Open Access Research article

Simulated effect of pneumococcal vaccination in the Netherlands on existing rules constructed in a non-vaccinated cohort predicting sequelae after bacterial meningitis

Arno E Commandeur1, Rogier CJ de Jonge12*, Irene Koomen3, Lodewijk Spanjaard4, A Marceline van Furth1 and Caroline B Terwee5

Author Affiliations

1 Department of Pediatrics and Infectious Diseases, VU University Medical Center, Amsterdam, The Netherlands

2 Department of Neonatology, Emma Children's Hospital - Academic Medical Center, Amsterdam, The Netherlands

3 Department of Pediatrics, Westfriesgasthuis, Hoorn, The Netherlands

4 Department of Medical Microbiology, Netherlands Reference Laboratory for Bacterial Meningitis, Academic Medical Center, Amsterdam, The Netherlands

5 Department of Epidemiology and Biostatistics and the EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands

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BMC Infectious Diseases 2010, 10:259  doi:10.1186/1471-2334-10-259

Published: 3 September 2010



Previously two prediction rules identifying children at risk of hearing loss and academic or behavioral limitations after bacterial meningitis were developed. Streptococcus pneumoniae as causative pathogen was an important risk factor in both. Since 2006 Dutch children receive seven-valent conjugate vaccination against S. pneumoniae. The presumed effect of vaccination was simulated by excluding all children infected by S. pneumoniae with the serotypes included in the vaccine, from both previous collected cohorts (between 1990-1995).


Children infected by one of the vaccine serotypes were excluded from both original cohorts (hearing loss: 70 of 628 children; academic or behavioral limitations: 26 of 182 children). All identified risk factors were included in multivariate logistic regression models. The discriminative ability of both new models was calculated.


The same risk factors as in the original models were significant. The discriminative ability of the original hearing loss model was 0.84 and of the new model 0.87. In the academic or behavioral limitations model it was 0.83 and 0.84 respectively.


It can be assumed that the prediction rules will also be applicable on a vaccinated population. However, vaccination does not provide 100% coverage and evidence is available that serotype replacement will occur. The impact of vaccination on serotype replacement needs to be investigated, and the prediction rules must be validated externally.