Should Pneumococcal Meningitis Prompt a Public Health Response?

Here in Pittsburgh a 6 year old boy died from bacterial meningitis this week. There was some interest from the media and the county health department held a press conference to announce some of the specifics of the case, including the important fact that the culprit organism was treptococcus pneumoniae (the pneumococcus). As such, no major public health intervention--such as antibiotic prophylaxis--was needed. 

However, children dying of invasive pneumococcal disease is not something that should be considered commonplace in light of the availability of pneumococcal vaccines. The really are two pneumococcal vaccines that are relevant: the traditional 23-valent pneumococcal polysaccharide vaccine targeted primarily at the elderly and 13-valent (formerly 7) pneumococcal conjugate vaccine targeted primarily at children. 

While an important question will be whether the child was vaccinated and if the specific pneumococcus isolated was a vaccine serotype, I wonder what the pneumococcal vaccine rate is in his neighborhood. 

I think about this because of an innovative approach employed in Philadelphia for a similar problem that I once heard about in a lecture. In Philadelphia, rates of invasive pneumococcal disease are mapped with vaccination rates. Such an approach uncovers areas in which vaccine--which reduces carriage rate as well as infections--should be prioritized. The approach is reminiscent of the surveillance and containment approach used to eradicate smallpox. 



Last night Dr. Lee Harrison of UPMC discussed meningococcal meningitis at the  Baltimore Tropical Medicine Club. Some highlights included the fact that the US is at an all-time low of meningococcal meningitis (despite the Princeton and UCSB outbreaks) and that serotype X (which there is no vaccine for) has been causing invasive disease in the meningitis belt in Africa. 

The Novartis serotype B vaccine, approved for use in the EU and Australia, is now being distributed to the Princeton University population in an investigational manner. It remains to be seen what the impact of his vaccine, for which no hard efficacy data is yet available, will be at Princeton and the rest of the world.