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

Published online by Cambridge University Press:  14 January 2005

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

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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.

Type
Research Article
Information
Epidemiology & Infection , Volume 133 , Issue 3 , June 2005 , pp. 493 - 501
Copyright
© 2005 Cambridge University Press

Footnotes

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