scholarly journals Changes in the Molecular Epidemiology of Pediatric Bacterial Meningitis in Senegal After Pneumococcal Conjugate Vaccine Introduction

2019 ◽  
Vol 69 (Supplement_2) ◽  
pp. S156-S163 ◽  
Author(s):  
Mouhamadou A Sonko ◽  
Felix S Dube ◽  
Catherine Bi Okoi ◽  
Amadou Diop ◽  
Aliou Thiongane ◽  
...  
Keyword(s):  
Bacterial Meningitis ◽  
Conjugate Vaccine ◽  
Pneumococcal Conjugate Vaccine ◽  
Pneumococcal Meningitis ◽  
Case Fatality ◽  
World Health ◽  
Sentinel Site ◽  
Surveillance Period ◽  
Vaccine Introduction ◽  
Health Organization

AbstractBackgroundBacterial meningitis is a major cause of mortality among children under 5 years of age. Senegal is part of World Health Organization–coordinated sentinel site surveillance for pediatric bacterial meningitis surveillance. We conducted this analysis to describe the epidemiology and etiology of bacterial meningitis among children less than 5 years in Senegal from 2010 and to 2016.MethodsChildren who met the inclusion criteria for suspected meningitis at the Centre Hospitalier National d’Enfants Albert Royer, Senegal, from 2010 to 2016 were included. Cerebrospinal fluid specimens were collected from suspected cases examined by routine bacteriology and molecular assays. Serotyping, antimicrobial susceptibility testing, and whole-genome sequencing were performed.ResultsA total of 1013 children were admitted with suspected meningitis during the surveillance period. Streptococcus pneumoniae, Neisseria meningitidis, and Haemophilus accounted for 66% (76/115), 25% (29/115), and 9% (10/115) of all confirmed cases, respectively. Most of the suspected cases (63%; 639/1013) and laboratory-confirmed (57%; 66/115) cases occurred during the first year of life. Pneumococcal meningitis case fatality rate was 6-fold higher than that of meningococcal meningitis (28% vs 5%). The predominant pneumococcal lineage causing meningitis was sequence type 618 (n = 7), commonly found among serotype 1 isolates. An ST 2174 lineage that included serotypes 19A and 23F was resistant to trimethoprim-sulfamethoxazole.ConclusionsThere has been a decline in pneumococcal meningitis post–pneumococcal conjugate vaccine introduction in Senegal. However, disease caused by pathogens covered by vaccines in widespread use still persists. There is need for continued effective monitoring of vaccine-preventable meningitis.

scholarly journals Pediatric Bacterial Meningitis Surveillance in Nigeria From 2010 to 2016, Prior to and During the Phased Introduction of the 10-Valent Pneumococcal Conjugate Vaccine

2019 ◽  
Vol 69 (Supplement_2) ◽  
pp. S81-S88 ◽  
Author(s):  
Beckie N Tagbo ◽  
Rowan E Bancroft ◽  
Iretiola Fajolu ◽  
Mohammed B Abdulkadir ◽  
Muhammad F Bashir ◽  
...  
Keyword(s):  
Bacterial Meningitis ◽  
Conjugate Vaccine ◽  
Pneumococcal Conjugate Vaccine ◽  
Invasive Disease ◽  
Latex Agglutination ◽  
World Health ◽  
Vaccine Introduction ◽  
Vaccine Type ◽  
Health Organization ◽  
Species Specific

Abstract Background Historically, Nigeria has experienced large bacterial meningitis outbreaks with high mortality in children. Streptococcus pneumoniae (pneumococcus), Neisseria meningitidis (meningococcus), and Haemophilus influenzae are major causes of this invasive disease. In collaboration with the World Health Organization, we conducted longitudinal surveillance in sentinel hospitals within Nigeria to establish the burden of pediatric bacterial meningitis (PBM). Methods From 2010 to 2016, cerebrospinal fluid was collected from children <5 years of age, admitted to 5 sentinel hospitals in 5 Nigerian states. Microbiological and latex agglutination techniques were performed to detect the presence of pneumococcus, meningococcus, and H. influenzae. Species-specific polymerase chain reaction and serotyping/grouping were conducted to determine specific causative agents of PBM. Results A total of 5134 children with suspected meningitis were enrolled at the participating hospitals; of these 153 (2.9%) were confirmed PBM cases. The mortality rate for those infected was 15.0% (23/153). The dominant pathogen was pneumococcus (46.4%: 71/153) followed by meningococcus (34.6%: 53/153) and H. influenzae (19.0%: 29/153). Nearly half the pneumococcal meningitis cases successfully serotyped (46.4%: 13/28) were caused by serotypes that are included in the 10-valent pneumococcal conjugate vaccine. The most prevalent meningococcal and H. influenzae strains were serogroup W and serotype b, respectively. Conclusions Vaccine-type bacterial meningitis continues to be common among children <5 years in Nigeria. Challenges with vaccine introduction and coverage may explain some of these finding. Continued surveillance is needed to determine the distribution of serotypes/groups of meningeal pathogens across Nigeria and help inform and sustain vaccination policies in the country.

