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. 2025 May 12:47:101120.
doi: 10.1016/j.lana.2025.101120. eCollection 2025 Jul.

The epidemiology of bacterial meningitis in the United States during 2008-2023: an analysis of active, laboratory, population-based, multistate surveillance data

Namrata Prasad  1   2 , Miwako Kobayashi  1 , Jennifer P Collins  1 , Amy B Rubis  1 , Gordana Derado  1 , Miranda J Delahoy  3 , Daniel C Payne  3 , Lesley McGee  1 , Sopio Chochua  1 , Henju Marjuki  1 , Lucy A McNamara  1 , LeAnne M Fox  1 , Arthur Reingold  4   5 , Megan Barnes  6 , Susan Petit  7 , Monica M Farley  8 , Lee H Harrison  9 , Ruth Lynfield  10 , Jessica Houston  11 , Bridget J Anderson  12 , Ann Thomas  13 , Keipp H Talbot  14 , William Schaffner  14 , Adam L Cohen  1 , Stephanie J Schrag  1 , Melissa Arvay  1
Affiliations

The epidemiology of bacterial meningitis in the United States during 2008-2023: an analysis of active, laboratory, population-based, multistate surveillance data

Namrata Prasad et al. Lancet Reg Health Am. .

Abstract

Background: Bacterial meningitis is a severe syndrome with dynamic epidemiology, but assessments of current trends are limited. We aimed to describe changing epidemiologic patterns among common bacterial causes of meningitis in the United States.

Methods: We analyzed data on bacterial meningitis cases caused by Streptococcus pneumoniae, group B Streptococcus (GBS), Haemophilus influenzae, Neisseria meningitidis, and Listeria monocytogenes in 10 U.S. surveillance sites. We compared incidence (cases per 100,000) across four epidemiologic periods: 2008-2009, 2010-2019, 2020-2021, and 2022-2023.

Findings: We identified 5,032 bacterial meningitis cases; among those with outcome data, 11% (573/5028) died. S. pneumoniae was the dominant pathogen (59% [2922/5032]) throughout. However, GBS predominated among infants aged 0-2 months (85% [660/775]), the age group with the highest incidence. Between 2008-2009 and 2010-2019, overall bacterial meningitis incidence declined from 1.3 to 1.1, driven by decreases in S. pneumoniae meningitis caused by serotypes contained in the 13-valent pneumococcal conjugate vaccine (PCV13) and N. meningitidis meningitis. Meningitis caused by non-b H. influenzae strains increased during this period. During 2020-2021, incidence declined to 0.7, driven by decreases in S. pneumoniae, H. influenzae, and N. meningitidis meningitis, regardless of organism subtype. During 2022-2023, incidence increased to 1.0, driven by increases in S. pneumoniae and H. influenzae meningitis. Case fatality ratios remained stable throughout.

Interpretation: Bacterial meningitis incidence rates have declined since 2008, with a notable low during 2020-2021, followed by a resurgence during 2022-2023. Case fatality remains high. Strategies that provide effective and broader pneumococcal and H. influenzae serotype protection and prevent infant GBS meningitis could reduce residual meningitis burden.

Funding: U.S. Centers for Disease Control and Prevention.

Keywords: Bacterial meningitis; Conjugate vaccines; Epidemiology; Surveillance.

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Conflict of interest statement

LH reported support for attending meetings and/or travel from Pfizer and GSK and participation on an Advisory Board for Merck. WS reported payment for a lecture to Abbott Diagnostics. RL reported support for attending meetings of CSTE, NFID, COID, and ID Week; Leadership or fiduciary roles as Executive Officer, CSTE; Executive Officer NFID, Associate Editor AAP Red Book (Report of the Committee on Infectious Diseases-COID), and ID Week Program Committee; and support for work as an Associate Editor on the AAP Red Book. KT and BA reported grant support from US CDC. MF reported grant support unrelated to the manuscript from NIH. No other authors reported a conflict of interest.

Figures

Fig. 1
Fig. 1
Annual incidence of bacterial meningitis in Emerging Infections Programs Network sites, 2008–2023, stratified by pathogen.
Fig. 2
Fig. 2
Proportion of all bacterial meningitis cases caused by each pathogen, stratified by epidemiologic period and age group — Emerging Infections Programs Network sites, 2008–2023.
See this image and copyright information in PMC

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