Bacterial meningitis following introduction of Hib conjugate vaccine in northern Uganda

Iriso, Robert; Ocakacon, R.; Acayo, J.A.; Mawanda, M.; Kisayke, A

doi:10.1179/146532808x335660

Cited by 12 publications

(14 citation statements)

References 13 publications

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“…Introduction of the Haemophilus influenza B conjugate vaccine in this set-up has been associated with a significant reduction in Haemophilus influenza B meningitis 16 17. It is expected that the recent launch of universal pneumococcal conjugate vaccine in the region will similarly result in significant reduction in cases of ABM 18 19.…”

Section: Discussionmentioning

confidence: 98%

Changing trends in incidence and aetiology of childhood acute non-traumatic coma over a period of changing malaria transmission in rural coastal Kenya: a retrospective analysis

et al. 2012

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ObjectivesRecent changes in malaria transmission have likely altered the aetiology and outcome of childhood coma in sub-Saharan Africa. The authors conducted this study to examine change in incidence, aetiology, clinical presentation, mortality and risk factors for death in childhood non-traumatic coma over a 6-year period.DesignRetrospective analysis of prospectively collected data.SettingSecondary level health facility: Kilifi, Coast, Kenya.ParticipantsChildren aged 9 months to 13 years admitted with acute non-traumatic coma (Blantyre Coma Score =2) between January 2004 and December 2009 to Kilifi District Hospital, Kenya. Exclusion criteria: delayed development, epilepsy and sickle cell disease.ResultsDuring the study period, 665 children (median age 32 (IQR 20–46) months; 46% were girls) were admitted in coma. The incidence of childhood coma declined from 93/100 000 children in 2004 to 44/100 000 children in 2009. There was a 64% overall drop in annual malaria-positive coma admissions and a 272% overall increase in annual admissions with encephalopathies of undetermined cause over the study period. There was no change in case death of coma. Vomiting, breathing difficulties, bradycardia, profound coma (Blantyre Coma Score=0), bacteraemia and clinical signs of meningitis were associated with increased risk of death. Seizures within 24 h prior to admission, and malaria parasitaemia, were independently associated with survival, unchanging during the study period.ConclusionThe decline in the incidence and number of admissions of childhood acute non-traumatic coma is due to decreased malaria transmission. The relative and absolute increase in admissions of encephalopathy of undetermined aetiology could represent aetiologies previously masked by malaria or new aetiologies.

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Section: Discussionmentioning

confidence: 98%

Changing trends in incidence and aetiology of childhood acute non-traumatic coma over a period of changing malaria transmission in rural coastal Kenya: a retrospective analysis

et al. 2012

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“…NTS, the second cause of bacterial meningitis in our cohort, is becoming increasingly recognized as an important cause of bacterial meningitis in sub-Saharan Africa 30 . It is the second or third cause in several countries after the introduction of the Hib vaccine 29, 31, 32 , and might even become the leading cause of bacterial meningitis after effective introduction of pneumococcal vaccine.…”

Section: Discussionmentioning

confidence: 99%

Aetiology and Outcomes of Suspected Infections of the Central Nervous System in Children in Mbarara, Uganda

Page¹,

Boum

Kemigisha

et al. 2017

Sci Rep

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Infections of the central nervous system (CNS) are severe conditions, leading to neurological sequelae or death. Knowledge of the causative agents is essential to develop guidelines for case management in resource-limited settings. Between August 2009 and October 2012, we conducted a prospective descriptive study of the aetiology of suspected CNS infections in children two months to 12 years old, with fever and at least one sign of CNS involvement in Mbarara Hospital, Uganda. Children were clinically evaluated on admission and discharge, and followed-up for 6 months for neurological sequelae. Pathogens were identified from cerebrospinal fluid (CSF) and blood using microbiological and molecular methods. We enrolled 459 children. Plasmodium falciparum (36.2%) and bacteria in CSF (13.3%) or blood (3.3%) were the most detected pathogens. Viruses were found in 27 (5.9%) children. No pathogen was isolated in 207 (45.1%) children. Patterns varied by age and HIV status. Eighty-three (18.1%) children died during hospitalisation, and 23 (5.0%) during follow-up. Forty-one (13.5%) children had neurological sequelae at the last visit. While malaria remains the main aetiology in children with suspected CNS infections, no pathogen was isolated in many children. The high mortality and high rate of neurological sequelae highlight the need for efficient diagnosis.

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“…Meningitis in human immunodeficiency virus (HIV)–infected persons is frequently associated with cryptococcosis, tuberculosis, and Streptococcus pneumoniae , Haemophilus influenzae type b (Hib), and Neisseria meningitidis [3, 4, 8–12]. Numerous other pathogens have been described as a cause of meningitis among HIV-infected persons [1, 7, 9, 12, 13].…”

mentioning

confidence: 99%

Clinical and Microbiological Features ofSalmonellaMeningitis in a South African Population, 2003–2013

Keddy

Sooka²,

Musekiwa³

et al. 2015

Clin Infect Dis.

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Background The clinical and microbiological characteristics of nontyphoidal Salmonella (NTS) meningitis in South Africa, where human immunodeficiency virus (HIV) prevalence is high (approximately 15% in persons ≥15 years of age), were reviewed. Methods From 2003 through 2013, 278 cases were identified through national laboratory-based surveillance. Clinical information (age, sex, outcome, Glasgow Coma Scale [GCS], and HIV status) was ascertained at selected sites. Isolates were serotyped; susceptibility testing and multilocus sequence typing on Salmonella enterica serovar Typhimurium isolates was performed. Multivariable logistic regression was used to determine factors associated with mortality outcome, using Stata software, version 13. Results Where age was ascertained, 139 of 256 (54.3%) patients were <15 years. Males represented 151 of 267 (56.6%). Mortality outcome was recorded for 112 of 146 (76.7%) enhanced surveillance patients; 53 of 112 (47.3%) died. Death was associated with GCS ≤13 (adjusted odds ratio [OR], 18.7; 95% confidence interval [CI], 3.0–118.5; P = .002) on multivariable analysis. Where data were available, all 45 patients aged >15 years were HIV infected, compared with 24 of 46 (52.2%) patients aged <5 years. Neonates were less likely to be HIV infected than infants aged 2–12 months (OR, 4.8; 95% CI, 1.1–21.1; P = .039). Salmonella Typhimurium represented 106 of 238 (44.5%) serotyped isolates: 65 of 95 (68.4%) were ST313 vs ST19, respectively, and significantly associated with HIV-infected patients (P = .03) and multidrug resistance (OR, 6.6; 95% CI, 2.5–17.2; P < .001). Conclusions NTS meningitis in South Africa is highly associated with HIV in adults, with neonates (irrespective of HIV status), and with Salmonella Typhimurium ST313. GCS is the best predictor of mortality: early diagnosis and treatment are critical. Focused prevention requires further studies to understand the sources and transmission routes.

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Bacterial meningitis following introduction of Hib conjugate vaccine in northern Uganda

Cited by 12 publications

References 13 publications

Changing trends in incidence and aetiology of childhood acute non-traumatic coma over a period of changing malaria transmission in rural coastal Kenya: a retrospective analysis

Changing trends in incidence and aetiology of childhood acute non-traumatic coma over a period of changing malaria transmission in rural coastal Kenya: a retrospective analysis

Aetiology and Outcomes of Suspected Infections of the Central Nervous System in Children in Mbarara, Uganda

Clinical and Microbiological Features ofSalmonellaMeningitis in a South African Population, 2003–2013

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