The epidemiology of bacterial meningitis in the United States during 2008-2023: an analysis of active, laboratory, population-based, multistate surveillance data

Namrata Prasad; Miwako Kobayashi; Jennifer P Collins; Amy B Rubis; Gordana Derado; Miranda J Delahoy; Daniel C Payne; Lesley McGee; Sopio Chochua; Henju Marjuki; Lucy A McNamara; LeAnne M Fox; Arthur Reingold; Megan Barnes; Susan Petit; Monica M Farley; Lee H Harrison; Ruth Lynfield; Jessica Houston; Bridget J Anderson; Ann Thomas; Keipp H Talbot; William Schaffner; Adam L Cohen; Stephanie J Schrag; Melissa Arvay

doi:10.1016/j.lana.2025.101120

The epidemiology of bacterial meningitis in the United States during 2008-2023: an analysis of active, laboratory, population-based, multistate surveillance data

Lancet Reg Health Am. 2025 May 12:47:101120. doi: 10.1016/j.lana.2025.101120. eCollection 2025 Jul.

Authors

Namrata Prasad^{1

2}, Miwako Kobayashi¹, Jennifer P Collins¹, Amy B Rubis¹, Gordana Derado¹, Miranda J Delahoy³, Daniel C Payne³, Lesley McGee¹, Sopio Chochua¹, Henju Marjuki¹, Lucy A McNamara¹, LeAnne M Fox¹, Arthur Reingold^{4

5}, Megan Barnes⁶, Susan Petit⁷, Monica M Farley⁸, Lee H Harrison⁹, Ruth Lynfield¹⁰, Jessica Houston¹¹, Bridget J Anderson¹², Ann Thomas¹³, Keipp H Talbot¹⁴, William Schaffner¹⁴, Adam L Cohen¹, Stephanie J Schrag¹, Melissa Arvay¹

Affiliations

¹ Division of Bacterial Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA.
² Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, GA, USA.
³ Division of Foodborne, Waterborne, and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA.
⁴ California Emerging Infections Program, Oakland, CA, USA.
⁵ Berkeley School of Public Health, University of California, Berkeley, CA, USA.
⁶ Colorado Department of Public Health and the Environment, Denver, CO, USA.
⁷ Connecticut Department of Public Health, Hartford, CT, USA.
⁸ Department of Medicine, Emory University School of Medicine and the Atlanta VAMC, Atlanta, GA, USA.
⁹ Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA.
¹⁰ Minnesota Department of Health, St. Paul, MN, USA.
¹¹ New Mexico Emerging Infections Program, New Mexico Department of Health, Santa Fe, NM, USA.
¹² New York State Department of Health, Albany, NY, USA.
¹³ Public Health Division, Oregon Health Authority, Portland, OR, USA.
¹⁴ Department of Health Policy, Vanderbilt University School of Medicine, Nashville, TN, USA.

Abstract

Background: Bacterial meningitis is a severe syndrome with dynamic epidemiology, but assessments of current trends are limited. We aimed to describe changing epidemiologic patterns among common bacterial causes of meningitis in the United States.

Methods: We analyzed data on bacterial meningitis cases caused by Streptococcus pneumoniae, group B Streptococcus (GBS), Haemophilus influenzae, Neisseria meningitidis, and Listeria monocytogenes in 10 U.S. surveillance sites. We compared incidence (cases per 100,000) across four epidemiologic periods: 2008-2009, 2010-2019, 2020-2021, and 2022-2023.

Findings: We identified 5,032 bacterial meningitis cases; among those with outcome data, 11% (573/5028) died. S. pneumoniae was the dominant pathogen (59% [2922/5032]) throughout. However, GBS predominated among infants aged 0-2 months (85% [660/775]), the age group with the highest incidence. Between 2008-2009 and 2010-2019, overall bacterial meningitis incidence declined from 1.3 to 1.1, driven by decreases in S. pneumoniae meningitis caused by serotypes contained in the 13-valent pneumococcal conjugate vaccine (PCV13) and N. meningitidis meningitis. Meningitis caused by non-b H. influenzae strains increased during this period. During 2020-2021, incidence declined to 0.7, driven by decreases in S. pneumoniae, H. influenzae, and N. meningitidis meningitis, regardless of organism subtype. During 2022-2023, incidence increased to 1.0, driven by increases in S. pneumoniae and H. influenzae meningitis. Case fatality ratios remained stable throughout.

Interpretation: Bacterial meningitis incidence rates have declined since 2008, with a notable low during 2020-2021, followed by a resurgence during 2022-2023. Case fatality remains high. Strategies that provide effective and broader pneumococcal and H. influenzae serotype protection and prevent infant GBS meningitis could reduce residual meningitis burden.

Funding: U.S. Centers for Disease Control and Prevention.

Keywords: Bacterial meningitis; Conjugate vaccines; Epidemiology; Surveillance.