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- Title
Declining Trends of Pneumococcal Meningitis in Gambian Children After the Introduction of Pneumococcal Conjugate Vaccines.
- Authors
Sanneh, Bakary; Okoi, Catherine; Grey-Johnson, Mary; Bah-Camara, Haddy; Fofana, Baba Kunta; Baldeh, Ignatius; Sey, Alhagie Papa; Bah, Mahamadou Labbo; Cham, Mamadi; Samateh, Amadou; Usuf, Effua; Ndow, Peter Sylvanus; Senghore, Madikay; Worwui, Archibald; Mwenda, Jason M; Kwambana-Adams, Brenda; Antonio, Martin
- Abstract
Background Acute bacterial meningitis remains a major cause of childhood mortality in sub-Saharan Africa. We document findings from hospital-based sentinel surveillance of bacterial meningitis among children <5 years of age in The Gambia, from 2010 to 2016. Methods Cerebrospinal fluid (CSF) was collected from children admitted to the Edward Francis Small Teaching Hospital with suspected meningitis. Identification of Streptococcus pneumoniae (pneumococcus), Neisseria meningitidis (meningococcus), and Haemophilus influenzae was performed by microbiological culture and/or polymerase chain reaction where possible. Whole genome sequencing was performed on pneumococcal isolates. Results A total of 438 children were admitted with suspected meningitis during the surveillance period. The median age of the patients was 13 (interquartile range, 3–30) months. Bacterial meningitis was confirmed in 21.4% (69/323) of all CSF samples analyzed. Pneumococcus, meningococcus, and H. influenzae accounted for 52.2%, 31.9%, and 16.0% of confirmed cases, respectively. There was a significant reduction of pneumococcal conjugate vaccine (PCV) serotypes, from 44.4% in 2011 to 0.0% in 2014, 5 years after PCV implementation. The majority of serotyped meningococcus and H. influenzae belonged to meningococcus serogroup W (45.5%) and H. influenzae type b (54.5%), respectively. Meningitis pathogens were more frequently isolated during the dry dusty season of the year. Reduced susceptibility to tetracycline, trimethoprim-sulfamethoxazole, and chloramphenicol was observed. No resistance to penicillin was found. Conclusions The proportion of meningitis cases due to pneumococcus declined in the post-PCV era. However, the persistence of vaccine-preventable meningitis in children aged <5 years is a major concern and demonstrates the need for sustained high-quality surveillance.
- Subjects
GAMBIA; PUBLIC health surveillance; ACADEMIC medical centers; SEQUENCE analysis; TETRACYCLINE; CO-trimoxazole; PNEUMOCOCCAL meningitis; PNEUMOCOCCAL vaccines; PEDIATRICS; STREPTOCOCCAL diseases; HAEMOPHILUS diseases; STREPTOCOCCUS; HAEMOPHILUS; BACTERIAL meningitis; SEROTYPES; TREATMENT effectiveness; GAMBIANS; NEISSERIA; MICROBIOLOGICAL techniques; CHLORAMPHENICOL; POLYMERASE chain reaction; NEISSERIA meningitidis; DRUG resistance in microorganisms; HOSPITAL care of children; DIAGNOSIS; CHILDREN
- Publication
Clinical Infectious Diseases, 2019, Vol 69, pS126
- ISSN
1058-4838
- Publication type
Article
- DOI
10.1093/cid/ciz505