The Lancet  
Nov 10, 2012  Volume 380  Number 9854  p1621 – 1712
http://www.thelancet.com/journals/lancet/issue/current

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Progress and challenges in bacterial meningitis
Diederik van de Beek

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Bacterial meningitis is a devastating disease that is associated with substantial mortality and morbidity. The major causative bacteria are Streptococcus pneumoniae and Neisseria meningitis, with case-fatality rates of 30% and 7%, respectively, in high-income countries.1 In resource-poor countries, fatality rates can be as high as 50%.2 Neurological sequelae, including hearing loss, developmental disorders, and neuropsychological impairment, occur in up to 50% of survivors of the disease.1,3 Although routine vaccination against the three most common causative bacteria has had a notable effect on the prevalence of bacterial meningitis, an estimated 1·2 million cases occur worldwide every year, resulting in 180 000 deaths in children aged 1–59 months in 2010.

Series
Bacterial Meningitis – Dilemmas in the diagnosis of acute community-acquired bacterial meningitis
Matthijs C Brouwer, Guy E Thwaites, Allan R Tunkel, Diederik van de Beek
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Bacterial Meningitis – Advances in treatment of bacterial meningitis
Diederik van de Beek, Matthijs C Brouwer, Guy E Thwaites, Allan R Tunkel
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Bacterial Meningitis – Effect of vaccines on bacterial meningitis worldwide
Peter B McIntyre, Katherine L O’Brien, Brian Greenwood, Diederik van de Beek
Summary
Three bacteria—Haemophilus influenzae, Streptococcus pneumoniae, and Neisseria meningitidis—account for most acute bacterial meningitis. Measurement of the effect of protein-polysaccharide conjugate vaccines is most reliable for H influenzae meningitis because one serotype and one age group account for more than 90% of cases and the incidence has been best measured in high-income countries where these vaccines have been used longest. Pneumococcal and meningococcal meningitis are caused by diverse serotypes and have a wide age distribution; measurement of their incidence is complicated by epidemics and scarcity of surveillance, especially in low-income countries. Near elimination of H influenzae meningitis has been documented after vaccine introduction. Despite greater than 90% reductions in disease attributable to vaccine serotypes, all-age pneumococcal meningitis has decreased by around 25%, with little data from low-income settings. Near elimination of serogroup C meningococcal meningitis has been documented in several high-income countries, boding well for the effect of a new serogroup A meningococcal conjugate vaccine in the African meningitis belt.