningitis in the Mature PCV10\/13 Period: Findings from the PSERENADE Project. Microorganisms, 9.","DOI":"10.3390\/microorganisms9040738"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"335","DOI":"10.1002\/(SICI)1097-0258(20000215)19:3<335::AID-SIM336>3.0.CO;2-Z","article-title":"Permutation tests for joinpoint regression with applications to cancer rates","volume":"19","author":"Kim","year":"2000","journal-title":"Stat. Med."},{"key":"ref_26","doi-asserted-by":"crossref","unstructured":"Oordt-Speets, A.M., Bolijn, R., van Hoorn, R.C., Bhavsar, A., and Kyaw, M.H. (2018). Global etiology of bacterial meningitis: A systematic review and meta-analysis. PLoS ONE, 13.","DOI":"10.1371\/journal.pone.0198772"},{"key":"ref_27","unstructured":"Organizaci\u00f3n Panamericana de la Salud (2023, June 23). Informe Regional de SIREVA II. Available online: https:\/\/iris.paho.org\/bitstream\/handle\/10665.2\/54567\/9789275324035_spa.pdf."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"306","DOI":"10.1093\/cid\/ciaa614","article-title":"Declines in Pneumonia Mortality Following the Introduction of Pneumococcal Conjugate Vaccines in Latin American and Caribbean Countries","volume":"73","author":"Shioda","year":"2021","journal-title":"Clin. Infect. Dis."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"541","DOI":"10.1093\/cid\/cix850","article-title":"Impact of Pneumococcal Vaccination on Pneumonia Hospitalizations and Related Costs in Ontario: A Population-Based Ecological Study","volume":"66","author":"Luca","year":"2018","journal-title":"Clin. Infect. Dis."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"32","DOI":"10.1016\/j.ijid.2021.02.031","article-title":"Burden of invasive pneumococcal disease (IPD) over a 10-year period in Bogot\u00e1, Colombia","volume":"105","author":"Bastidas","year":"2021","journal-title":"Int. J. Infect. Dis."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"7107","DOI":"10.1016\/j.vaccine.2017.10.090","article-title":"Impact of infant pneumococcal conjugate vaccination on community acquired pneumonia hospitalization in all ages in the Netherlands","volume":"35","author":"Man","year":"2017","journal-title":"Vaccine"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"1813","DOI":"10.1093\/cid\/cix638","article-title":"Impact of Pneumococcal Conjugate Vaccines on Pneumonia Hospitalizations in High- and Low-Income Subpopulations in Brazil","volume":"65","author":"Warren","year":"2017","journal-title":"Clin. Infect. Dis."},{"key":"ref_33","unstructured":"Secretaria de Estado da Sa\u00fade (2023, June 23). Coordenadoria de Controle de Doen\u00e7as Instituto Adolfo Lutz. Informa\u00e7\u00e3o da Vigil\u00e2ncia das Pneumonias e Meningites Bacterianas, Available online: http:\/\/www.ial.sp.gov.br\/resources\/insituto-adolfo-lutz\/publicacoes\/sireva_2022.pdf."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"14","DOI":"10.1186\/s12963-020-00206-3","article-title":"The burden of disease among Brazilian older adults and the challenge for health policies: Results of the Global Burden of Disease Study 2017","volume":"18","author":"Champs","year":"2020","journal-title":"Popul. Health Metr."},{"key":"ref_35","unstructured":"GBD 2016 Lower Respiratory Infections Collaborators (2018). Estimates of the global, regional, and national morbidity, mortality, and aetiologies of lower respiratory infections in 195 countries, 1990\u20132016: A systematic analysis for the Global Burden of Disease Study 2016. Lancet Infect. Dis., 18, 1191\u20131210."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"233","DOI":"10.1016\/S1473-3099(22)00526-6","article-title":"Safety, tolerability, and immunogenicity of a 21-valent pneumococcal conjugate vaccine, V116, in healthy adults: Phase 1\/2, randomised, double-blind, active comparator-controlled, multicentre, US-based trial","volume":"23","author":"Platt","year":"2023","journal-title":"Lancet Infect. Dis."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"S46","DOI":"10.1016\/j.jped.2022.11.003","article-title":"Impact of PCV10 on pediatric pneumococcal disease burden in Brazil: Time for new recommendations?","volume":"99","author":"Jarovsky","year":"2023","journal-title":"J. Pediatr."