scholarly journals Declines in Pediatric Bacterial Meningitis in the Republic of Benin Following Introduction of Pneumococcal Conjugate Vaccine: Epidemiological and Etiological Findings, 2011–2016

2019 ◽  
Vol 69 (Supplement_2) ◽  
pp. S140-S147 ◽  
Author(s):  
Joseph Agossou ◽  
Chinelo Ebruke ◽  
Alphonse Noudamadjo ◽  
Julien D Adédémy ◽  
Eric Y Dènon ◽  
...  
Keyword(s):  
Bacterial Meningitis ◽  
Haemophilus Influenzae ◽  
Conjugate Vaccine ◽  
Pneumococcal Conjugate Vaccine ◽  
Case Fatality ◽  
Sentinel Site ◽  
Surveillance Period ◽  
Predominant Pathogen ◽  
Republic Of Benin ◽  
The Republic

Abstract Background Pediatric bacterial meningitis (PBM) remains an important cause of disease in children in Africa. We describe findings from sentinel site bacterial meningitis surveillance in children <5 years of age in the Republic of Benin, 2011–2016. Methods Cerebrospinal fluid (CSF) was collected from children admitted to Parakou, Natitingou, and Tanguieta sentinel hospitals with suspected meningitis. Identification of Streptococcus pneumoniae (pneumococcus), Haemophilus influenzae, and Neisseria meningitidis (meningococcus) was performed by rapid diagnostic tests, microbiological culture, and/or polymerase chain reaction; where possible, serotyping/grouping was performed. Results A total of 10 919 suspected cases of meningitis were admitted to the sentinel hospitals. Most patients were 0–11 months old (4863 [44.5%]) and there were 542 (5.0%) in-hospital deaths. Overall, 4168 CSF samples were screened for pathogens and a total of 194 (4.7%) PBM cases were confirmed, predominantly caused by pneumococcus (98 [50.5%]). Following pneumococcal conjugate vaccine (PCV) introduction in 2011, annual suspected meningitis cases and deaths (case fatality rate) progressively declined from 2534 to 1359 and from 164 (6.5%) to 14 (1.0%) in 2012 and 2016, respectively (P < .001). Additionally, there was a gradual decline in the proportion of meningitis cases caused by pneumococcus, from 77.3% (17/22) in 2011 to 32.4% (11/34) in 2016 (odds ratio, 7.11 [95% confidence interval, 2.08–24.30]). Haemophilus influenzae meningitis fluctuated over the surveillance period and was the predominant pathogen (16/34 [47.1%]) by 2016. Conclusions The observed decrease in pneumococcal meningitis after PCV introduction may be indicative of changing patterns of PBM etiology in Benin. Maintaining vigilant and effective surveillance is critical for understanding these changes and their wider public health implications.

scholarly journals Impact of 10-Valent Pneumococcal Conjugate Vaccine on Bacterial Meningitis in Madagascar

2019 ◽  
Vol 69 (Supplement_2) ◽  
pp. S121-S125
Author(s):  
Emilson Jean P R Andriatahirintsoa ◽  
Julia Liliane Raboba ◽  
Vonintsoa Lalaina Rahajamanana ◽  
Ando Lalaina Rakotozanany ◽  
Mengouom M Nimpa ◽  
...  
Keyword(s):  
Bacterial Meningitis ◽  
Conjugate Vaccine ◽  
Pneumococcal Conjugate Vaccine ◽  
Pneumococcal Meningitis ◽  
World Health ◽  
Pcr Analysis ◽  
Sentinel Site ◽  
Reference Laboratory ◽  
Rt Pcr ◽  
The Impact

