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Neisseria meningitidis

Clinical Features	Fever, headache and stiff neck in meningitis cases, and sepsis and rash in meningococcemia.
Etiologic Agent	Multiple serogroups of Neisseria meningitidis.
Incidence	0.5-5/100,000 for endemic disease, worldwide in distribution. During 1996-1997, 213,658 cases with 21,830 deaths were reported in West African countries. Up to 2% in epidemics in Africa.
Sequelae	10%-14% of cases are fatal. Of patients who recover 11%-19% have permanent hearing loss, mental retardation, loss of limbs, or other serious sequelae.
Transmission	N. meningitidis colonizes mucosal surfaces of nasopharynx and is transmitted through direct contact with large droplet respiratory secretions from the patients or asymptomatic carriers. Humans are the only host.
Risk Groups	Risk groups include infants and young children (for endemic disease), refugees, household contacts of case patients, military recruits, college freshmen who live in dormitories, microbiologists who work with isolates of N. meningitidis, patients without spleens or with terminal complement component deficiencies, and people exposed to active and passive tobacco smoke.

Streptococcus pneumoniae Disease

Clinical Features	Pneumonia, bacteremia, otitis media, meningitis, sinusitis, peritonitis and arthritis.
Etiologic Agent	Streptococcus pneumoniae. More than 90 serotypes exist; of strains causing invasive disease, 88% are serotypes included in the 23-valent polysaccharide vaccine. Before the new pneumococcal conjugate vaccine was introduced in 2001, over 80% of invasive isolates in children <5 years old were included in the 7-valent vaccine.
Incidence	Until 2000, S. pneumoniae infections caused 100,000-135,000 hospitalizations for pneumonia, 6 million cases of otitis media, and 60,000 cases of invasive disease, including 3300 cases of meningitis. Incidence of sterile-site infections showed geographic variation from 21 to 33 cases per 100,000 population. Disease figures are now changing due to conjugate vaccine introduction.; in 2002, the rate of invasive disease was 13 cases per 100,000 in the United States.
Sequelae	Death occurs in 14% of hospitalized adults with invasive disease. Neurologic sequelae and/or learning disabilities can occur in meningitis patients. Hearing impairment can result from recurrent otitis media.
Transmission	Person to person.
Risk Groups	Persons at higher risk for infection are the elderly, children under 2 years old, blacks, American Indians and Alaska Natives, children who attend group day care centers, and persons with underlying medical conditions including HIV infection and sickle-cell disease.

Clinical Features	Haemophilus influenzae Serotype b (Hib) Disease Invasive disease caused by Haemophilus influenzae type b can affect many organ systems. The most common types of invasive disease are pneumonia, occult febrile bacteremia, meningitis, epiglottitis, septic arthritis, cellulitis, otitis media, purulent pericarditis, and other less common infections such as endocarditis, and osteomyelitis.
Etiologic Agent	Haemophilus influenzae serotype b.
Incidence	Due to routine use of the Hib conjugate vaccine since 1990, the incidence of Hib disease in infants and young children has decreased by 99% to fewer than 1 case per 100,000 children under 5 years of age. In the United States, Hib disease occurs primarily in underimmunized children and among infants too young to have completed the primary immunization series. In developing countries, where routine vaccination with Hib vaccine is not widely available, Hib remains a major cause of lower respiratory tract infections in infants and children.
Sequelae	3%-6% of cases are fatal; up to 20% of surviving patients have permanent hearing loss or other long-term sequelae.
Transmission	Direct contact with respiratory droplets from nasopharyngeal carrier or case patient.
Risk Groups	Infants and young children , household contacts, and day-care classmates. American Indian/Alaska Native populations are also at increased risk.

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