Pneumococcal meningitis is a serious infection caused by Streptococcus pneumoniae. Previous reports describe pneumococcal meningitis, often recurrent, in patients with histories of prior head trauma. There is currently no routine recommendation for pneumococcal vaccination of persons with a history of head injury or brain surgery (HI/BS) unless a CSF leak is present. Approximately 275,000 nonfatal hospitalizations for traumatic brain injuries occur annually in the United States; however, the prevalence of persons living with a history of HI/BS has not been well characterized. We evaluated the percentage of reported pneumococcal meningitis cases with a history of prior HI/BS and estimated the overall prevalence of HI/BS conditions requiring hospitalization in California.
We analyzed clinical, laboratory, and epidemiological data for pneumococcal meningitis patients reported to the California Department of Public Health during 2013-2014. HI/BS history was collected from case report forms or medical records. The prevalence of HI/BS was estimated using ICD-9 codes for HI/BS conditions from inpatient discharges from non-federal licensed California hospitals and average life expectancy estimates.
181 cases of pneumococcal meningitis were reported in 2013-2014; 101 had information available to determine their prior HI/BS history. Sixteen (15.8%) patients had a history of HI/BS, which is 2.7 times higher than the estimated prevalence of HI/BS requiring hospitalization (5.8%) among the general population (p<0.001). Among the 181 cases of pneumococcal meningitis, eight patients had a history of recurrent meningitis. HI/BS history was available for four of these cases; two had a history of HI/BS.
Having a history of prior HI/BS was significantly more common among patients with pneumococcal meningitis than in the general population. Limitations to this analysis include inconsistent reporting of pneumococcal meningitis, incomplete HI/BS ascertainment, and use of administrative hospital discharge data. Additional analyses are needed to better define which populations are at most risk and may benefit most from vaccination, including which types of HI/BS increase the risk of pneumococcal meningitis.
K. Harriman, None