Abstract Background The 10-valent pneumococcal conjugate vaccine (PCV10) was introduced in Madagascar in 2012. The objective of this study was to determine the impact of PCV10 on bacterial meningitis in hospitalized children <5 years of age. Methods During 2010–2017, data from the hospital admission logbook were recorded for bacterial meningitis and pneumonia hospitalizations in children <5 years of age. Between April 2011 and December 2017, 3312 cerebrospinal fluid (CSF) samples collected from children who fulfilled the World Health Organization case definition of suspected bacterial meningitis were analyzed at the sentinel site laboratory (SSL) by microscopy, culture, and antigen detection tests. A total of 2065 CSF samples were referred to the regional reference laboratory for real-time polymerase chain reaction (RT-PCR) analysis. 2010–2011 was defined as the prevaccine period, 2012 as vaccine introduction year, and 2013–2017 the postvaccine period. The number of cases, causative agent, and pneumonia hospitalizations were compared before and after PCV10 introduction. Results In the prevaccine period, bacterial meningitis and pneumonia hospitalizations accounted for 4.5% and 24.5% of all hospitalizations while there were 2.6% and 19%, respectively, in the postvaccine period (P < .001). In samples tested at the SSL, 154 were positive with 80% Streptococcus pneumoniae and 20% other bacteria. Pneumococcal meningitis diagnosed by RT-PCR declined from 14% in 2012 to 3% in 2017. Also, 14% of children with pneumococcal meningitis died. Conclusions Following PCV10 introduction, pneumococcal meningitis, bacterial meningitis, and pneumonia hospitalizations declined. Surveillance should continue to monitor the impact of PCV10.

scholarly journals Hospital-based Surveillance for Pediatric Bacterial Meningitis in the Era of the 13-Valent Pneumococcal Conjugate Vaccine in Ghana

2019 ◽  
Vol 69 (Supplement_2) ◽  
pp. S89-S96 ◽  
Author(s):  
Lorna Awo Renner ◽  
Effua Usuf ◽  
Nuredin Ibrahim Mohammed ◽  
Daniel Ansong ◽  
Thomas Dankwah ◽  
...  
Keyword(s):  
World Health Organization ◽  
Conjugate Vaccine ◽  
Pneumococcal Conjugate Vaccine ◽  
Clinical Signs ◽  
World Health ◽  
Sentinel Site ◽  
Reference Laboratory ◽  
Vaccine Type ◽  
The World ◽  
Health Organization

Abstract Background Global surveillance for vaccine preventable invasive bacterial diseases has been set up by the World Health Organization to provide disease burden data to support decisions on introducing pneumococcal conjugate vaccine (PCV). We present data from 2010 to 2016 collected at the 2 sentinel sites in Ghana. Methods Data were collected from children <5 years of age presenting at the 2 major teaching hospitals with clinical signs of meningitis. Cerebrospinal fluid specimens were collected and tested first at the sentinel site laboratory with conventional microbiology methods and subsequently with molecular analysis, at the World Health Organization Regional Reference Laboratory housed at the Medical Research Council Unit The Gambia, for identification of Streptococcus pneumoniae, Haemophilus influenzae, and Neisseria meningitidis, the 3 most common bacteria causing meningitis. Results There were 4008 suspected cases of meningitis during the surveillance period, of which 31 (0.8%) were laboratory confirmed. Suspected meningitis cases decreased from 923 in 2010 to 219 in 2016. Of 3817 patients with available outcome data, 226 (5.9%) died. S. pneumoniae was the most common bacterial pathogen, accounting for 68.5% of confirmed cases (50 of 73). H. influenzae and N. meningitidis accounted for 6.8% (5 of 73) and 21.9% (16 of 73), respectively. The proportion of pneumococcal vaccine serotypes causing meningitis decreased from 81.3% (13 of 16) before the introduction of 13-valent PCV (2010–2012) to 40.0% (8 of 20) after its introduction (2013–2016). Conclusions Cases of suspected meningitis decreased among children <5 years of age between 2010 and 2016, with declines in the proportion of vaccine-type pneumococcal meningitis after the introduction of 13-valent PCV in Ghana.

scholarly journals Pneumococcal Meningitis Among Children in the Post-13-Valent Pneumococcal Conjugate Vaccine Era: Three Case Reports

2020 ◽  
Vol 5 (9) ◽  
Keyword(s):  
Streptococcus Pneumoniae ◽  
Bacterial Meningitis ◽  
Conjugate Vaccine ◽  
Pneumococcal Conjugate Vaccine ◽  
Pneumococcal Meningitis ◽  
Case Reports ◽  
Vaccine Introduction ◽  
The Third ◽  
Neurological Sequel ◽  
Typable Strain

We report three cases under two years of age, of meningitis due to Streptococcus pneumoniae in vaccinated children. Two grew non-typable strain and the third serotype 10A. All improved with no neurological sequel. Continued monitoring of the epidemiology of bacterial meningitis within the post13-valent pneumococcal conjugate vaccine introduction is warranted.

