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. 2023 Jul 25;11(8):1279.
doi: 10.3390/vaccines11081279.

Trends in Pneumococcal and Bacterial Meningitis in Brazil from 2007 to 2019

Cintia Irene Parellada  1 , Ariane de Jesus Lopes de Abreu  2 , Marina G Birck  2 , Carolina Zampirolli Dias  2 , Thais das Neves Fraga Moreira  1 , Guilherme Silva Julian  2 , Paula de Mendonça Batista  1 , Juan Carlos Orengo  3 , Ana Luiza Bierrenbach  4
Affiliations

Trends in Pneumococcal and Bacterial Meningitis in Brazil from 2007 to 2019

Cintia Irene Parellada et al. Vaccines (Basel). .

Abstract

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 (2007-2009) and post-PCV (2011-2019) 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 ≥50 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.

Keywords: Brazil; epidemiology; invasive pneumococcal disease; meningitis; vaccination.

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Conflict of interest statement

Ana Luiza Bierrenbach is a medical scientific consultant and received honoraria from MSD Brazil; Cintia Irene Parellada, Thais das Neves Fraga Moreira and Paula Mendonça Batista are employees of MSD Brazil, a subsidiary of Merck & Co., Inc., Rahway, NJ, USA, who may own stock and/or hold stock options in Merck & Co., Inc., Rahway, NJ, USA; Juan Carlos Orengo is an employee of Merck Sharp & Dohme LLC, a subsidiary of Merck & Co., Inc., Rahway, NJ, USA, who may own stock and/or hold stock options in Merck & Co., Inc., Rahway, NJ, USA; Ariane de Jesus Lopes de Abreu, Marina Birck, Carolina Zampirolli Dias and Guilherme Silva Julian were employees of IQVIA Brazil, which was contracted by MSD Brazil to conduct the study.

Figures

Figure 1
Figure 1
Annual incidence rates of pneumococcal and bacterial meningitis per 100,000 individuals by year and age group, Brazil, 2007–2019. (A) Pneumococcal meningitis incidence rate by age group. (B) Pneumococcal meningitis incidence rate in age groups ≥ 1 year of age. (C) Bacterial meningitis incidence rate by age group. (D) Bacterial meningitis incidence rate in age groups ≥1 year of age. Infant pneumococcal vaccination coverage (%) is displayed in gray bars starting at the introduction of this vaccine in the Brazilian National Immunization Program in 2010.
Figure 2
Figure 2
Incidence rate change in pneumococcal and bacterial meningitis in the before-after analysis (comparison between pre-PCV10 (2007–2009) and post-PCV10 (2011–2019) periods). The change is given as a percentage. The error bars represent the 95% CI. p < 0.05 marked with an asterisk. Changes were considered statistically significant if the 95% CI did not cross zero. See also Table S4.
Figure 3
Figure 3
Case fatality rate change in pneumococcal and bacterial meningitis in the before-after analysis (comparison between pre-PCV10 (2007–2009) and post-PCV10 (2011–2019) periods). The change is given as a percentage. The error bars represent the 95% CI. p < 0.05 is marked with an asterisk. Changes were considered statistically significant if the 95% CI did not cross zero. See also Table S4.
Figure 4
Figure 4
Joinpoint regression analysis of incidence rates of pneumococcal and bacterial meningitis by age group, 2007–2019, Brazil. (A) Pneumococcal meningitis rates in the pediatric population. (B) Pneumococcal meningitis rates in adults. (C) Bacterial meningitis rates in the pediatric population. (D) Bacterial meningitis rates in adults. * p-value < 0.05.
Figure 5
Figure 5
Joinpoint regression analysis of case fatality rate of pneumococcal and bacterial meningitis by age group, 2007–2019, in Brazil. (A) Pneumococcal meningitis rates in the pediatric population. (B) Pneumococcal meningitis rates in adults. (C) Bacterial meningitis rates in the pediatric population. (D) Bacterial meningitis rates in adults. * p-value <0.05.
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