- Author
-
M.W. Bijlsma
- Title
- Bacterial meningitis: epidemiology, herd protection, clinical characteristics, and risk assessment
- Supervisors
-
D. van de Beek
- Co-supervisors
-
A. van der Ende
M.C. Brouwer - Award date
- 1 July 2016
- Number of pages
- 173
- ISBN
- 9789462993655
- Document type
- PhD thesis
- Faculty
- Faculty of Medicine (AMC-UvA)
- Abstract
-
This thesis studied the epidemiology of community-acquired bacterial meningitis after the nationwide implementation of paediatric conjugate vaccines, as well as the long-term epidemiology of invasive meningococcal disease and neonatal group B streptococcal disease in the Netherlands. Furthermore, clinical features of adult community-acquired bacterial meningitis after the introduction of adjunctive dexamethasone therapy and routine paediatric conjugate vaccines were investigated in a prospective nationwide cohort. Predictors of severe illness were found, both in adults with bacterial meningitis as well as in patients presenting with cerebrospinal pleocytosis and a negative cerebrospinal fluid gram stain. A risk score was developed that identifies adults with cerebrospinal fluid pleocytosis and a negative cerebrospinal fluid Gram stain at low risk of an urgent treatable cause, and an external validation study of nine risk scores that predict adverse clinical outcome in bacterial meningitis was performed. Risk scores were identified through a systematic review of the literature. We found that bacterial meningitis is still a formidable disease with high mortality and morbidity, but progress has been made over the last decades. Outcome has been improved substantially by the introduction of adjunctive dexamethasone. Conjugate paediatric vaccines have greatly reduced the incidence of meningococcal, pneumococcal and H. influenzae type b meningitis. These vaccines have been unexpectedly effective against colonization and transmission, thereby making it possible to protect infants, immunocompromised patients, and the elderly by vaccinating healthy carriers. High quality and long-term surveillance studies will remain essential for vaccine development, implementation and evaluation.
- Note
- Research conducted at: Universiteit van Amsterdam
- Persistent Identifier
- https://hdl.handle.net/11245/1.535442
- Downloads
-
Thesis (complete)
Front matter
Chapter 1: Introduction
Chapter 2: Community-acquired bacterial meningitis in adults in the Netherlands, 2006-14: a prospective cohort study
Chapter 3: Epidemiology of invasive meningococcal disease in the Netherlands, 1960 -2012: an analysis of national surveillance data
Chapter 4: A decade of herd protection after introduction of meningococcal serogroup C conjugate vaccination
Chapter 5: No evidence of clusters of serogroup C meningococcal disease in the Dutch MSM community
Chapter 6: Incidence of invasive group B streptococcal disease and pathogen genotype distribution in newborn babies in the Netherlands over 25 years: a nationwide surveillance study
Chapter 7: Risk score for identifying adults with csf pleocytosis and negative csf gram stain at low risk for an urgent treatable cause
Chapter 8: Risk scores for outcome in bacterial meningitis: systematic review and external validation study
Chapter 9: Discussion
Addendum
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