scholarly journals Etiology of Bacterial Meningitis Among Children <5 Years Old in Côte d’Ivoire: Findings of Hospital-based Surveillance Before and After Pneumococcal Conjugate Vaccine Introduction

2019 ◽  
Vol 69 (Supplement_2) ◽  
pp. S114-S120 ◽  
Author(s):  
Catherine Boni-Cisse ◽  
Sheikh Jarju ◽  
Rowan E Bancroft ◽  
Nicaise A Lepri ◽  
Hamidou Kone ◽  
...  
Keyword(s):  
Bacterial Meningitis ◽  
Conjugate Vaccine ◽  
Cote D'ivoire ◽  
Pneumococcal Conjugate Vaccine ◽  
Côte D’Ivoire ◽  
Type B ◽  
Cote D’Ivoire ◽  
Vaccine Serotypes ◽  
Vaccine Introduction ◽  
Côte D'ivoire

Abstract Background Bacterial meningitis remains a major disease affecting children in Côte d’Ivoire. Thus, with support from the World Health Organization (WHO), Côte d’Ivoire has implemented pediatric bacterial meningitis (PBM) surveillance at 2 sentinel hospitals in Abidjan, targeting the main causes of PBM: Streptococcus pneumoniae (pneumococcus), Haemophilus influenzae, and Neisseria meningitidis (meningococcus). Herein we describe the epidemiological characteristics of PBM observed in Côte d’Ivoire during 2010–2016. Methods Cerebrospinal fluid (CSF) was collected from children aged <5 years admitted to the Abobo General Hospital or University Hospital Center Yopougon with suspected meningitis. Microbiology and polymerase chain reaction (PCR) techniques were used to detect the presence of pathogens in CSF. Where possible, serotyping/grouping was performed to determine the specific causative agents. Results Overall, 2762 cases of suspected meningitis were reported, with CSF from 39.2% (1083/2762) of patients analyzed at the WHO regional reference laboratory in The Gambia. In total, 82 (3.0% [82/2762]) CSF samples were positive for bacterial meningitis. Pneumococcus was the main pathogen responsible for PBM, accounting for 69.5% (52/82) of positive cases. Pneumococcal conjugate vaccine serotypes 5, 18C, 19F, and 6A/B were identified post–vaccine introduction. Emergence of H. influenzae nontypeable meningitis was observed after H. influenzae type b vaccine introduction. Conclusions Despite widespread use and high coverage of conjugate vaccines, pneumococcal vaccine serotypes and H. influenzae type b remain associated with bacterial meningitis among children aged <5 years in Côte d’Ivoire. This reinforces the need for enhanced surveillance for vaccine-preventable diseases to determine the prevalence of bacterial meningitis and vaccine impact across the country.

scholarly journals Toward Control? The Prospects and Challenges of Typhoid Conjugate Vaccine Introduction

2019 ◽  
Vol 69 (Supplement_5) ◽  
pp. S408-S411 ◽  
Author(s):  
Megan E Carey ◽  
Zoey I Diaz ◽  
Martin Broadstock ◽  
Roderick Bailey ◽  
Adwoa D Bentsi-Enchill ◽  
...  
Keyword(s):  
Conjugate Vaccine ◽  
Vaccine Development ◽  
Low Cost ◽  
Control Program ◽  
World Health ◽  
Vaccine Hesitancy ◽  
Vaccine Introduction ◽  
Optimal Deployment ◽  
Health Organization ◽  
Communication Planning

Abstract With a newly World Health Organization (WHO)–prequalified typhoid conjugate vaccine (TCV), Gavi funding for eligible countries, and a WHO policy recommendation for TCV use, now is the time for countries to introduce TCVs as part of an integrated typhoid control program, particularly in light of the increasing burden of antimicrobial resistance. Continued vaccine development efforts will lead to secure supply of low-cost vaccines, and ongoing vaccine studies will provide critical vaccine performance data and inform optimal deployment strategies, in both routine use and in outbreak settings. TCV programs should include thoughtful communication planning and community engagement to counter vaccine hesitancy.

scholarly journals Pediatric Bacterial Meningitis Surveillance in Niger: Increased Importance of Neisseria meningitidis Serogroup C, and a Decrease in Streptococcus pneumoniae Following 13-Valent Pneumococcal Conjugate Vaccine Introduction

