Author response: Zoonotic bacterial meningitis in human adults

We thank Tan et al. for the comment considering a fish consumption–related outbreak of S agalactiae or GBS disease, written in response to our review on zoonotic meningitis.¹ The outbreak of sequence type ST283 GBS disease was found to frequently cause meningitis compared to non-ST283 strains, and farmed fish was the outbreak source.¹ The specific strain was not previously described to colonize humans, but few studies on GBS colonization in Southeast Asia are available.^2,3 The specific sequence type was previously reported to cause disease in both humans and fish, but the mode of transmission and primary reservoir of the pathogen is unclear.² Zoonotic meningitis, as described in our review, is caused by pathogens that have a primary reservoir in animals and cause disease in humans following transmission, either by animal contact or food.¹ GBS is generally not considered a zoonotic pathogen, being a commensal in humans. This does not influence the importance of the foodborne infection and warrants vigilance for public health officials and the fish industry. Locally performed studies on colonization of fish during life, in food processing procedures, and of healthy humans may shed light on the mode of transmission of this particular sequence type.