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Volume 24, Number 7—July 2018
Research

Pneumococcal Meningitis in Adults after Introduction of PCV7 and PCV13, Israel, July 2009–June 20151

Gili Regev-YochayComments to Author , Klaris Reisenberg, Michal Katzir, Yonit Wiener-Well, Galia Rahav, Jacob Strahilevitz, Valery Istomin, Evgenia Tsyba, Avi Peretz, Shirley Khakshoor, Ron Dagan, and on behalf of the Israeli Adult Invasive Pneumococcal Disease Group
Author affiliations: Sheba Medical Center, Ramat Gan, Israel (G. Regev-Yochay, G. Rahav, S. Khakshoor); Tel Aviv University, Tel Aviv, Israel (G. Regev-Yochay, M. Katzir, G. Rahav); Soroka Medical Center, Beersheba, Israel (K. Reisenberg); Bar-Ilan University, Safed, Israel (K. Reisenberg, A. Peretz); Meir Medical Center, Kfar Saba, Israel (M. Katzir); Shaare Zedek Medical Center, Jerusalem, Israel (Y. Wiener-Well); Hadassah-Hebrew University, Jerusalem (J. Strahilevitz); Hillel Yaffe Medical Center, Hadera, Israel (V. Istomin); Barzilai Medical Center, Ashkelon, Israel (E. Tsyba); Baruch Padeh Medical Center, Tiberias, Israel (A. Peretz); Ben-Gurion University of the Negev, Beersheba (R. Dagan)

Main Article

Table 1

Univariate analysis of the characteristics of patients with meningitis IPD and nonmeningitis IPD by IPD source, Israel, July 1, 2009–June 30, 2015*

Variable
Meningitis IPD, n = 221
Nonmeningitis IPD, n = 2,124† p value§
Pneumonia
Bacteremia, no source
IPD, rare types‡
All
Population with full data available
213
1,596
301
203
2,124

Sex¶
M 104 (48.6) 890 (55.8) 171 (56.8) 108 (53.2) 1,182 (55.7) 0.047
F
110 (51.4)
704 (44.2)
130 (43.2)
95 (46.8)
940 (44.3)

Jewish ethnicity¶
166 (75.5)
1,157 (72.6)
221 (73.7)
154 (75.9)
1,551 (73.0)
0.46
Age, y¶ <0.0001
Mean 57.68 64.83 61.83 64.03 64.37
Median (range) 61.47
(18.2–91.3) 66.53
(18.1–105.0) 65.45
(18.1–98.3) 66.91
(18.1–97.8) 66.35
(18.1–105.0)
18–49 72 (32.6) 368 (23.1) 74 (24.6) 45 (22.2) 491 (23.1)
50–64 68 (30.8) 382 (23.9) 75 (24.9) 47 (23.2) 510 (24.0)
>65
81 (36.7)
846 (53.0)
152 (50.5)
111 (54.7)
1,123 (52.9)

Concurrent medical conditions
Any 186 (87.3) 1,481 (92.8) 287 (95.4) 189 (93.1) 1,972 (92.8) 0.004
High risk and at risk 130 (61.0) 1,093 (68.5) 233 (77.4) 156 (76.49) 1,495 (70.4) 0.005
High risk 81 (38.0) 645 (40.4) 179 (59.5) 107 (52.7) 939 (44.2) 0.083
Any immunosuppression 16 (7.5) 187 (11.7) 61 (20.3) 35 (17.2) 285 (13.4) 0.014
Bone marrow transplantation 4 (1.9) 42 (2.6) 17 (5.7) 12 (5.9) 71 (3.3) 0.248
HIV 0 33 (2.1) 3 (1.0) 3 (1.5) 39 (1.8) 0.046
Hematologic malignancy 19 (8.9) 208 (13.0) 68 (22.6) 41 (20.2) 320 (15.1) 0.015
Metastatic cancer 3 (1.4) 73 (4.6) 34 (11.3) 8 (3.9) 116 (5.5) 0.010
Asplenia 9 (4.2) 26 (1.6) 18 (6.0) 14 (6.9) 58 (2.7) 0.213
Chronic renal failure 14 (6.6) 277 (17.4) 46 (15.3) 35 (17.2) 363 (17.1) <0.0001
Previous neurosurgery, CSF leak 43 (20.2) 29 (1.8) 6 (2.0) 7 (3.5) 42 (2.0) <0.0001
At risk 49 (23.0) 448 (28.1) 54 (17.9) 49 (24.1) 556 (26.2) 0.314
Congestive heart failure 13 (6.1) 270 (16.9) 38 (12.6) 36 (17.7) 350 (16.5) <0.0001
Chronic lung disease 20 (9.4) 358 (22.5) 35 (11.6) 29 (14.3) 425 (20.0) 0.0002
Cirrhosis 2 (0.9) 29 (1.8) 16 (5.3) 17 (8.4) 62 (2.9) 0.091
Diabetes mellitus 47 (22.1) 437 (27.4) 87 (28.9) 54 (26.6) 584 (27.5) 0.089
Alcohol abuse
3 (1.4)
51 (3.2)
10 (3.3)
8 (3.9)
69 (3.3)
0.138
Healthy 27 (12.7) 115 (7.2) 14 (4.7) 14 (6.9) 152 (7.2) 0.004

*Values are no. (%) except as indicated. CSF, cerebospinal fluid; IPD, invasive pneumococcal disease.
†The source of 24 nonmeningitis IPD cases was not reported, so these cases were only included in the “All” column.
‡These IPD cases occurred after endocarditis, sinusitis, mastoiditis, peritonitis, endometritis, osteomyelitis, cellulitis, or septic arthritis; a few resulted from abscesses in various locations.
§p value of meningitis vs. nonmeningitis IPD cases. Bold indicates significance.
¶The denominators are the total number of cases with information available pertaining to the relevant variable.

Main Article

1Some results from this study were presented at the 10th International Symposium on Pneumococci and Pneumococcal Diseases, June 26–30, 2016, Glasgow, Scotland.

2Additional members of the Israeli Adult Invasive Pneumococcal Disease Group are listed at the end of this article.

Page created: June 18, 2018
Page updated: June 18, 2018
Page reviewed: June 18, 2018
The conclusions, findings, and opinions expressed by authors contributing to this journal do not necessarily reflect the official position of the U.S. Department of Health and Human Services, the Public Health Service, the Centers for Disease Control and Prevention, or the authors' affiliated institutions. Use of trade names is for identification only and does not imply endorsement by any of the groups named above.
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