2019 ◽  
Vol 69 (Supplement_2) ◽  
pp. S133-S139 ◽  
Author(s):  
Mamadou Kourna Hama ◽  
Dam Khan ◽  
Boubou Laouali ◽  
Catherine Okoi ◽  
Abdoulaye Yam ◽  
...  
Keyword(s):  
Streptococcus Pneumoniae ◽  
Bacterial Meningitis ◽  
Neisseria Meningitidis ◽  
Conjugate Vaccine ◽  
Pneumococcal Conjugate Vaccine ◽  
Vaccination Campaign ◽  
Haemophilus Influenzae Type ◽  
Vaccine Introduction ◽  
Meningitis In Children ◽  
Using Data

Abstract Background Meningitis is endemic in Niger. Haemophilus influenzae type b (Hib) vaccine and the 13-valent pneumococcal conjugate vaccine (PCV13) were introduced in 2008 and 2014, respectively. Vaccination campaign against Neisseria meningitidis serogroup A was carried out in 2010–2011. We evaluated changes in pathogen distribution using data from hospital-based surveillance in Niger from 2010 through 2016. Methods Cerebrospinal fluid (CSF) specimens from children <5 years old with suspected meningitis were tested to detect vaccine-preventable bacterial pathogens. Confirmatory identification and serotyping/grouping of Streptococcus pneumoniae, N. meningitidis, and H. influenzae were done. Antimicrobial susceptibility testing and whole genome sequencing were performed on S. pneumoniae isolates. Results The surveillance included 2580 patients with suspected meningitis, of whom 80.8% (2085/2580) had CSF collected. Bacterial meningitis was confirmed in 273 patients: 48% (131/273) was N. meningitidis, 45% (123/273) S. pneumoniae, and 7% (19/273) H. influenzae. Streptococcus pneumoniae meningitis decreased from 34 in 2014, to 16 in 2016. PCV13 serotypes made up 88% (7/8) of S. pneumoniae meningitis prevaccination and 20% (5/20) postvaccination. Neisseria meningitidis serogroup C (NmC) was responsible for 59% (10/17) of serogrouped N. meningitidis meningitis. Hib caused 67% (2/3) of the H. influenzae meningitis isolates serotyped. Penicillin resistance was found in 16% (4/25) of S. pneumoniae isolates. Sequence type 217 was the most common lineage among S. pneumoniae isolates. Conclusions Neisseria meningitidis and S. pneumoniae remain important causes of meningitis in children in Niger. The decline in the numbers of S. pneumoniae meningitis post-PCV13 is encouraging and should continue to be monitored. NmC is the predominant serogroup causing N. meningitidis meningitis.

scholarly journals Meningococcal Meningitis Outbreaks in the African Meningitis Belt After Meningococcal Serogroup A Conjugate Vaccine Introduction, 2011–2017

2019 ◽  
Vol 220 (Supplement_4) ◽  
pp. S225-S232 ◽  
Author(s):  
Katya Fernandez ◽  
Clément Lingani ◽  
Olaolu Moses Aderinola ◽  
Kadadé Goumbi ◽  
Brice Bicaba ◽  
...  
Keyword(s):  
Conjugate Vaccine ◽  
Control Measures ◽  
World Health ◽  
Median Response ◽  
Vaccine Introduction ◽  
Meningitis Belt ◽  
Median Proportion ◽  
Significant Burden ◽  
Health Organization ◽  
Reactive Vaccination

Abstract Background In 2010–2017, meningococcal serogroup A conjugate vaccine (MACV) was introduced in 21 African meningitis belt countries. Neisseria meningitidis A epidemics have been eliminated here; however, non-A serogroup epidemics continue. Methods We reviewed epidemiological and laboratory World Health Organization data after MACV introduction in 20 countries. Information from the International Coordinating Group documented reactive vaccination. Results In 2011–2017, 17 outbreaks were reported (31 786 suspected cases from 8 countries, 1–6 outbreaks/year). Outbreaks were of 18–14 542 cases in 113 districts (median 3 districts/outbreak). The most affected countries were Nigeria (17 375 cases) and Niger (9343 cases). Cumulative average attack rates per outbreak were 37–203 cases/100 000 population (median 112). Serogroup C accounted for 11 outbreaks and W for 6. The median proportion of laboratory confirmed cases was 20%. Reactive vaccination was conducted during 14 outbreaks (5.7 million people vaccinated, median response time 36 days). Conclusion Outbreaks due to non-A serogroup meningococci continue to be a significant burden in this region. Until an affordable multivalent conjugate vaccine becomes available, the need for timely reactive vaccination and an emergency vaccine stockpile remains high. Countries must continue to strengthen detection, confirmation, and timeliness of outbreak control measures.

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