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"e175","DOI":"10.1017\/S0950268819000657","article-title":"Decreasing case fatality rate following invasive pneumococcal disease, North East England, 2006\u20132016","volume":"147","author":"Houseman","year":"2019","journal-title":"Epidemiol. Infect."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"24","DOI":"10.31365\/issn.2595-1769.v18i2p24-27","article-title":"Doen\u00e7a meningoc\u00f3cica: Situa\u00e7\u00e3o epidemiol\u00f3gica atual no Brasil","volume":"18","author":"Guedes","year":"2018","journal-title":"Rev. Pediatr. SOPERJ"},{"key":"ref_40","unstructured":"Brasil. Minist\u00e9rio da Sa\u00fade (2023, June 23). Orienta\u00e7\u00f5es T\u00e9cnico-Operacionais Para a Vacina\u00e7\u00e3o dos Adolescentes Com a Vacina Meningoc\u00f3cica ACWY (Conjugada), Available online: https:\/\/saude.es.gov.br\/Media\/sesa\/PEI\/Informe%20T%C3%A9cnico%20Informe_ACWY___Adolescente_02_03_2020.pdf."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"464","DOI":"10.1016\/S2213-2600(14)70060-8","article-title":"Effectiveness of ten-valent pneumococcal conjugate vaccine against invasive pneumococcal disease in Brazil: A matched case-control study","volume":"2","author":"Domingues","year":"2014","journal-title":"Lancet Respir. Med."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"672","DOI":"10.1590\/0004-282X20130148","article-title":"Evolution of bacterial meningitis diagnosis in S\u00e3o Paulo State-Brazil and future challenges","volume":"71","author":"Salgado","year":"2013","journal-title":"Arq. Neuropsiquiatr."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"e360","DOI":"10.1016\/S2589-7500(21)00077-7","article-title":"Changes in the incidence of invasive disease due to Streptococcus pneumoniae, Haemophilus influenzae, and Neisseria meningitidis during the COVID-19 pandemic in 26 countries and territories in the Invasive Respiratory Infection Surveillance Initiative: A prospective analysis of surveillance data","volume":"3","author":"Brueggemann","year":"2021","journal-title":"Lancet Digit. Health"},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"e2218959","DOI":"10.1001\/jamanetworkopen.2022.18959","article-title":"Association of Nonpharmaceutical Interventions During the COVID-19 Pandemic With Invasive Pneumococcal Disease, Pneumococcal Carriage, and Respiratory Viral Infections Among Children in France","volume":"5","author":"Rybak","year":"2022","journal-title":"JAMA Netw. Open"},{"key":"ref_45","first-page":"100222","article-title":"Brazil\u2032s health system functionality amidst of the COVID-19 pandemic: An analysis of resilience","volume":"10","author":"Bigoni","year":"2022","journal-title":"Lancet Reg. Health Am."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"1384","DOI":"10.1093\/cid\/civ023","article-title":"Seasonality of both bacteremic and nonbacteremic pneumonia coincides with viral lower respiratory tract infections in early childhood, in contrast to nonpneumonia invasive pneumococcal disease, in the pre-pneumococcal conjugate vaccine era","volume":"60","author":"Greenberg","year":"2015","journal-title":"Clin. Infect. Dis."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"e1154","DOI":"10.1093\/cid\/ciab1014","article-title":"Decline in Pneumococcal Disease in Young Children During the Coronavirus Disease 2019 (COVID-19) Pandemic in Israel Associated With Suppression of Seasonal Respiratory Viruses, Despite Persistent Pneumococcal Carriage: A Prospective Cohort Study","volume":"75","author":"Danino","year":"2022","journal-title":"Clin. Infect. Dis."}],"container-title":["Vaccines"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2076-393X\/11\/8\/1279\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T20:18:27Z","timestamp":1760127507000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2076-393X\/11\/8\/1279"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,7,25]]},"references-count":47,"journal-issue":{"issue":"8","published-online":{"date-parts":[[2023,8]]}},"alternative-id":["vaccines11081279"],"URL":"https:\/\/doi.org\/10.3390\/vaccines11081279","relation":{},"ISSN":["2076-393X"],"issn-type":[{"value":"2076-393X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,7,25]]}}}