Impact of 13-valent pneumococcal conjugate vaccine on pneumococcal meningitis in children

•PCV13 reduced the incidence pneumococcal meningitis in children in Madrid.•The reduction was mainly due to a decrease of those cases caused by serotype 19A.•Isolates nonsusceptible to cefotaxime almost disappeared after PCV13 use.•A shift of pneumococcal meningitis towards older ages occurred after PCV13 vaccination.•Case fatality rate and sequelae were similar before and after the use of PCV13. To evaluate the impact of 13-valent pneumococcal conjugate vaccine on pneumococcal meningitis in children. Children younger than 15years of age attending 27 hospitals in the Region of Madrid with confirmed pneumococcal meningitis were identified in a prospective surveillance study, from 2007 to 2015. Clinical data, neurological sequelae, pneumococcal vaccination status, serotyping and antibiotic susceptibility were recorded. One hundred and four cases of pneumococcal meningitis were identified, 63 during the period of routine 7-valent pneumococcal conjugate vaccine immunisation (May 2007–April 2010) and 41 during the period of 13-valent pneumococcal conjugate vaccine immunisation (May 2010–April 2015). When both periods were compared, a 62% (95% CI: 45–75%) decrease in the incidence of pneumococcal meningitis was observed, from 2.19 cases per 100,000 inhabitants in the PCV7 period to 0.81 per 100,000 inhabitants in the PCV13 period (p=0.0001), mainly due to an 83% (95% CI: 30–96%) reduction in cases caused by serotype 19A. Isolates not susceptible to cefotaxime (MIC>0.5μg/L) decreased from 27% to 8%, (p=0.02). Mean patient ages rose from 28.7months to 38.5months (p