Epidemiology and Infection

Penicillin-resistant pneumococcal meningitis: high antibiotic exposure impedes new vaccine protection 1

L. TEMIME a1c1, P. Y. BOËLLE a1a2, A. J. VALLERON a1a2 and D. GUILLEMOT a3
a1 INSERM U444 – Epidémiologie et Sciences de l'Information, Paris, France
a2 Assistance publique – Hôpitaux de Paris, Université Pierre et Marie Curie, Paris, France
a3 Institut Pasteur, Paris, France

Article author query
temime l   [PubMed][Google Scholar] 
boelle py   [PubMed][Google Scholar] 
valleron aj   [PubMed][Google Scholar] 
guillemot d   [PubMed][Google Scholar] 


The frequency of meningitis due to penicillin-resistant Streptococcus pneumoniae (PRP) has increased in recent years, making treatment failure more likely. It is currently expected that pneumococcal conjugate vaccines might curb this trend. We investigated this issue using a mathematical model applied to the current prevalence of resistance and antibiotic exposure in the United States and in France. Our main finding was that the level of antibiotic exposure may limit the effect of the vaccine. In relatively low antibiotic exposure environments such as the United States, large-scale vaccination prevents a large part of PRP meningitis cases, whereas in high antibiotic-exposure environments such as France, vaccination alone does not lead to a substantial reduction in PRP meningitis incidence. Our results suggest that antibiotic exposure reduction will remain of primary importance for the control of PRP meningitis despite wide scale use of pneumococcal conjugate vaccines.

(Accepted November 18 2004)

c1 Chaire Hygiène et Securité, CNAM, 2 rue Conté, 75141 Paris Cedex 03, France. (Email: laura.temime@sat.ap-hop-paris.fr)


1 This work was presented in part at the 13th ECCMID, Glasgow, 2003 (abstract O73).